Comparing the Harmonic Scalpel with Electrocautery in Reducing Postoperative Flap Necrosis and Seroma Formation after Modified Radical Mastectomy in Carcinoma Breast Patients: A Double-Blind Prospective Randomized Control Trail

Objective: To compare the frequency of seroma formation in harmonic scalpel vsunipolar electrocautery in post modified radical mastectomy (MRM). Study Design: Quasi experimental study. Place and Duration of Study: General Surgery Department, Pak Emirates Military Hospital Rawalpindi, from Jul to Dec 2017. Methodology: Eighty women with breast carcinoma planned for modified radical mastectomy were included in the study with inclusion and exclusion criteria and divided in equal group A (Harmonic) and group B (Unipolar cautery). Randomization was performed by lottery method for both groups. A standard level III clearance was performed. All patients were followed up on weekly basis and seroma formation was evaluated in both groups. Results: Mean age in group A and B was 51.36 ± 11.04 years vs 52 ± 11.19 years (p>0.05). Mean duration of complain in group A and B was 1.675 ± 0.47 months vs 1.775 ± 0.42 (p>0.05). Mean time of procedure in group A and B was 110.00 ± 4.71 mins vs 100.875 ± 5.14 (p>0.05). Mean body mass index in group A and B was 30.217 ± 4.99 kg/m2 vs 30.210 ± 5.31 kg/m2 (p>0.05). Seroma formation in group A and group B patients were found to be 5 (12.5%) vs 10 (25%) with (p>0.05). Conclusion: Frequency of seroma formation in harmonic scalpel is lower than electrocautery in post modified radical mastectomy, so it can be safely performed along with harmonic scalpel with reduced duration of drainage and seroma formation.

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Frequency of Early Post-Operative Complications following Modified Radical Mastectomy (MRM) in patients with Breast Carcinoma

10.53350/pjmhs211561623 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1623-1625

Author(s):

Sadia Shah ◽

Rahmat Ullah Shah ◽

Adnan Badar ◽

Monawar Shah ◽

Shabir Ahmad ◽

...

Keyword(s):

Breast Carcinoma ◽

Wound Infection ◽

Skin Flap ◽

Radical Mastectomy ◽

Wound Dehiscence ◽

Seroma Formation ◽

Flap Necrosis ◽

Modified Radical Mastectomy ◽

Operative Complications ◽

Post Operative Complications

Objective: Breast carcinoma is the commonest cancer affecting female gender and is the second major cause of mortality in females globally. Among different surgical options, modified radical mastectomy (MRM) with or without neoadjuvant therapy is the most frequent surgery carried out globally for breast carcinoma. In this study we aimed to determine the frequency of early post-operative complications following modified radical mastectomy (MRM) in patients with breast carcinoma. Material and methods: This dual setting retrospective descriptive study was conducted at General surgery departments of Kuwait Teaching Hospital and MTI-Lady Reading Hospital Peshawar between January, 2018 and June, 2019. A total of 60 patients aged >18 years with biopsy proven stage-I to stage-III breast carcinoma who underwent modified radical mastectomy were included.All patients were followed on weekly basis for six weeks at the out-patient department (OPD) and evaluated for the development of early complications such as seroma/hematoma, flap necrosis and wound infections. Results: Seroma formation found in 9 patients (15%) and wound infection seen in 5 patients (8.3%) were the commonest complications. Conclusion: In our study seroma formation was the most common complication followed by wound infection. Skin flap necrosis, wound dehiscence, hematoma formation and development of early lymphoedema were less common. None of our patients presented with muscle paralysis secondary to nerves injury. Keywords: Breast carcinoma, modified radical mastectomy, complications, seroma, wound infection.

