A randomized controlled trial evaluating the efficacy of mastectomy flap quilting sutures in reducing post modified radical mastectomy seroma formation

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Background: One of the most common complication post modified radical mastectomy is the formation of seroma. Seroma formation in-turn delays wound healing, increases susceptibility to infection, skin flap necrosis, persistent pain and thus prolongs convalescence. For this, several techniques have been tried and trialed to improve primary healing and decrease the formation of seroma.Methods: Between Aug 2014 and July 2016, 60 patients with carcinoma of the breast, posted for modified radical mastectomy at KR Hospital, Mysuru, Karnataka, India were randomly divided into 2 groups, the study group (30) and the control group (30). In the study group; the mastectomy flap quilting sutures were put between the flap and the pectoral fascia and muscle at different parts of the flap and at the flap edge with absorbable sutures (polyglactin 3-0). In the control group; the flaps were approximated by the conventional method at the edges. Closed suction drains were placed in both the groups. Patients, tumour characteristics and operative related factors were documented. The volume and colour of the fluid drained was recorded everyday. The drains were removed when the amount became less than 30 cc in a 24 hour period. The total volume and duration (number of days) of fluid drained and the complications were recorded and compared.Results: In the study group, the drain was removed much earlier when compared to the control group (p < 0.001). The total amount of fluid drained was much lower in the study group (p < 0.001). The study group showed a much lower frequency of seroma formation when compared to the control group.Conclusions: The mastectomy quilting suture technique is an effective procedure that considerably reduces the incidence of seroma formation in patients undergoing modified radical mastectomy.