Frequency Of Seroma Formation Research Articles

Frequency of seroma formation after modified radical mastectomy. A comparison between electrocautery and scalpel dissection techniques.

Objective: To compare the use of electrocautery and scalpel dissection while performing modified radical mastectomy in terms of frequency of seroma formation. Study Design: Randomized Clinical Trial. Setting: Department of Surgery, Fauji Foundation Hospital, Rawalpindi. Period: 19-06-2019 to 22-06-2022. Material & Methods: A total of one hundred (n=100) female patients between age 22-60 years, who underwent modified radical mastectomy for breast carcinoma were enrolled in the study and randomized into two groups. Electrocautery dissection was performed in group A while patient in group B will undergo Scalpel dissection. Outcome was measured in terms of seroma formation at 7th day postoperatively. Results: Mean age of patients in our study was 42.39 years and standard deviation 8.26. At day 7 after the surgery, mean drain volume was 39.77 ml in our patients. Seroma formation was observed in a total of 14(28%) patients in group A (electrocautery) and 8(16%) patients in group B (Scalpel). Conclusion: Frequency of seroma formation was significantly lower with scalpel dissection as compared to those with electrocautery dissection after MRM.

Role of Transamin in Reduction of Seroma in Post-Operative Mastectomy

Objective:The purpose of this study to determine the effectiveness of transamin in reduction of seroma in post-operative mastectomy. Study Design:Retrospective study Place and Duration: District Headquarter Hospital Attock and Medicare Hospital, Attock. September 2021-July 2022. Methods: There were 40 females had breast cancer with age 20-65 years were included. Patients were underwent for mastectomy and admitted to hospital. After obtaining informed written consent detailed demographics of enrolled cases included age, body mass index and socio-economic status was recorded. After surgery patients received injection of tranexamic acid. Outcomes among all patients were assessed in terms of reduction in seroma formation, wound infection, amount of drainage and time of drainage. SPSS 22.0 was used to analyze all data. Results: We found that 7 (20%) patients had age 21-30 years, 12 (30%) cases had age 31-40 years, 17 (42.5%) cases had age 41-50 years and 4 (10%) cases had age 51-65 years. 26 (65%) patients had BMI >25kg/m2 and 14 (35%) had BMI <25kg/m2. There were 22 (55%) patients had poor socio-economic status. Mean amount of drainage was 812.7±99.24 ml and mean time of drainage was 7.5±12.40 days. Frequency of seroma formation was found in 5 (12.5%) cases in which mostly had BMI >25kg/m2 and had increased age. Wound infection found in 3 (7.5%) cases. Conclusion:We concluded in this study use of tranexamic acid among patients undergoing mastectomy was affective and useful in terms of reduction in seroma formation and lower number of wound infection. Except this duration and volume of drainage was also seen lower in our study. Keywords: Breast Cancer, Mastectomy, Seroma, Tranexamic Acid, Complications

Comparing Seroma Formation at the Deep Inferior Epigastric Perforator, Transverse Musculocutaneous Gracilis, and Superior Gluteal Artery Perforator Flap Donor Sites after Microsurgical Breast Reconstruction.

Background Seroma formation is the most common donor site complication following autologous breast reconstruction, along with hematoma. Seroma may lead to patient discomfort and may prolong hospital stay or delay adjuvant treatment. The aim of this study was to compare seroma rates between the deep inferior epigastric perforator (DIEP), transverse musculocutaneous gracilis (TMG), and superior gluteal artery perforator (SGAP) donor sites. Methods The authors conducted a retrospective single-center cohort study consisting of chart review of all patients who underwent microsurgical breast reconstruction from April 2018 to June 2020. The primary outcome studied was frequency of seroma formation at the different donor sites. The secondary outcome evaluated potential prognostic properties associated with seroma formation. Third, the number of donor site seroma evacuations was compared between the three donor sites. Results Overall, 242 breast reconstructions were performed in 189 patients. Demographic data were found statistically comparable between the three flap cohorts, except for body mass index (BMI). Frequency of seroma formation was highest at the SGAP donor site (75.0%), followed by the TMG (65.0%), and DIEP (28.6%) donor sites. No association was found between seroma formation and BMI, age at surgery, smoking status, diabetes mellitus, neoadjuvant chemotherapy, or DIEP laterality. The mean number of seroma evacuations was significantly higher in the SGAP and the TMG group compared with the DIEP group. Conclusion This study provides a single center's experience regarding seroma formation at the donor site after microsurgical breast reconstruction. The observed rate of donor site seroma formation was comparably high, especially in the TMG and SGAP group, necessitating an adaption of the surgical protocol.

