The Implication of Mastectomy Flap Fixation in Decreasing the Incidence of Seroma on Breast Cancer Patient

Highlight: Modification of radical mastectomy with flap fixation treatment in seroma production in breast cancer patients was analyzed.The number of seromas from the drain removal time in patients undergoing modified radical mastectomy with flap fixation was reduced. Abstract: Seroma is the most common complication after mastectomy procedure. This study was conducted to analyse the treatment of flap fixation in seroma production after modified radical mastectomy in breast cancer patients. An interventional prospective clinical study in 35 female patients with breast cancer who underwent modified radical mastectomy with flap fixation in the period August-December 2018 and 35 patients without flap fixation through historical data of patient who underwent modified radical mastectomy in the period 2016-2017 at RSUD Dr. Soetomo Surabaya. Data of characteristic patients will be presented descriptively and analyzed statistically using the appropriate test. The result of the statistical test using Chi Square with a 95% significance level obtained a value of p = 0.000 (p <0.05), it was said statistically that there was a significant relationship between the treatment of flap fixation and the time of releasing drain in this study. The treatment of flap fixation will reduce drainage time by <10 days. The results of the odds ratio (OR) obtained OR = 16 and CI: 95% (4.094 – 62.528) which means that the treatment of flap fixation will reduce the releasing time of the drain 16 times more effectively than not performing flap fixation. Correlation between the treatment of flap fixation and the time of releasing drain was considered to be moderately positive (Contingency Coefficient Chi Square = 0.476). There was a significant reduction in the number of seroma assessed from the time of releasing drain faster in patients who underwent modified radical mastectomy with flap fixation.

Flap fixation in preventing seroma formation after mastectomy: an updated meta-analysis

Seroma formation following mastectomy is one of the most experienced complications, with a very variable incidence ranging from 3 to 90%. In recent years, many publications have been realized to define an effective technique to prevent its formation and several approaches have been proposed. Given the potential of flap fixation in reducing seroma formation, we performed a meta-analysis of the literature to investigate the role of this approach as definitive gold standard in mastectomy surgery. Inclusion criteria regarded all studies reporting on breast cancer patients undergoing mastectomy with or without axillary lymph node dissection; studies that compared mastectomy with flap fixation to mastectomy without flap fixation were selected. Papers were eligible for inclusion if outcome was described in terms of seroma formation. As secondary outcome, also surgical site infection (SSI) was evaluated. The included studies were 12, involving 1887 female patients: 221/986 (22.41%) patients experienced seroma formation after flap fixation and 393/901 (43.61%) patients had this complication not receiving flap fixation, with a significant statistical difference between the two groups (OR = 0.267, p = 0.001, 95% CI 0.153, 0.464). About, SSI 59/686 (8.6%) in flap fixation group and 67/686 (9.7%) in patients without flap fixation, with no statistical differences between groups (OR = 0.59, p = 0.056, 95% CI 0.344, 1.013).The heterogeneity between included studies does not allow us to reach definitive conclusions but only to suggest the strong evaluation of this approach after mastectomy in seroma preventing and SSI reduction.

Randomized Controlled Trial of Modified Radical Mastectomy with and Without Quilting Technique and Its Effect on Seroma Formation

Objective: To determine the frequency of seroma formation after flap fixation by quilting technique in MRM patients as compared to control group. Study Design: Randomized controlled trial. Place and Duration of study: This study was conducted from 11th November ,2017 to 10th May , 2018 in Department of Surgery, Holy family Hospital, Rawalpindi. Patients and Method: A total of 60 patients were included in the study having histologically proven breast cancer stage 2 or 3 in age group of 40-70 years undergoing modified radical mastectomy. Patients were allocated to group1 or 2 by random selection. In group I patients, flap fixation was done by quilting technique during MRM . In group II , no quilting was done. Post operative follow up was done after 05 days in OPD and development of seroma was observed clinically. Results: Mean age of patients was 55.23 ± 7.94 years. Mean BMI was 30.05 ± 2.63 kg/m2. Seroma formation was seen in 04 patients (13.33%) in group I (flap fixation by quilting technique ) and 19 patients (63.33%) in group II (control group) with p-value of 0.0001. Conclusion: This study concluded that there is significantly low incidence of post mastectomy seroma formation in MRM patients with quilting technique as compared to the conventional method of wound closure in MRM

