Background Seroma formation is one of the most common complications after breast cancer surgery. Various risk factors have been evaluated for their associations with the development of seromas in Western populations. ...Background Seroma formation is one of the most common complications after breast cancer surgery. Various risk factors have been evaluated for their associations with the development of seromas in Western populations. However, similar data are not available in Chinese series. Therefore, we sought to investigate the potential risk factors for Chinese breast cancer patients. Methods A prospective study of female breast cancer patients undergoing surgery was carried out in Cancer Hospital of Fudan Unversity, Shanghai, China. Univariate analyses were performed by chi-square test or Student＇s t test or Mann-Whitney test and multivariate analyses by stepwise Logistic regression. The logistic model included age （years）, total serum protein concentration （g/L）, drainage volume on postoperative day 3 （POD 3; ml） and time to daily drainage volume not more than 30 ml （TTV30; days）. Results A total of 158 patients with breast cancer were studied. The mean age at diagnosis was （52.14±10.77） years （range 25-92）. During the follow-up period, 24 （15.2%） patients developed seromas. Calculated as continuous variables in the stepwise Logistic regression, age （0R=1.090, 95% CI 1.028-1.155, P=0.004）, total serum protein concentration （OR=0.886, 95% Cl 0.791-0.992, P=0.036）, drainage volume on POD3 （OR=1.013, 95% Cl 1.002-1.023, P=0.017） and TTV30 （OR=1.273, 95% CI 1.039-1.561, P=0.020） were independent risk factors for seroma formation. Additionally, significant difference in daily drainage volume was substantiated in the analysis by seroma formation （P=0.034） rather than by type of surgery （P=0.713）. Conclusions Although the pathogenesis of seroma remains controversial, such risk factors as age, nutritional status, drainage volume on POD3 and TTV30 should be considered for prediction and prevention of seroma formation in Chinese breast cancer patients.展开更多
Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplica...Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplications can delay the initiation of adjuvant therapies,increase healthcare costs,and negatively affectpatients’quality of life.This study evaluated the use of a latex-based tissue adhesive(LTA)as an intraoperativestrategy to prevent seroma formation and prolonged lymphorrhea following axillary dissection.Methods:In this prospective study,65 female patients diagnosed with stage Ⅱb-Ⅲ breast cancer and clinicallyconfirmed axillary lymph node involvement were enrolled.Participants were divided into two groups.The studygroup(n=33)received an intraoperative application of LTA without drainage,while the control group(n=32)underwent standard ALND with placement of a silicone vacuum drain.Postoperative outcomes assessed includedlymphatic drainage volume,number of aspirations,duration of lymphorrhea,length of hospital stay,and incidence of complications.Results:Use of the LTA significantly reduced both the volume and duration of postoperative lymphorrhea.Bypostoperative day 10,the average wound exudate volume in the LTA group was 8.2±3.3 mL,compared to54.1±3.9 mL in the control group—an 84.8%reduction.The LTA group also experienced shorter hospital staysand fewer cases of postoperative seroma requiring intervention.Conclusion:LTA appears to be a safe,effective,and practical intraoperative technique for preventing lymphaticcomplications after ALND.Its use may reduce dependence on drainage systems,shorten hospitalization,andsupport earlier initiation of adjuvant therapies,ultimately improving surgical outcomes and patient recovery.展开更多
Studies have shown that a combined application of several ion channel inhibitors immediately after central nervous system injury can inhibit secondary degeneration. However, for clinical use, it is necessary to determ...Studies have shown that a combined application of several ion channel inhibitors immediately after central nervous system injury can inhibit secondary degeneration. However, for clinical use, it is necessary to determine how long after injury the combined treatment of several ion channel inhibitors can be delayed and efficacy maintained. In this study, we delivered Ca^2＋ entry-inhibiting P2X7 receptor antagonist oxidized-ATP and AMPA receptor antagonist YM872 to the optic nerve injury site via an iPRECIO-@ pump immediately, 6 hours, 24 hours and 7 days after partial optic nerve transection surgery. In addition, all of the ion channel inhibitor treated rats were administered with calcium channel antagonist lomerizine hydrochloride. It is important to note that as a result of implantation of the particular pumps required for programmable delivery of therapeutics directly to the injury site, seromas occurred in a significant proportion of animals, indicating infection around the pumps in these animals. Improvements in visual function were observed only when treatment was delayed by 6 hours; phosphorylated Tau was reduced when treatment was delayed by 24 hours or 7 days. Improvements in structure of node/paranode of Ranvier and reductions in oxidative stress indicators were also only observed when treatment was delayed for 6 hours, 24 hours, or 7 days. Benefits of ion channel inhibitors were only observed with time-delayed treatment, suggesting that delayed therapy of Ca^2＋ ion channel inhibitors produces better neuroprotective effects on secondary degeneration, at least in the presence of seromas.展开更多
