Prospective Study on Efficacy of Mechanical Obliteration of Dead Space Following Axillary Clearance for Carcinoma Breast in Reducing the Incidence of Seroma Formation

Abstract

BACKGROUND Seroma formation and its sequelae including infection, flap necrosis, delayed wound healing and patient discomfort form one of most commonly encountered complication following mastectomy and axillary dissection. Mechanical closure of dead space by flap fixation is a simple surgical procedure that eliminates dead space after mastectomy by decreasing the movement of flap over chest wall and thereby reducing the exudate. The aim of this study is to evaluate the effect of mechanical closure of dead space after mastectomy in prevention of seroma formation. MATERIALS AND METHODS A total of 80 patients of carcinoma breast who underwent modified radical mastectomy in Department of General Surgery, Government Rajaji Hospital, Madurai, during the period from March 2016 to August 2016, were included, randomised into two groups based on inpatient number. 42 patients with odd IP number in conventional simple wound closure (Group A) and 38 patients with even IP number in flap fixation (Group B). Patients were evaluated for day 1 drain volume, total drain volume, drain removal day, seroma and wound complications. RESULTS Of the 80 women, 42 women with mean age 48 ± 8 years belongs to group A and 38 women with mean age 46 ± 7 years belongs to group B. Average size of the tumour at presentation was 3.4 cm. 36 (45%) women presented with stage IIA disease and 44 (55%) with stage IIB disease. Drain volume in first postoperative day varied from 100 to 200 mL with average of 170 mL in group A and 163 mL in group B. There was no statistically significant difference in the drain volume in first postoperative day (p>0.05). The average total drain volume in the postoperative period in group A was 1426 mL and 932 mL in group B. P value was found to be significant (<0.001). The average day of drain removal in group A was 13 days and 8 days in group B. P value was found to be significant (<0.001). 8 patients developed seroma in group A vs. none in group B. P value was found to be significant (>0.05). One patient developed wound complication (cellulitis) vs. none in group B. There was no statistically significant difference in the incidence of wound complications in both groups. CONCLUSION The present prospective study demonstrated that the mechanical obliteration of dead space by flap fixation significantly decreases the incidence of seroma formation. So, when performing modified radical mastectomy, the flap fixation technique is a valuable technique for reducing seroma formation allowing early drain removal and increased patient satisfaction.