Flap Anchoring Following Primary Breast Cancer Surgery Facilitates Early Hospital Discharge and Reduces Costs

Almond, L. Max; Khodaverdi, Laura; Kumar, Belindra; Coveney, Eamonn

doi:10.1159/000301586

Cited by 52 publications

(55 citation statements)

References 18 publications

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“…Halsted first advocated creating a short superior flap and suturing it with interrupted silk to the fascia below the first rib and skin grafting the remaining part of the defect [29]. In 1951, Orr [30] used tension sutures tied over rubber tubing bolsters to tack flaps to the chest wall.…”

Section: Obliteration Of Dead Spacementioning

confidence: 99%

Seroma Formation after Breast Cancer Surgery: What We Have Learned in the Last Two Decades

2012

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Formation of a seroma most frequently occurs after mastectomy and axillary surgery. Prolonged drainage is troublesome as it increases the risk for infection and can significantly delay adjuvant therapy. Seroma has been defined as serous fluid collection under the skin flaps or in the axillary dead space following mastectomy and/or axillary dissection. Because the true etiology of a seroma is unknown, a multifactorial-causation hypothesis has been accepted. Surgical factors include technique, extent of dissection and the surgical devices used for dissection. Obliteration of dead space with various flap fixation techniques, use of sclerosants, fibrin glue and sealants, octreotide, and pressure garments have been attempted with conflicting results and none have been consistent. Early movement of the shoulder during the postoperative period may increase the formation of seroma, although delayed physiotherapy decreases the formation of seroma. A detailed analysis of the use of drains showed that use of single or multiple drains, early or late removal, and drains with or without suction are not significantly different for the incidence of seroma. Although there is evidence for reduced seroma formation after early drain removal, very early removal within 24 hours seems to increase formation of seroma. No patient or tumor factors seem to affect seroma formation except body mass index and body weight. Consensus is lacking among studies/trials with different groups producing conflicting evidence. Besides a few established factors such as body mass index, the use of electrocautery for dissection, early drain removal, low vacuum drains, obliteration of dead space, and delayed shoulder physiotherapy, most of the hypothesized causes have not been demonstrated consistently. Thus, seroma remains a threat to both the patient and surgeon. Recurrent transcutaneous aspiration remains the only successful management.

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Section: Obliteration Of Dead Spacementioning

confidence: 99%

Seroma Formation after Breast Cancer Surgery: What We Have Learned in the Last Two Decades

2012

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“…Some studies have demonstrated that dead space under the skin will result in seroma formation and seroma may lead to unwanted complications. [15][16][17] Although the relationship between compression and seroma formation is controversial, we expect that the compression does have a role in reducing seroma-related complications by obliterating the dead space of the flap with appropriate pressure. 18,19 In our experience, we note increased discharge from the flap margins when compression is applied early, supporting our notion.…”

Section: Discussionmentioning

confidence: 99%

Is Early Compression Therapy after Perforator Flap Safe and Reliable?

Suh

Jeong

Hong

2018

J reconstr Microsurg

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Background Due to the concern of circulation compromise, many surgeons hesitate to dangle or challenge the flap in the early postoperative phase. In our experience, early compression may have advantages such as collapse of dead space, evacuation of hematoma, reduction of edema, and stabilization of flap when ambulating. In this study, the effect of early compression of flaps with regard to flap physiology and outcome is evaluated. Methods From postoperative day 3 to 5, a custom-made compression garment was fitted aiming to compress with a pressure of 30 to 35 mmHg. A total of 52 patients (52 flaps) were enrolled for the study and 48 flaps underwent early compression. The compression was applied not only over the flap but also over the extremity or trunk. The flap outcome as well as flow velocity and flow volume of the pedicle before and after compression was measured and evaluated. Results There was no flap complication during the early compression and early ambulation. And, there was no statistical difference either in the flow velocity or in the volume before and after the compression therapy (29.21 vs. 29.42 cm/s and 7.13 vs. 6.56 cm3/s, respectively). Conclusion Early compression with a 30-mmHg pressure customized pressure garment after the flap surgery does not affect the hemodynamics of the perforator and can be safely used after extremity reconstruction before ambulation.