Introduction: A seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and woun...Introduction: A seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound breakdown. Infection developing within seroma increases morbidity and often results in the need for re-admission, re-imaging, drainage and antibiotic usage. Numerous methods to reduce post-mastectomy seroma formation have been tried with no consistent success. Methods: 24 consecutive patients undergoing mastectomy and axillary clearance were recruited before and after a departmental change in practice. At the point of skin closure, patients either underwent “axillary exclusion” or not. Total drain outputs were recorded by community district nursing staff for all patients. At the first post-operative visit, the presence and severity of seroma was recorded. Results: 24 patients were included (study group 14, control group 10). Age, size of tumour, and number of positive lymph nodes and laterality were comparable between groups. Mean drain output for the entire group was 471 ml (3 - 1030 ml) over 5.21 days. The control group had a drain output of 763.5 ml (95%CI 674.2 - 852.8) while the study group had a mean drainage of 262.2 ml (95%CI 161.9 - 362.5), a reduction of over 65%, p < 0.001. 15 (62.5%) out of 24 patients developed seroma. 42.9% of the study group and 90% of the control group developed seroma, p < 0.01. Conclusion: Seromas are a common complication following mastectomy and axillary clearance. Our technique of axillary exclusion has resulted in significantly reduced drainage volumes and fewer seromas.展开更多
BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical i...BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.展开更多
Background: Radical lymph node dissection (RLND) is the treatment of choice in stage III melanoma patients. Over half of the observed complications were related to post-operative serum collection affecting wound heali...Background: Radical lymph node dissection (RLND) is the treatment of choice in stage III melanoma patients. Over half of the observed complications were related to post-operative serum collection affecting wound healing. The aim of this study was to evaluate the use of the LigaSureTM Small Jaw (LSJ) on postoperative drainage fluid volume and drainage permanence in patients undergoing RLND. Study design: This was a prospective single-center study in which consecutive melanoma patients underwent nodal dissection using the LSJ. Daily drainage volume and duration of drainage were recorded in post-operative course on days 3, 10 or 15 and day 20. Results: A total of 70 patients were included. Mean postoperative drainage volume was lower. Around two-thirds of patients had a drainage fluid volume of less than 50cc at 10 days. Mean time to drainage removal was 14.5 days. Conclusions: This is the first report of nodal dissection in patients with cutaneous melanoma using an electrothermal bipolar vessel sealing system. The technique was feasible, safe, and effective and resulted in reduced drainage fluid volume and drainage permanence.展开更多
Background and Purpose: Seroma formation is a common complication following a mastectomy and axillary surgery. Decreasing the dead space is believed to decrease seroma formation. The aim of this study is to compare th...Background and Purpose: Seroma formation is a common complication following a mastectomy and axillary surgery. Decreasing the dead space is believed to decrease seroma formation. The aim of this study is to compare the incidence of seroma formation with the use of Glubran-2 versus normal saline during the wound closure in participants undergoing mastectomy with or without axillary dissection. Methods: This multicentre, prospective, double-blinded, randomised controlled trial, enrolled women 18 years of age or older with breast cancer, who were underwent total or partial mastectomy, with or without axillary dissection. Participants were randomised to Glubran-2 or Saline arm. The primary outcome was the volume and duration of wound seroma. Secondary outcome was post-operative wound infection. Results: A total of 76 women were randomised and there was no loss to follow-up or mortality. The total seroma volume was higher in the Glubran-2 arm. The duration of seroma was higher in the mastectomy and axillary dissection group in the Glubran-2 arm (P = 0.69). Elderly and participants with higher BMI had a higher volume of seroma. Post-operative infection rate was higher in the Glubran-2 arm (13.2% vs. 5.6%;P = 0.26). There was no statistically significant difference between the groups. Conclusion: Our study did not show any benefit with the use of Glubran-2 in mastectomy and axillary surgery in reducing the risk of seroma formation. In elderly and obese participants the use of Glubran-2 showed an increase in seroma formation and post-operative wound infection.展开更多