Effects of Different Applications on Postoperative Seroma Formation and Wound Healing Following Mastectomy and Axillary Dissection in Rats

The most frequent postoperative complication after breast surgery is seroma formation. Seroma occurs due to lymphatic and vascular fluid leakage into the dead space created by surgical dissection. The objective of the research was to evaluate the effects of local fibrin glue, tetracycline, talc applications, and flap fixation technique on reducing seroma formation after mastectomy and axillary dissection. In addition, we aimed to determine the level of efficacy for these applications, as well as to identify the most appropriate method to be used in operations with high risk of seroma formation. Materials and Methods. This experimental study was conducted using a total of 60 female Wistar albino rats. They were allocated into six groups and each comprised ten rats. Unilateral mastectomy and axillary dissection were performed on all the rats. Local applications of fibrin glue, tetracycline, talc, and alcoholic iodine were performed in four separate groups. Flap fixation technique was applied in one group and those rats that did not receive any intervention constituted the control group. On the 10th postoperative day, seroma was aspirated under anesthesia, and the amount of seroma fluid was recorded. Seroma fluid was analyzed for interleukin 1-β, vascular endothelial growth factor, and C-reactive protein levels. Tissue samples were obtained from the skin overlaying the dissection area, the axilla, and the thoracic wall. Wound healing was evaluated with histopathological examination. Results. Seroma volume was lower and the wound healing scores were the highest in the flap fixation group and the tetracycline group as compared to the control group. However, the alcoholic iodine group and the talc group had a greater amount of seroma (p < 0.05). There was no difference between the fibrin glue group and the control group. Conclusions. In our mastectomy model, local application of alcoholic iodine and talc substances caused more wound site problems and postoperative seroma formation. While fibrin glue did not cause wound site problems, it did increase seroma formation. These three substances were determined to be inefficacious in postoperative seroma formation. Local tetracycline application and flap fixation technique were found to reduce postoperative seroma and benefit wound healing.

A new device for bone cranial flap fixation: Technical note and surgical remarks. A multicentric experience

Background: Fixation of bone flaps after craniotomy is a routine part of every neurosurgical procedure. The ideal fixation device should be safe, reliable, biologically inert, easy to use, and inexpensive and should not produce artifacts on neuroimaging. The authors describe a new device that meets these criteria. Methods: This is an observational, multicentric, and case series study of 56 patients who underwent a craniotomy and were subject to cranial bone flap fixation with the NT cranial small fixation system. A case–control group in whom titanium miniplates and screws were implanted was collected. All patients underwent CT scans of the head with 3D reconstruction at day 1 and day 90 postoperatively to evaluate bone flap position and fusion. Results: A total of 140 NT cranial small were implanted in 56 patients (mean age 44.2, range 22–63 years). The new device has shown stronger fixation qualities with optimal bone flap fusion and good cosmetic features. No surgical or relevant postsurgical follow-up complications have been associated with the device. Conclusion: Although this is a preliminary report in a relatively small number of patients, NT cranial small provides a safe, reliable, and easily applied postoperative cranial bone flap fixation system.

A Modified Surgical Method Combined with Blepharoplasty Design for Treatment of Xanthelasma Palpebrarum

