两种皮瓣分离方式对乳腺癌改良根治术伤口的影响

目的比较肾上腺盐水皮下浸润后手术刀片游离皮瓣和电刀游离皮瓣对乳腺癌改良根治术伤口的影响。方法自2002年1月至2006年9月实施Auchincloss乳腺癌改良根治术者130例,均采用横切口,肾上腺盐水皮下浸润后手术刀片游离皮瓣组75例(A组),电刀游离皮瓣55例(B组)。结果A组发生皮瓣坏死共6例(8.0%),均经换药治疗后痊愈;B组发生皮瓣坏死18例(32.7%),其中3例需植皮治疗,两组比较有非常显著性差异(P<0.01);A组发生皮下积液3例(4.0%),B组发生皮下积液8例(14.6%),两组比较有显著性差异(P<0.05)。结论肾上腺盐水皮下浸润后手术刀片游离皮瓣是简捷安全和值得推广的方法     

Recurrent cochlear implant associated seroma: A series of five patients

Introduction: We have observed a small number of patients with cochlear implants who have a tendency to develop recurrent seromas overlying the implant package.

Methods: Five patients with a current or previous history of recurrent seromas presenting for review over a three-month period were identified. A retrospective review of their case notes was undertaken.

Results: All patients identified were children, with a mean age at first seroma of 5.0 years (range 1.9–10.4 years). The mean interval between implantation and first episode of seroma was 3.1 years (range 0.9–6.4 years). With the exception of imaging showing a fluid-density collection, investigations were generally unremarkable. Fluid aspirated from one patient was cultured and no organisms were grown. Antibiotics, most commonly amoxicillin / clavulanic acid, were commonly but not universally prescribed.

Conclusions: Recurrent cochlear implant associated seroma appears to be an idiopathic process. Investigations are generally unhelpful, and whilst it is probably prudent to treat with antibiotics during an initial presentation, once a pattern of recurrent seroma is established, patients can be treated conservatively.     

Breast cancer surgery without suction drainage: The impact of adopting a ‘no drains’ policy on symptomatic seroma formation rates

Aim

To determine the effect of a ‘no drains’ policy on seroma formation and other complications in women undergoing breast cancer surgery.

Materials and methods

Before May 2010 drains were routinely used in our unit following mastectomy ± axillary surgery and axillary lymph node dissection (ALND) ± wide local excision (WLE). Since then, a ‘no drains’ policy has been adopted. Data was collected prospectively between 01/12/06 and 30/11/11 to compare symptomatic seroma, wound infection, re-admission and re-operation rates in women treated with a drain and those without.

Results

596 women were included in the study. 247 women underwent modified radical mastectomy (MRM) and ALND (Group 1), 184 MRM ± sentinel lymph node biopsy (SLNB)/axillary node sampling (ANS) (Group 2) and 165 ALND ± WLE (Group 3).In group 1, 149 had a drain, in group 2, 62, and in group 3, 50.Within each group, the presence or absence of a drain did not significantly affect the rate of symptomatic seroma, number of aspirations performed, wound infection rates or the incidence of complications requiring re-admission. Having a drain was associated with lower volumes of seroma aspirated. In all three groups, the presence of a drain was associated with a longer hospital stay (p < 0.001).

Conclusion

This study suggests that MRM ± ALND/SLNB/ANS and ALND ± WLE can be performed without the use of suction drains without increasing seroma formation and other complication rates. Adopting a ‘no-drains’ policy may also contribute to earlier hospital discharge.     

Implant-associated anaplastic large cell lymphoma of the breast: Insight into a poorly understood disease

Implant-associated anaplastic large cell lymphoma (ALCL) is the subject of much debate in the field of plastic surgery. Only a few published cases have been reported and the rarity of the disease may make proving causality exceedingly difficult. Despite this, it is of utmost importance that full attention be devoted to this subject to ensure the safety and well-being of patients. The authors report one new case of implant-associated ALCL that recently presented to their institution. Implant-associated ALCL is a poorly understood disease. It should likely be considered its own clinical entity and categorized into two subtypes: one presenting as a seroma and the other as a distinct mass or masses. When reported, only textured implants have been associated with ALCL. The United States Food and Drug Administration and American Society of Plastic Surgeons have initiated a registry and have collected critical data to gain further understanding of this disease.     

Prevention of seroma formation after axillary dissection in breast cancer: A systematic review

Background

The most common complication after breast cancer surgery is seroma formation. It is a source of significant morbidity and discomfort. Many articles have been published describing risk factors and preventive measures. The aim of this paper is to provide a systematic review of studies and reports on risk factors and preventive measures. Surgery lies at the core of seroma formation; therefore focus will be placed on surgical ways of reducing seroma.

Methods

A computer assisted medline search was carried out, followed by manual retrieval of relevant articles found in the reference listings of original articles.

