Efficacy of axillary exclusion on seroma formation after modified radical mastectomy

Abstract

BackgroundBreast cancer represented 35.1 % of total female cancer cases in Egypt. Seroma is one of the most serious and common complications of mastectomy and axillary dissection with incidence between 15 and 81 %. Seroma formation delays wound healing and increases susceptibility to infection, skin flap necrosis, and persistent pain as well as prolonging convalescence. Therefore, several techniques have been investigated to minimize seroma formation with no consistent success. Axillary exclusion is a technique aimed to obliterate dead space after axillary clearance and minimize collection.MethodsSixty-four patients were prepared for modified radical mastectomy. Of those, the study group contains 32 patients and the control group contains 32 patients. Study group had axillary exclusion while the other had the conventional procedure; total drain outputs were recorded daily for all patients prior to drain removal. The drains were removed when the daily drainage was less than 30 ml.ResultsThis study contains 64 patients, the study group contains 32 patients, and the control group contains 32 patients. Age, BMI (mean control = 31.7 and study = 30.2), and tumor size were of no significant differences to be more concise on the effect of axillary exclusion. The mean of day of drain removal in the control group was 17.8 day (15–19) with a mean of total drain output of 4525.6 ml (4430–3660 ml) while the mean in the study group of day of drain removal was 11.3 (10–13) with a mean of total drain output of 1476.2 ml (620–2200 ml), p < 0.00.ConclusionsAxillary exclusion technique is a valuable procedure that significantly decreases seroma postmastectomy and axillary dissection.

“Axillary Space Obliteration”—An Effective Technique in Reducing Seroma Formation after Mastectomy and Axillary Dissection

“…90% was in the control group and 42.5% in the study group with a reduction of about 65%. and in another study published by Faisal M, et al at (2016) [23] on 64 patients also they found significant reduction in seroma formation as well as time of drain removal after they have used similar technique (p < 0.01).…”

Effect of autologous fibrin glue on seroma reduction after modified radical mastectomy for breast cancer: A randomized controlled trial

“…Seroma is a prevalent and annoying problem post breast and lymph nodes removal leading to the majority of complications that happens, for instance, wound infection, skin flap necrosis, wound dehiscence, and lymphedema. Because of the potentially severe effects of seroma, several approaches have been described to obliterate the dead space aiming at reduction of seroma formation; for example, using compression bandage, suction drains, flap fixation with sutures, utilization of ultrasound scalpel or laser scalpel in dissection, sclerotherapy, immobilization from the affected arm, topical use of tranexamic acid and fibrin glue application [ [2] , [3] , [4] , [5] ].…”

Comparison of Axillary Exclusion Versus no Exclusion on Seroma Formation after Modified Radical Mastectomy

“…8 Axillary exclusion is a procedure devised to obliterate dead space thereby excluding axilla from the rest of wound after axillary clearance and leading to minimize collection. 9 In this technique we apply continuous stitches with vicryl 2/0 between the mastectomy skin flap and the lateral margin of pectoralis major, and place few interrupted sutures between www.apmcfmu.com pectoralis major and minor and the flap to separate the axillary space from the rest of the mastectomy wound and obliterate the dead space so created after axillary clearance. A pressure dressing is applied over axilla and also the mastectomy wound.…”