Purpose. Xanthelasma palpebrarum manifests as a yellowish placoid on the medial aspect of the upper eyelids, often in middle and old age. Aggravated lateral hooding of the eyelid might cause a deformity with conventional surgery, which appears to be more deficient on the medial side with excess hooding of the lateral skin. The authors suggest a novel surgical technique to solve this problem and reconstruct the defect appropriately. Methods. From July 2017 to December 2018, our method of combining excision with blepharoplasty was performed on 8 patients, consisting of 15 lesions on the upper eyelid and 6 lesions on the lower lid. Lesion removal incorporating blepharoplasty incision was done. After resection, the orbicularis oculi musculocutaneous flap was widely elevated extending through the whole upper eyelid with the lateral flap first along with fat maneuver. The flap was advanced into the defect, with even distribution of tension, after lower flap fixation to the required height of the eyelid fold. Taping was done with a hydrocolloid bandage and kept for 2 weeks. Results. The wounds were healed primarily, and no cases of recurrence, lagophthalmos, hypertrophic scar, pigmentation, or remarkable deformity were noted. All patients were satisfied, and the functional outcomes were excellent. Two patients had trivial complications specific to our method, that of triple fold and neo-Mongolian fold, which were simply revised later. Conclusions. This modality overcame the drawbacks of eyelid deformity observed in previous surgical methods, giving excellent results without any critical complications.

A prospective study of factors affecting seroma formation after modified radical mastectomy in patients of carcinoma of breast

Background: Seroma, a clinically evident subcutaneous collection of serous fluid after breast cancer surgery, developing in approximately 30% of cases. To prevent seroma formation, it is important to estimate individual risk of seroma formation, i.e., the identification of predictive variables will be helpful in designing future trials aimed at reducing the incidence of this seroma. This study intends to find out the association between certain pre-operative, intra-operative, and post-operative factors related to MRM and incidence of seroma formation.Methods: It was an observational prospective on 100 females undergoing MRM at Department of Gandhi Medical College Bhopal, Madhya Pradesh, India. Patients were observed postoperatively for seroma formation and factors affecting it.Results: patients with seroma formation in this study tended to be older age (age, 62.60±10.40 years versus 56.13±10.31 years; p<0.001) and more obese (BMI, 26.95±4.2 versus 24.61±3.61; p<0.001). Higher amount of initial drain volume was directly related to seroma formation. Initiation of arm physiotherapy after surgery (3.14±0.23 days versus 2.17±0.74 days; p=0.043).Conclusions: The incidence of seroma is higher in older and in more obese patients. The incidence is decreased by flap fixation under muscles and early physiotherapy. Furthermore, few interventions in the operative period can help minimize the chances of seroma formation.

The endonasal patient reference tracker: a novel solution for accurate noninvasive electromagnetic neuronavigation

OBJECTIVEElectromagnetic (EM) navigation provides the advantages of continuous guidance and tip-tracking of instruments. The current solutions for patient reference trackers are suboptimal, as they are either invasively screwed to the bone or less accurate if attached to the skin. The authors present a novel EM reference method with the tracker rigidly but not invasively positioned inside the nasal cavity.METHODSThe nasal tracker (NT) consists of the EM coil array of the AxiEM tracker plugged into a nasal tamponade, which is then inserted into the inferior nasal meatus. Initially, a proof-of-concept study was performed on two cadaveric skull bases. The stability of the NT was assessed in simulated surgical situations, for example, prone, supine, and lateral patient positioning and skin traction. A deviation ≤ 2 mm was judged sufficiently accurate for clinical trial. Thus, a feasibility study was performed in the clinical setting. Positional changes of the NT and a standard skin-adhesive tracker (ST) relative to a ground-truth reference tracker were recorded throughout routine surgical procedures. The accuracy of the NT and ST was compared at different stages of surgery.RESULTSEx vivo, the NT proved to be highly stable in all simulated surgical situations (median deviation 0.4 mm, range 0.0–2.0 mm). In 13 routine clinical cases, the NT was significantly more stable than the ST (median deviation at procedure end 1.3 mm, range 0.5–3.0 mm vs 4.0 mm, range 1.2–11.2 mm, p = 0.002). The loss of accuracy of the ST was highest during draping and flap fixation.CONCLUSIONSApplication of the EM endonasal patient tracker was found to be feasible with high procedural stability ex vivo as well as in the clinical setting. This innovation combines the advantages of high precision and noninvasiveness and may, in the future, enhance EM navigation for neurosurgery.