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“…Halsted first advocated creating a short superior flap and suturing it with interrupted silk to the fascia below the first rib and skin grafting the remaining part of the defect. [29] In 1951, Orr [30] used tension sutures tied over rubber tubing bolsters to tack flaps to the chest wall. In 1953, Keyes et al [31] used through and through sutures to attach the skin flaps to the chest wall.…”

Section: Management Of Dead Spacementioning

confidence: 99%

Seroma Formation in Cancer Breast Surgery

Sitaram¹,

Hemanthi²

2015

jemds

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Post-operative breast surgery for malignancy has a common side effect of seromas, whose formation and drainage requires a special attention to prevent as much as possible and as early as possible to avoid morbidity. How best we can prevent the dead space is the problem. In this study a review of various methods adopted all over the world is reviewed including early discharge of the patient with drain. It is always preferable to remove the drain when the collection of serum is less than 25ml in 24 hours the chance of re accumulation of fluid is less likely. INTRODUCTION: Carcinoma breast has remained the second leading cause of cancer death among women worldwide over the past three decades [1] and contributes significantly to cancer surgical load. Surgical treatment for breast cancer includes breast conservation therapy and mastectomy with or without axillary dissection depending on disease stage. Seroma formation is the most frequent postoperative Side effect seen after mastectomy and axillary surgery with an incidence of 3% to 85%. OBSERVATIONS: TYPE OF SURGERY: Surgical treatment for breast cancer has undergone a paradigm shift from Halstead's radical mastectomy to breast conservation. It has been demonstrated that radical mastectomy increases seroma formation compared with that of simple mastectomy, but the association is inconclusive when radical mastectomy is compared with modified radical mastectomy (MRM). SURGICAL DEVICES: Various electro-mechanical devices are used during surgery to reduce blood loss and operating time. These include electrocautery, laser scalpel, argon diathermy, ultrasonic scalpel, ultrasonic scissors, and vessel sealing systems. All of these devices have been investigated in an effort to reduce seroma formation. Randomized trials have shown that the use of electrocautery for dissecting flaps is significantly associated with increased seroma formation when compared to that of scalpel dissection. However, no individual study has shown a significant effect on seroma formation with or without the use of a laser scalpel, argon diathermy, or an ultrasonic scalpel. Ultrasonic scissors resulted in reduced seroma formation in a randomized controlled trial comparing level I and II axillary dissection using either ultrasound scissors or surgical scissors with ligation. MANAGEMENT OF DEAD SPACE: MECHANICAL DEVICES: Different techniques have been employed to obliterate the dead space (under flaps and the axilla) to reduce seroma formation. CHEMICAL: Fibrin glue.light activated fibrin sealant, and transdermal photo-polymerized adhesive reduce seroma formation after mastectomy in animal models. Use of a fibrinolysis inhibitor was based on the hypothesis that fibrinolytic activity in serum and lymph might contribute to fluid accumulation. SHOULDER MOVEMENT: Shoulder dysfunction is a common complication of mastectomy,and it is necessary to mobilize the shoulder early to prevent this complication. It was thought that early shoulder mobilization led to increased seroma formation and this hypot...

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Flap Anchoring Following Primary Breast Cancer Surgery Facilitates Early Hospital Discharge and Reduces Costs

Cited by 52 publications

References 18 publications

Seroma Formation after Breast Cancer Surgery: What We Have Learned in the Last Two Decades

Seroma Formation after Breast Cancer Surgery: What We Have Learned in the Last Two Decades

Is Early Compression Therapy after Perforator Flap Safe and Reliable?

Seroma Formation in Cancer Breast Surgery

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