Evaluating HEmopatch® in Reducing Seroma-Related Complications following Axillary Lymph Node DIssection: A Pilot Study (HEIDI)

Abstract

Purpose: Axillary lymph node dissection (ALND) is performed to treat locoregional metastatic disease in breast cancer and melanoma patients. However, it is notorious for its complications, most commonly seroma formation and its sequelae. Ample research has been done to evaluate seroma formation after ALND; these results, however, have not been conclusive. Hence, this pilot study aimed to evaluate a readily available haemostatic patch, Hemopatch®, to assess its effect on seroma formation following ALND. Methods: In this pilot study a prospective cohort of 20 patients receiving Hemopatch® following ALND, was compared to a retrospective cohort of patients who underwent ALND between 2014-2019. The primary outcome measure was the number of patients developing clinically significant seroma (CSS) after ALND. Additionally, the number of wound complications, subsequent interventions, additional outpatient clinic visits and drain output were assessed. Differences between groups were deemed clinically relevant if the proportions differed >50% between groups. Results: In total, 20 prospective and 42 retrospective patients were included. In the Hemopatch® group, 30% of the patients developed CSS, compared to 43% in the control group. Three patients in both groups developed a surgical site infection (SSI). Thirty-five percent of patients in the Hemopatch® group required additional unscheduled visits versus 62% patients in the control group. Conclusion: The application of Hemopatch® after ALND did not lead to a clinically relevant reduction of CSS and wound complications. However, fewer Hemopatch® patients required additional outpatient clinic visits. Due to the limited amount of participants, the true value of Hemopatch® in ALND remains unclear.

Impact of Topical Epinephrine with Xylocaine on Drainage After Axillary Lymph Node Dissection: A Randomized Controlled Trial

“…Tranexamic acid and tissue adhesives like fibrin glue and cyanoacrylate have been tried; however, apart from an occasional study showing reduced drainage and earlier removal of the drain, meta-analyses have failed to show their advantage [3,[23][24][25][26][27]. Other techniques like use of compression dressing, somatostatin analog, newer energy devices and hemostatic patch have been tried for seroma formation following ALND; but have shown limited or no benefit [5,18,19,[28][29][30][31].…”

“…However, excessive lymphorrhea due to insufficient lymphatic function post-ALND results in increased axillary drainage which causes morbidity for the patients and increases hospital stay [1,2]. Various techniques have been tried to reduce the post-ALND drainage with variable results [3][4][5][6]. We hypothesized that using topical epinephrine with xylocaine after ALND can stimulate the lymphatic function and reduce the drainage.…”