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A NOVEL TECHNIQUE OF HARMONIC TISSUE DISSECTION REDUCES POSTOPERATIVE HEMATOMA, FLAP NECROSIS, WOUND SEPSIS AFTER MODIFIED RADICAL MASTECTOMY COMPARED TO CONVENTIONAL ELECTROCAUTERY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i11.1536 ◽

2020 ◽

Vol 4 (11) ◽

Author(s):

Ajay Kumar ◽

Bhavesh Devkaran ◽

Arun Chauhan ◽

Sunil Kumar Negi

Keyword(s):

Harmonic Scalpel ◽

Public Health Problem ◽

Radical Mastectomy ◽

P Value ◽

Flap Necrosis ◽

Modified Radical Mastectomy ◽

Wound Sepsis ◽

Postoperative Hematoma ◽

High Incidence ◽

One Year

Background: Breast cancer is a serious public health problem with high incidence and prevalence coefficients. This study was undertaken with the intention to evaluate the benefits of harmonic scalpel dissection over electrocautery in MRM. Methods: This comparative study was conducted in Department of Surgery, IGMC Shimla over a period of one year from 1 July 2015 to 30 June 2016. Histologically proven cases of carcinoma breast presenting in the surgery OPD or admitted in the surgery wards were included in the present study. Results: Postoperative hematoma occured in 1 patient of Electrocautery Group, which was drained. There were no cases of postoperative hematoma in Harmonic Group. This difference was not found to be statistically significant with P value=.313. Postoperative flap necrosis occurs in 1 (3%) patient of harmonic MRM Group and 4(11.8%) patients of electrocautery MRM Group. This difference was not found to be statistically significant with P value 0 .1633. Postoperative wound sepsis occurs in 2 (5%) patient of Harmonic MRM Group and 5(14%) patients of Electrocautery MRM Group. This difference was not found to be statistically significant with P value 0.2312. Conclusion- Harmonic scalpel signi?cantly reduces postoperative overall complications (?ap necrosis, and SSI) in the patient undergoing MRM Keywords: Flap necrosis, SSI, MRM

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Comparison of frequency of seroma formation in flap fixation versus conventional closure after modified radical mastectomy.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.05.3526 ◽

2020 ◽

Vol 27 (05) ◽

pp. 907-909

Author(s):

Muhammad Dilawaiz Mujahid ◽

Muneeza Zubair ◽

Tayyab Ahsan Tanvir ◽

Jaweria Masood

Keyword(s):

Subcutaneous Tissue ◽

Radical Mastectomy ◽

Seroma Formation ◽

Common Source ◽

Modified Radical Mastectomy ◽

Fixation Technique ◽

Flap Fixation ◽

Randomized Control ◽

Hospital Ethics ◽

Trial Setting

Seroma formation is a known complication after any surgery where excessive dissection of subcutaneous tissue leads to disruption of lymphatic channels. Seroma formation, its sequelae and frequent visits to doctor for their management are a common source of discomfort for patients. Objectives: Comparison of frequency of seroma formation after flap fixation versus convetional closure after modified radical mastectomy. Study Design: Randomized control trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: 6 months from May 1, 2016 to October 31, 2016. Material & Methods: After permission from Hospital ethics committee and informed consent from patients, 70 patients were randomly divided into two groups (35 participants in each group). Findings were noted and data was analyzed statistically. Results: It was observed that incidence of seroma formation following modified radical mastectomy was lower with flap fixation technique (14.29%) as compared to conventional closure of wound margins (42.86%). Conclusion: Flap fixation technique is better approach compared to conventional method to prevent seroma formation.

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Comparison of Outcome of one Versus two Drains Insertion for Seroma Formation Following Modified Radical Mastectomy in Breast Carcinoma

Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University ◽

10.48036/apims.v17i1.499 ◽

2021 ◽

Vol 17 (1) ◽

pp. 52-55

Author(s):

Shiraz Shaikh ◽

Ambreen Munir ◽

Shahnawaz Abro ◽

Shahida Khatoon ◽

Zameer Hussain Laghari ◽

...

Keyword(s):