Results

136 relevant articles were reviewed. Though the level of evidence remain varied several factors, type of dissection, tools with which dissection is carried out, reduction of dead space, suction drainage, use of fibrin glue and octreotide usage, have been found to correlate with seroma formation and have been shown to significantly reduce seroma rates.

Conclusion

Seroma formation after breast cancer surgery cannot be avoided at present. There are however several methods to minimize seroma and associated morbidity. Future research should be directed towards the best ways of reducing seroma by combining proven methods.     

Prevention of seroma formation after mastectomy and axillary dissection by lymph vessel ligation and dead space closure: a randomized trial

Introduction

We aimed to reduce the incidence of seroma formation by altering surgical technique.

Methods

Two hundred one breast cancer patients were randomly divided into 2 arms: arm 1 was operated on using an altered surgical technique, which is to ligate all of the tissue connecting axillary vein bundles to the specimen, to suture the anterior edge of the latissimus dorsi to the chest wall, and to fix the skin flap to the underlying muscle by subcutaneous sutures; arm 2 was operated on using the conventional technique.

Results

The drainage volume, in the initial 3 days, for patients in arm 1 was significantly less than that for patients in arm 2 (P < .01). The duration of drainage in arm 1 was shorter than that in arm 2 (P < .01). The incidence of seroma formation in arm 1 (2%) was significantly less than that in arm 2 (14%) (P < .01).

Conclusion

The modified operating technique is an effective approach to reducing the incidence of seroma formation after mastectomy and axillary dissection.     

肩肘约束带用于乳癌术后预防皮下积液的效果观察及护理

目的探讨肩肘部约束带用于乳腺癌改良根治术后防止皮下积液的效果。方法选择2010年3～10月乳腺癌改良根治术后162例患者,随机分为对照组和实验组,对照组采用传统单纯胸带加压包扎,观察组除胸带加压包扎外另加肩肘部约束带,观察两组创腔引流量,拔管时间及患肢功能恢复情况。结果实验组创腔引流量明显少,引流管置管时间短,患肢恢复良好,两组比较差异有显著意义（P〈0.05）。结论乳腺癌改良根治术后患者加用肩肘部约束带可有效防止皮下积液的发生,利于切口愈合,促进康复。     

Initial experience with hemostatic fibrin glue as adjuvant during drainless parotidectomy

Objectives

To evaluate the use of Hemostatic Fibrin Glue in parotidectomy without the use of surgical drains.

Study design

Prospective cohort study of 10 patients undergoing parotidectomy. Surgery as a one day admission without the use of surgical drains was planned. The complication and duration of the hospital stay were obtained.

Methods

Parotidectomy was undertaken by one surgeon. Prior to wound closure, the skin flap and wound bed were approximated using Tisseel tissue sealant. Data regarding the incidence of any complication and the duration of the hospital stay were obtained. Patients were followed to assess surgical outcome and document any complications. The mean follow-up period was 8 months (range 4–12 months).

Results

There were no major surgical complications. Two patients had facial nerve weakness due to adherence of the tumour in the facial nerve, in there was which complete recovery after few months. All patients were discharged the next day. None of the patients felt that the discharge had been premature.

Conclusions

Parotidectomy can be undertaken safely without the need for surgical drains, therefore, allowing the patients to leave the hospital on the first postoperative day.     

Influence of the hernia sac treatment method on the occurrence of seroma after laparoscopic transabdominal preperitoneal hernia repair

PurposeTo determine whether transection of the hernia sac during laparoscopic transabdominal preperitoneal hernia repair (TAPP) affects the occurrence of seroma, and to explore the risk factors for seroma.MethodsIn total, 330 consecutive male patients with indirect inguinal hernia who underwent TAPP repair at the Qingdao University Affiliated Hospital from January 2020 to June 2021 were retrospectively enrolled in this study. According to the intraoperative hernia sac treatment, patients were divided into a completely reduced sac group and a transected sac group.ResultsAmong the 330 inguinal hernia male patients, 240 received hernia sac reduction and 90 received hernia sac transection. Fifty-four patients developed seroma, with an incidence of 16.4%. In patients with a hernia defect measuring ≥3 cm and extension into the scrotum, the difference in the incidence of seroma between the two treatment groups approached significance (P = 0.052). The risk factors for seroma, high body mass index, hernia sac ≥3 cm, extension of the hernia into the scrotum and operation time were significantly associated with postoperative seroma.ConclusionThis study showed that the incidence of seroma after TAPP was as high as 16.4%. For patients with a hernia sac that is too large and descended extends into the scrotum, transection may be better than complete dissection of the hernia sac and preventive measures should be taken for patients with high body mass index, hernia sac measuring ≥3 cm, and a high risk of the hernia extending into the scrotum.