Abstract
Mastectomy is still one of the fundamental options for treatment of breast cancer. Postmastectomy seroma formation is a common complication that can lead to significant morbidity. A lot of studies focused on mechanical obliteration of the postmastectomy dead space assuming it is the primary factor for seroma development. The aim of this study was to evaluate the efficacy of quilting technique in reducing the incidence of postmastectomy seroma. The study included 800 patients who were randomized into two equal groups; A and B, where quilting has been performed to “group B.” The patients were followed up to measure daily drain output with monitoring of seroma formation in the next 14 days after drain removal. “Group B” showed significant reduction in the mean of fluid drained (246.08 ± 78.94 mL) (P < 0.001) compared with “group A” (664.75 ± 69.43 mL) together with significant reduction in incidence of seroma formation with incidence of 21.75% and 3.5% (P < 0.001) for groups A and B, respectively. Quilting is an effective technique in reducing the incidence of postmastectomy seroma formation.
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Kolak A, Kaminska M, Sygit K, Budny A, Surdyka D, Kukielka-Budny B, Burdan F (2017) Primary and secondary prevention of breast cancer. Ann Agric Environ Med 24(4):549–553. https://doi.org/10.26444/aaem/75943
Troost MS, Kempees CJ, de Roos MA (2015) Breast cancer surgery without drains: no influence on seroma formation. Int J Surg 13:170–174. https://doi.org/10.1016/j.ijsu.2014.11.050
Khater A, Elnahas W, Roshdy S, Farouk O, Senbel A, Fathi A, Hamed E, Abdelkhalek M, Ghazy H (2015) Evaluation of the quilting technique for reduction of postmastectomy seroma: a randomized controlled study. Int J Breast Cancer 2015:287398. https://doi.org/10.1155/2015/287398
Sampathraju S, Rodrigues G (2010) Seroma formation after mastectomy: pathogenesis and prevention. Indian J Surg Oncol 1(4):328–333. https://doi.org/10.1007/s13193-011-0067-5
Hashemi E, Kaviani A, Najafi M, Ebrahimi M, Hooshmand H, Montazeri A (2004) Seroma formation after surgery for breast cancer. World J Surg Oncol 2(44):44. https://doi.org/10.1186/1477-7819-2-44
Gonzalez EA, Saltzstein EC, Riedner CS, Nelson BK (2003) Seroma formation following breast cancer surgery. Breast J 9(5):385–388. https://doi.org/10.1046/j.1524-4741.2003.09504.x
Shin IS, Lee DW, Lew DH (2012) Efficacy of quilting sutures and fibrin sealant together for prevention of seroma in extended latissimus dorsi flap donor sites. Arch Plast Surg 39(5):509–513. https://doi.org/10.5999/aps.2012.39.5.509
Somers RG, Jablon LK, Kaplan MJ, Sandler GL, Rosenblatt NK (1992) The use of closed suction drainage after lumpectomy and axillary node dissection for breast cancer. A prospective randomized trial. Ann Surg 215(2):146–149. https://doi.org/10.1097/00000658-199202000-00009
Cipolla C, Fricano S, Vieni S, Graceffa G, Licari G, Torcivia A, Latteri MA (2010) Does the use of fibrin glue prevent seroma formation after axillary lymphadenectomy for breast cancer? A prospective randomized trial in 159 patients. J Surg Oncol 101(7):600–603. https://doi.org/10.1002/jso.21531
Throckmorton AD, Askegard-Giesmann J, Hoskin TL, Bjarnason H, Donohue JH, Boughey JC, Degnim AC (2008) Sclerotherapy for the treatment of postmastectomy seroma. Am J Surg 196(4):541–544. https://doi.org/10.1016/j.amjsurg.2008.06.020
Vasileiadou K, Kosmidis C, Anthimidis G, Miliaras S, Kostopoulos I, Fahantidis E (2017) Cyanoacrylate adhesive reduces seroma production after modified radical mastectomy or quadrantectomy with lymph node dissection-a prospective randomized clinical trial. Clin Breast Cancer 17(8):595–600. https://doi.org/10.1016/j.clbc.2017.04.004
Faisal M, Abu-Elela ST, Mostafa W, Antar O (2016) Efficacy of axillary exclusion on seroma formation after modified radical mastectomy. World J Surg Oncol 14(1):39. https://doi.org/10.1186/s12957-016-0801-0
