REDUCING SEROMA AFTER MODIFIED RADICAL MASTECTOMY: THE ROLE OF FLAP-MUSCLE SUTURES APPLIED ON MASTECTOMY FLAPS
Main Article Content
Keywords
modified radical mastectomy, mastectomy flap-muscle suture technique, seroma formation
Abstract
Background: A common problem following a modified radical mastectomy is seroma formation; incidence rates have been found to range from 15% to 81%. This consequence increases the likelihood of flap necrosis, infections, slows down the healing process, reopened wounds, pain, and further extension of recovery time. Because of this, different flap-fixing techniques have been tried in an effort to lessen the problems associated with local wounds.
The goal is to find out if mastectomy flap-muscle sutures to the chest wall muscles can reduce the amount and length of drained fluid as well as the number of cases of seroma after a modified radical mastectomy.
Study design: an analytical cross-sectional study
Place and Duration: This study was conducted at Shaheed Mohtarma Benazir Bhutto Medical University Larkana from June 2020 to June 2023
Methodology: There were a total of 80 patients who participated in this investigation. All of the participants were booked for a modified radical mastectomy. Women diagnosed with breast cancer scheduled for a modified radical mastectomy were included in the study. All 80 patients were equally divided into 2 groups (study group and control group), with 40 patients in each group. After the study group's modified radical mastectomy was finished, the mastectomy flaps were sutured together using polyglactin 3-0 sutures, and the underlying chest wall (pectoral fascia and muscle) was secured with flat-muscle sutures.
Results: The removal of drains happened significantly faster in the study group than in the control group (p < 0.001). Furthermore, the research group's total drained fluid volume was considerably lower (p < 0.001). In addition, the study group showed a much lower incidence of seroma formation than the control group.
Conclusion: For patients following modified radical mastectomy, the mastectomy flap-muscle suture technique is a successful surgery that significantly lowers the incidence of seroma formation.
References
2. Bhagchandani M, Shukla V, Maurya RK, Chaudhary A, Kumar K. A Comparative Study Between Mastectomy Flap Quilting Sutures with Axillary Drain Versus Conventional Sutures with Axillary and Pectoral Drain in Reducing Post-Modified Radical Mastectomy Seroma Formation. Indian Journal of Surgery. 2023 Apr 6:1-6.
3. Vettuparambil A, Subramanya C. Flap fixation as a technique for reducing seroma formation in patients undergoing modified radical mastectomy: An institutional experience. Indian journal of surgical oncology. 2021 Mar;12(1):48-53.
4. Trefoux-Bourdet A, Body G, Jacquet A, Hebert T, Kellal I, Marret H, Ouldamer L. Quilting suture after mastectomy in prevention of postoperative seroma: a prospective observational study. Gynecologie, Obstetrique & Fertilite. 2015 Feb 21;43(3):205-12.
5. Khater A, Elnahas W, Roshdy S, Farouk O, Senbel A, Fathi A, Hamed E, Abdelkhalek M, Ghazy H. Evaluation of the quilting technique for reduction of postmastectomy seroma: a randomized controlled study. International journal of breast cancer. 2015 Jul 12;2015.
6. Myint ST, Khaing KS, Yee W, Mon SM, Lwin T. Quilting suture versus conventional closure in prevention of seroma after total mastectomy and axillary dissection in breast cancer patients. ANZ journal of surgery. 2020 Jul;90(7-8):1408-13.
7. Awad AT, Alhussini MA, Balbaa MA. Quilting of mastectomy flaps; a simple way to avoid postmastectomy seroma. Indian Journal of Surgery. 2020 Feb;82:9-13.
8. Najeeb E, Rashid R, Zaffar S. Effect of flap fixation technique in modified radical mastectomy on incidence of postoperative seroma formation. J Coll Physicians Surg Pak. 2019 May 1;29(5):410-3.
9. Van Bastelaar J, Granzier R, Van Roozendaal LM, Beets G, Dirksen CD, Vissers Y. A multi-center, double blind randomized controlled trial evaluating flap fixation after mastectomy using sutures or tissue glue versus conventional closure: protocol for the Seroma reduction After Mastectomy (SAM) trial. BMC cancer. 2018 Dec;18(1):1-8.
10. Hakseven M, Avşar G, Çetindağ Ö, Deryol R, Benk MS, Sırgancı G, Culcu S, Ünal AE, Bayar S. Prospective Study on Avoiding Seroma Formation by Flap Fixation After Modified Radical Mastectomy. The American Surgeon™. 2023 May 15:00031348231175497.
11. Boolsen S, Nielsen VB, Jensen J, Bak S. Post mastectomy seroma. a study of the nature and origin of seroma after mastectomy. Dan Med Bull. 1989;36:487-9.
12. Petrek J, Peters M, Nori S, Knauer C, Kinne D, Rogatko A. Axillary lymphadenectomy. A prospective, randomized trial of 13 factors influencing drainage, including early or delayed arm mobilization. Arch Surg. 1990;125:378-82.
13. Halsted WS. Developments in the skin grafting operations for cancer of the breast. JAMA. 1913;60:416-51.
14. Larsen BB, Hugan C. Fixation of skin flaps in radical mastectomy by subcutaneous sutures; observations. AMA Arch Surg. 1955;71:419-23.
15. Aitken DR, Hunsaker R, James AG. Prevention of seromas following mastectomy and axillary dissection. Surg Gynecol Obstet. 1984;158:327-30.
16. Hea BJ, Ho MN, Petrek JA. External compression dressing versus standard dressing after axillary lymphadenectomy. Am J Surg. 1999;177:450-3.
17. Chen CY, Hoe AL, Wong CY. The effect of a pressure garment on post-surgical drainage and seroma formation in breast cancer patients. Singapore Med J. 1998;39:412-5.
18. Purushotham AD, Mclatchie E, Young D, George WD, Stallard S, Doughty J, et al. Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer. Br J Surg. 2002;89:286-92
19. Gonzalez EA, Saltzstein EC, Riedner CS, Nelson BK. Seroma formation following breast cancer surgery. Breast J. 2003;9:385-8.
20. Hashemi E, Kaviani A, Najafi M, Ebrahimi M, Hooshmand H, Montazeri A. Seroma formation after surgery for breast cancer. World J Surg Oncol. 2004;2:44.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Aisha Shaikh
Associate Professor General Surgery, Shaheed Mohtarma Benazir Bhutto Medical University Larkana.
Saira Fatima
Associate Professor General Surgery, Shaheed Mohtarma Benazir Bhutto Medical University Larkana.
Ibrahim Asgher
Assistant Professor General Surgery, Gambat Institute of Medical Sciences Gambat.
Nargis Shaikh
Consultant General Surgeon Chandka Medical College Hospital Larkana.
Zoya Mehran
Consultant General Surgeon Chandka Medical College Hospital Larkana.
Muhammad Muqeem
Assistant Professor General Surgery, Gambat Institute of Medical Sciences Gambat.