Breast Carcinoma ◽

General Surgery ◽

Stable Condition ◽

Radical Mastectomy ◽

Seroma Formation ◽

University Hospital ◽

P Value ◽

Modified Radical Mastectomy ◽

Group A ◽

Group B

Objective: Comparative outcome of one versus two drains insertion for in the term of seroma formation following modified radical mastectomy in breast carcinoma. Methodology: This Prospective Interventional trial was conducted at Department of General Surgery, Liaquat University Hospital Hyderabad from February 2018 to January 2019. Females with breast carcinoma admitted for modified radical mastectomy were included. Patients were divided into two groups. Groups I underwent one drain placement and group II underwent two drains placement. All patients were observed to measure and record the volume of the fluid. Patients were discharged from Hospital in stable condition and after removal of drains, and followed up weekly for one month. Data was recorded on self-made proforma and analyzed by using SPSS-20. Results: Total of 80 patients were selected, 38 in group A and 42 in group B. Mean age of patients of group A was 49.08 ± 9.89 years and group B was 51.40 ± 13.59 years. , Excised Mass weight was lesser in group A as compared to group B. Mean volume of drain discharge was significantly higher in Group B 323.43 ± 158.88 ml, while it was in group A 230.29± 200.98, findings were statistically significant 0.013. Seroma formation was statistically insignificant among both groups as 8(21.1%) in group A and 10(23.8%) in group B, p-value 0.768. Conclusion: One-drain and two-drain insertion are equally effective to reduce the seroma formation after modified radical mastectomy; however, one drain insertion leads to more patient compliance and comfort with probably less morbidity and cost.

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Comparison of the post-operative analgesic effect of paravertebral block, pectoral nerve block and local infiltration in patients undergoing modified radical mastectomy: A randomised double-blind trial

Indian Journal of Anaesthesia ◽

10.4103/ija.ija_81_17 ◽

2017 ◽

Vol 61 (8) ◽

pp. 643 ◽

Cited By ~ 19

Author(s):

Ankita Chandel ◽

Kartik Syal

Keyword(s):

Nerve Block ◽

Analgesic Effect ◽

Radical Mastectomy ◽

Paravertebral Block ◽

Double Blind Trial ◽

Modified Radical Mastectomy ◽

Double Blind ◽

Local Infiltration ◽

Blind Trial ◽

Pectoral Nerve

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77P Harmonic Scalpel Vs. Electrocautery Dissection in Modified Radical Mastectomy: Randomized Controlled Trial

Annals of Oncology ◽

10.1016/s0923-7534(19)65721-2 ◽

2012 ◽

Vol 23 ◽

pp. ii36

Author(s):

S. Khan ◽

G. Murtaza ◽

N. Haroon

Keyword(s):

Randomized Controlled Trial ◽

Harmonic Scalpel ◽

Controlled Trial ◽

Radical Mastectomy ◽

Modified Radical Mastectomy ◽

Randomized Controlled

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Comparison of electrocautery and plasmablade on ischemia and seroma formation after modified radical mastectomy for locally advanced breast cancer

Surgical Techniques Development ◽

10.4081/std.2017.7011 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

Husnu Alptekin ◽

Huseyin Yılmaz ◽

Bahadir Ozturk ◽

Ilhan Ece ◽

Mehmet Ertugrul Kafali ◽

...

Keyword(s):

Locally Advanced Breast Cancer ◽

Statistical Significance ◽

Locally Advanced ◽

Radical Mastectomy ◽

Seroma Formation ◽

Modified Radical Mastectomy ◽

Drainage Volume ◽

Drain Removal ◽

Postoperative Drainage ◽

The Mean

The aim of this study was to compare postoperative drainage volumes and IMA levels in patients who underwent modified radical mastectomy (MRM) with using PlasmaBlade (PB) or electrocautery (EC). A total of 36 patients who underwent MRM with PB or EC in our clinic between August 2012 to February 2013 were enrolled. Number of removed and positive lymph nodes, duration of drainage and total drainage volume was recorded. Seroma formation after drain removal and number of aspirations were also recorded. Serum ischemia modified albümine (IMA) levels were analysed before surgery, 1 hour and 24 hour after surgery. In total, 36 patients were treated with MRM in the study period. Of the 36 patients, 16 underwent MRM with PB, and 20 underwent MRM with EC. The patients demographics were similar in both groups. The mean drainage volume and seroma formation were significantly higher in the PB group when compared with EC group (P<0.05). Number of aspirations due to the seroma were also high in PB group. The total aspiration volume of seroma was not different in both groups. IMA levels 24 hours after surgery in the PB group was significantly higher than EC group. There was no statistical significance between the groups for IMA levels at 1st hour. PB is a monopolar energy device and is associated with increased levels of ischemia. This situation resulted with an increased volume of total axillary drainage and elevated risk of seroma formation.

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