Harmonic Scalpel versus Electrocautery: An Experience of Modified Radical Mastectomy at Tertiary Care Teaching Hospital

Background: The harmonic scalpel, commonly used in laparoscopic surgery, now has promise for MRM dissection. The harmonic scalpel's high frequency mechanical vibrations cut and coagulate intraoperatively at the same time, generating less heat injury than electrocautery.
 Objective: To compare the outcome of modified radical mastectomy using harmonic scalpel versus electrocautery at tertiary care teaching hospital.
 Methodology: The randomized controlled trial was conducted from 12th September 2018 11th March 2019 at Department of Surgery, Liaquat University of Medical and Health Science, Jamshoro. A total of 128 patients with infiltrating ductal carcinoma undergoing modified radical mastectomy, 20 to 50 years of age were included. Chronic Hepatitis, diabetes, and neo-adjuvant treatment patients were excluded. Modified radical mastectomy employing harmonic scalpel for Group A and electrocautery for Group B. Postoperative problems such as seroma development, postoperative hematoma, marginal necrosis, lymphedema, and wound infection were also observed.
 Results: The mean age of women in group A was 39.81 ± 6.73 years and in group B was 39.45 ± 6.60 years. Mean duration of disease was 5.41 ± 1.91 months. The frequency of seroma formation in harmonic scalpel group as 7.81% vs 26.56% in electrocautery group, p=0.005), frequency of pain is 53.13% vs 68.75% respectively, p=0.070, frequency of hematoma is 1.56% vs 17.19% respectively, p=0.002), frequency of marginal necrosis was 0.0% vs 7.81% respectively, p=0.023), lymphedema 3.13% vs 14.06% respectively, p=0.027) and wound infection 17.19% vs 35.94% respectively, p=0.016.
 Conclusion: This research indicated that harmonic scalpel is superior to electrocautery in modified radical mastectomy.

Lichtenstein Versus Desarda’s Technique of Hernia Repair

Aim: To compare Desarda’s versus Lichtenstein’s mesh repair in patients with unilateral, primary, reducible inguinal hernia in terms of mean operative time and seroma formation
 Methods: This randomized control trial conducted at Department of Surgery, Patuakhali Medical College & Hospital, Patuakhali. Eighty patients with unilateral, primary, reducible inguinal hernia were randomly distributed into two groups to undergo hernia repair i.e. Lichtenstein (L) and Desarda’s (D). Outcome was measured in terms of mean operative time and seroma formation. Seroma formation was defined as presence of enclosed cavity containing serous fluid determined by ultrasonography at 30th post-operative day.
 Results: Thirty three patients (41.25%) were above 50 years of age, whereas remaining 47 patients (58.75%) were below 50 years of age. Five patients (6.25%) were female and 75 patients(93.75%) were male. Seroma formation was 5% in Desarda’s group while 7.5% in Lichtenstein group (P> 0.05). Similarly difference in mean operative time was statistically non-significant. Seroma formation was common in older age group. There was no effect of smoking, obesity, operative time and gender on seroma formation. Conclusion: It is concluded that there is no difference in frequency of seroma formation and mean operative time in Desarda’s or Lichtenstein’s technique of hernia repair.
 Journal of Surgical Sciences (2018) Vol. 22 (2) : 99-103

Tension-free primary closure compared with modified Limberg flap for pilonidal sinus disease: a prospective balanced randomized study

Background Pilonidal sinus disease (PSD) is a common disease that affects the patient's quality of life. We analyzed the outcome of the tension-free primary closure (TF 1ry) in comparison with the modified Limberg flap (MLF) technique. Patients and methods A total of 120 patients suffering PSD were assigned to one of two equal groups by closed envelope balanced randomization. Group I represents TF 1ry method and group II represents MLF. Results There were 102 (85%) male patients and 18 (15%) female patients elected for surgery. The mean follow-up period was 43.5 ± 3.4 months. There were no statistically significant differences between the two groups regarding patients' demographic data, clinical presentation, immediate postoperative complications, and disease recurrences. The operative time, blood loss, hospital stay, surgeon's performance scale, wound hypothesia, wound cosmoses score, patient satisfaction score, and patient quality of life (bodily pain and social functioning) were better in the TF 1ry group. The MLF group had better clinical results regarding frequency of seroma formation and time to drain removal. Conclusion Flap techniques are effective and efficient for PSD. TF 1ry closure can be tailored for female PSD patients and a junior surgeon. MLF can be tailored for male PSD patients and a senior surgeon.

Recognizing seromadesis to prevent false-positive PET-CT interpretations.