MannuI GS, Qurihi K, Carey F, Ahmad MA, Hussien M (2015) Quilting after mastectomy significantly reduces seroma formation. SAJS 53(2):50–54
ten Wolde B, van den Wildenberg FJ, Keemers-Gels ME, Polat F, Strobbe LJ (2014) Quilting prevents seroma formation following breast cancer surgery: closing the dead space by quilting prevents seroma following axillary lymph node dissection and mastectomy. Ann Surg Oncol 21(3):802–807. https://doi.org/10.1245/s10434-013-3359-x
Gong Y, Xu J, Shao J, Cheng H, Wu X, Zhao D, Xiong B (2010) Prevention of seroma formation after mastectomy and axillary dissection by lymph vessel ligation and dead space closure: a randomized trial. Am J Surg 200(3):352–356. https://doi.org/10.1016/j.amjsurg.2009.10.013
Srivastava V, Basu S, Shukla VK (2012) Seroma formation after breast cancer surgery: what we have learned in the last two decades. J Breast Cancer 15(4):373–380. https://doi.org/10.4048/jbc.2012.15.4.373
Ouldamer L, Caille A, Giraudeau B, Body G (2015) Quilting suture of mastectomy dead space compared with conventional closure with drain. Ann Surg Oncol 22(13):4233–4240. https://doi.org/10.1245/s10434-015-4511-6
Ouldamer L, Trefoux-Bourdet A, Duquesne M, Body G (2011) How I do ... quilting suture of dead space after mastectomy. Gynecol Obstet Fertil 39(11):663–664. https://doi.org/10.1016/j.gyobfe.2011.07.050
Ouldamer L, Bonastre J, Brunet-Houdard S, Body G, Giraudeau B, Caille A (2016) Dead space closure with quilting suture versus conventional closure with drainage for the prevention of seroma after mastectomy for breast cancer (QUISERMAS): protocol for a multicentre randomised controlled trial. BMJ Open 6(4):e009903. https://doi.org/10.1136/bmjopen-2015-009903
Bourke JB, Balfour TW, Hardcastle JD, Wilkins JL (1976) A comparison between suction and corrugated drainage after simple mastectomy: a report of a controlled trial. Br J Surg 63(1):67–69. https://doi.org/10.1002/bjs.1800630115
Sakkary MA (2012) The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients. World J Surg Oncol 10:8. https://doi.org/10.1186/1477-7819-10-8
Özaslan C, Yilmaz KB, Doğan L, Atalay C, Altinok M (2010) Effect of mechanical closure of dead space on seroma formation in modified radical mastectomy. Turk J Med Sci 40(5):751–755
Mazouni C, Mesnard C, Cloutier AS, Amabile MI, Bentivegna E, Garbay JR, Sarfati B, Leymarie N, Kolb F, Rimareix F (2015) Quilting sutures reduces seroma in mastectomy. Clin Breast Cancer 15(4):289–293. https://doi.org/10.1016/j.clbc.2014.12.014
Purushotham AD, McLatchie E, Young D, George WD, Stallard S, Doughty J, Brown DC, Farish C, Walker A, Millar K, Murray G (2002) Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer. Br J Surg 89(3):286–292. https://doi.org/10.1046/j.0007-1323.2001.02031.x
Classe JM, Berchery D, Campion L, Pioud R, Dravet F, Robard S (2006) Randomized clinical trial comparing axillary padding with closed suction drainage for the axillary wound after lymphadenectomy for breast cancer. Br J Surg 93(7):820–824. https://doi.org/10.1002/bjs.5433
Yu KD, Huang S, Zhang JX, Liu GY, Shao ZM (2013) Association between delayed initiation of adjuvant CMF or anthracycline-based chemotherapy and survival in breast cancer: a systematic review and meta-analysis. BMC Cancer 13:240. https://doi.org/10.1186/1471-2407-13-240
Gagliato Dde M, Gonzalez-Angulo AM, Lei X, Theriault RL, Giordano SH, Valero V, Hortobagyi GN, Chavez-Macgregor M (2014) Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer. J Clin Oncol 32(8):735–744. https://doi.org/10.1200/JCO.2013.49.7693
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Awad, A.T., Alhussini, M.A. & Balbaa, M.A. Quilting of Mastectomy Flaps; a Simple Way to Avoid Postmastectomy Seroma. Indian J Surg 82, 9–13 (2020). https://doi.org/10.1007/s12262-019-01875-7
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DOI: https://doi.org/10.1007/s12262-019-01875-7