e22084 Background: Seromas are the result of a local inflammatory response to a mechanical injury incurred by tissue aggression either during surgery or the presence of foreign bodies. Unfortunately, the common practice of using of percutaneous or surgical drains, does not decrease the frequency of seroma formation and is associated with an increased risk of infection. Methods: Since first introduced in 1935 for pleurodesis, talcum powder has been used extensively as a simple, effective, and economic procedure for the treatment and prophylaxis of recurrent pleural effusions. It induces a strong fibrotic reaction due to the activation of polymorphonuclear neutrophils, interleukin 8 and fibroblast growth factor. One of the earliest documented uses was by Coons et al., in 1993 utilizing an experimental dog model. In 2006, Saeb-Parsy et al. described its use in recurrent seroma after breast surgery. More recently in 2012, Klima et al. reported that a prophylactic application of subcutaneous talc after axillary dissection in a porcine model safely reduces drain duration and prevents seromas without local or systemic side effects. More recently, it has also been used in superficial soft tissue excisions for melanomas and large metastatic lymphadenopathy excisions. Currently, F-18 FDG PET-CT is widely used in the diagnosis and management of patients with malignancies. However, the imaging tracer F-18 FDG is utilized not only by malignant cells but by infectious, inflammatory cells as well resulting in false ‘positive’ findings. Results: When a patient undergoes pleurodesis using talc, the local inflammatory process is seen as intense increased F18 FDG activity on PET-CT scan. This can be perceived and misinterpreted as initial or recurrent malignant foci or infection. Thus it is imperative that interpreting physicians be aware of the wide range of application of talcum powder to any site with a potential of seroma development. Conclusions: Presence of intense F-18 FDG activity corresponding to somewhat linear irregular area of hyperdensity seen in the CT portion of PET-CT in previous surgical bed should alert the interpreting physician on strong probability of talc induced exuberant inflammatory reaction and associated F-18 FDG activity.

Composite polypropylene mesh versus lightweight polypropylene mesh: The TAPP repair for laparoscopic inguinal hernia repair

Aims and Objectives: To determine the frequency of complications and pain scores post-operatively following TAPP (Transabdominal Pre-peritoneal)repair for inguinal hernia, comparing lightweight polypropylene versus the composite polypropylene mesh. Materials and Methods: This study was conducted at Lady Reading Hospital, Peshawar, from December 1, 2007, to November 30, 2011. Group A included all those patients with inguinal hernia that were operated using the TAPP method and extraperitoneal placement of the lightweight polypropylene mesh, whereas group B comprised of those patients that were placed a composite polypropylene mesh (VYPRO II R ). A pro forma was prepared to record all the relevant data such as the NYHUS classification of the type of hernia, the post-operative pain scale score, and the complications that included seroma formation, testicular pain and atrophy, preoperative injuries, surgical emphysema, adhesion obstruction, mesh infection, wound infection, and perioperative mortality. The planned sequence of follow-up after discharge of the patient was at 1 week, 1month, 3 months, 6 months, and one year. Data were analyzed using SPSS R for Windows version 13.0. Results: A total of 192 patients were operated, equally divided between both groups. The VYPRO II R group had a higher number of direct hernias and the operative time was also much less but this was not statistically significant (P=0.91). The mean hospital stay was slightly higher in the polypropylene group but that was also not significant (P=0.89). The frequency of seroma formation was higher in the polypropylene group (6.25%) and majority of these patients from both groups had larger scrotal hernias (P=0.34). The most significant finding in this study was the frequency of chronic pain with a visual analogue score of >3(1-10) after the six-month period was significantly higher in the polypropylene group (P=0.02). The recurrence rate was comparable in both groups with 3 patients in group B(P=0.62). Conclusions: No difference in the frequency of recurrence was observed over a one-year follow-up period but significant pain scores were observed in the polypropylene group. Studies with longer follow-up to rule the rate of recurrence in composite meshes will determine its benefit over the lightweight polypropylene meshes.

External compression dressing versus standard dressing after axillary lymphadenectomy

Background: Closed-catheter drainage after axillary lymph node dissection (ALND) for breast cancer may constitute a significant inconvenience to the recovering patient, and may also serve as portals of entry for bacteria. Any intervention that could reduce the volume and duration of postoperative drainage would be beneficial. The purpose of this study was to determine whether an external compression dressing after ALND would decrease postoperative drainage, afford earlier drain removal, and reduce subsequent seroma formation.Patients and methods: One hundred thirty-five women undergoing definitive surgical treatment for breast cancer were randomized to receive a compression dressing (n = 66) or standard dressing (n = 69). They were also stratified for modified radical mastectomy (MRM; n = 74) or breast conservation therapy (BCT; n = 61). All patients had ALND. The compression dressing consisted of a circumferential chest wrap of two 6-inch Ace bandages, held in place by circumferential Elastoplast bandage, and it was applied by the same nurse. This dressing remained intact until postoperative day 4. Patients in the standard dressing group (control) were fitted with a front-fastening Surgibra only. Drains were removed when the total daily amount was <50 cc. Postoperative drainage volume, total days with drain, and frequency of seroma formation were recorded for each patient.Results: After 4 days, wound drainage in both groups was nearly identical (compression = 490 cc, standard = 517 cc; P = 0.48). Total days with drain were also similar (compression = 6.4 days, standard = 6.1 days; P = 0.69). The compression dressing did not reduce seroma formation. In fact, there was a statistically significant increase in the number of seroma aspirations per patient in the compression group (compression = 2.9, standard = 1.8; P <0.01). The increase in seroma aspirations was more significant in MRM patients (compression = 3.1, standard = 1.7; P <0.01) than in BCT patients (compression = 2.6, standard = 1.8; P = 0.20).Conclusions: External compression dressing fails to decrease postoperative drainage and may increase the incidence of seroma formation after drain removal. Thus, routine use of a compression dressing to reduce postoperative drainage after ALND for breast cancer is not warranted.