Study Objective: To evaluate the imaging characteristics and healing following application of an absorbable biocompatible hydrogel into the excision cavity following breast conservation surgery. Design: Non-randomized...Study Objective: To evaluate the imaging characteristics and healing following application of an absorbable biocompatible hydrogel into the excision cavity following breast conservation surgery. Design: Non-randomized study evaluating hydrogel application feasibility, post-operative hydrogel imaging characteristics, cavity healing following hydrogel absorption and the resulting breast cosmesis. Setting: Teaching hospital University of Essen, Germany. Patients: Seven (7) patients underwent unilateral or bilateral breast conservation surgery to remove cancerous or benign tumors. Interventions: All patients received hydrogel application following primary tumor excision. Imaging performed in the first postoperative week included ultrasound, MRI and CT. Breast cosmesis scores were obtained at one and three months following surgery. Measurements and Main Results: While preliminary, a relationship between percent cavity filling and drainage was observed, with 30% or more cavity filling resulting in decreased drainage. Additionally, the hydrogel was readily visible under ultrasound, MRI and CT imaging modalities. Finally, patients were satisfied and surgeons felt that patient cosmesis was improved relative to their prior experience. Conclusion: Initial data suggest that hydrogel filling may reduce excision cavity drainage, which may reduce seroma or hematoma formation. Additionally, these gels may improve cavity visibility and stability, furthering the use of partial breast irradiation. Finally, while more studies are required, these materials may have a role in improving long term patient cosmesis.展开更多
Introduction: Seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound ...Introduction: Seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound dehiscence. Seroma management can be difficult and frustrating for both the patient and surgeon. Numerous methods to reduce post-mastectomy seroma formation have been tried with no consistent success. Methods: Sixty patients were prepared for modified radical mastectomy. Of those, the study group contains 30 patients and the control group contains 30 patients. Study group had axillary space obliteration while the other had the conventional procedure;total drain outputs were recorded daily for all patients prior to drain removal. The drains were removed when the daily drainage was less than 30 ml. Results: This study contains 60 patients, and the study group contains 30 patients, and the control group contains 30 patients. Age, tumor size, No. of positive lymph nodes were of no significant differences to be more concise on the effect of axillary space obliteration. The mean of day of drain removal in the control group was 13.2 ± 1.0 days (9 - 18 days) with a mean of total drain output of (4700 ± 90.3 ml) (3722 - 4930) while the mean in the study group of day of drain removal was 7.1 ± 1.3 days (6 - 12) with a mean of total drain output of 1530 ± 422 ml (range 600 - 2100 ml) p < 0.001. Conclusion: Obliteration of axillary space is a valuable procedure that significantly decreases seroma after mastectomy and axillary dissection.展开更多
Background:Use of internal filling ports in tissue expander–based reconstructions are advantageous because of easier self-care,lower infection rates,and fewer instances of capsule formation.The appearance of peripros...Background:Use of internal filling ports in tissue expander–based reconstructions are advantageous because of easier self-care,lower infection rates,and fewer instances of capsule formation.The appearance of periprosthetic fluid accumulation after internal-port tissue expander implantation is a common complication that warrants treatment.In this study,we introduced a noninvasive method using fine-needle aspiration(FNA)to remove fluids accumulated after implantation of a remote internal-port tissue expander.Methods:In this study,245 patients who underwent implantation of remote internal-port tissue expanders in our hospital from July 1,2012,to July 1,2019,were included and divided into two groups.In the control group,patients underwent tissue expander implantation before July 1,2016,and large quantities of fluids were removed with surgical aspiration procedures in most cases.In the FNA group,the patients underwent implantation after July 1,2016,and large quantities of fluids were removed first with the FNA procedure.Patients’demographic data,indications for FNA application,and related complications were collected and analyzed.Results:Overall,395 expanders were placed in 245 patients.Postoperative management was similar in both groups.Fluids were managed with 23 expanders in the control group and with 31 expanders in the FNA group.There was no difference in the fluid aspiration rate between the two groups.The surgical aspiration rate was 11.1%(23/208)in the control group.The success rate of FNA was 90.3%(28/31).In the FNA group,the surgical aspiration rate was 1.6%(3/187),which was significantly lower than that in the control group.There were no significant differences in complications between the two groups.Conclusion:FNA can be used for periprosthetic fluid removal after the implantation of a remote internal-port tissue expander in most cases.This method is more convenient and safer than surgical aspiration for the postoperative management of internal-port tissue expander implantation.展开更多
Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was...Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment. Methods： A retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time （i.e. the size of the seroma did not increase） were observed without treatment. The measured outcomes included the incidence ofseromas, the volume and duration of postoperative wound drainage, and other demographic characteristics. Results： Twenty-four patients （53.3%） developed a seroma at the donor site. Of these, 21 patients （87.5%） did not require treatment, and the seroma resolved over time. The mean duration of a sustained serol-na was 6.8 ± 1.4 weeks （range： 4-9 weeks）. Conclusions： This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatnlent.展开更多
Background Postoperative radiotherapy after conservative surgery for patients with breast cancer usually includes focal over-irradiation(boost)to the surgical bed(SB).Irradiation planning using computed tomography(CT)...Background Postoperative radiotherapy after conservative surgery for patients with breast cancer usually includes focal over-irradiation(boost)to the surgical bed(SB).Irradiation planning using computed tomography(CT)is difficult in many cases because of insufficient intrinsic soft tissue contrast.To ensure appropriate radiation to the tumor,large boost volumes are delineated,resulting in a higher dose to the normal tissue.Magnetic resonance imaging(MRI)provides superior soft tissue contrast than CT and can better differentiate between normal tissue and the SB.However,for SB delineation CT images alone remain the pathway followed in patients undergoing breast irradiation.This study aimed to evaluate the potential advantages in boost dosimetry by using MRI and CT as pre-treatment imaging.Methods Eighteen boost volumes were drawn on CT and MRI and elastically co-registered using commercial image registration software.The radiotherapy treatment plan was optimized using the CT volumes as the baseline.The dose distributions of the target volumes on CT and MRI were compared using dose-volume histogram cutoff points.Results The radiation volumes to the SB varied considerably between CT and MRI(conformity index between 0.24 and 0.67).The differences between the MRI and CT boost doses in terms of the volume receiving 98%of the prescribed dose(V98%)varied between 10%and 30%.Smaller differences in the V98%were observed when the boost volumes were delineated using MRI.Conclusion Using MRI to delineate the volume of the SB may increase the accuracy of boost dosimetry.展开更多
Hernia repair is the most common general surgical procedure performed in the United States;however,historically,there has been a surprising lack of consensus regarding hernia complications and their management.The dev...Hernia repair is the most common general surgical procedure performed in the United States;however,historically,there has been a surprising lack of consensus regarding hernia complications and their management.The development of international,prospectively-collected databases such as the Americas Hernia Society Quality Collaborative has introduced a new era of evidence-based practice around the prevention and management of these complications.This review seeks to equip surgeons with evidence-based techniques for prevention and management of the most common complications of open ventral hernia repair.展开更多
Aim:Auricular seroma is a cystic swelling with a collection of serous fluid between the perichondrium and cartilage.The successful treatment of auricular seromas remains a challenge because this disease has a high pro...Aim:Auricular seroma is a cystic swelling with a collection of serous fluid between the perichondrium and cartilage.The successful treatment of auricular seromas remains a challenge because this disease has a high propensity for recurrence.Methods:A total of 20 patients with auricular seromas were treated by remodeling a corrugated rubber drain.Results:All patients tolerated the procedure well.No patient had any collection of fluid after the removal of the splint.No patient experienced pain,fever,or edema after treatment.The seroma disappeared without disfigurement.There were no recurrences on further follow-up.Conclusion:Aspiration and splint application by remodeling a corrugated rubber drain provides very simple,minimally invasive,and effective management of seromas.It is a cost-effective treatment that prevents patient distress from fluid recollection and social embarrassment.展开更多
Aim:Autoinflation of the breast following mammoplasty using breast implants can be divided into early and late.Early autoinflation of the breast is commonly due to haematoma.Late autoinflation of the breast is an unco...Aim:Autoinflation of the breast following mammoplasty using breast implants can be divided into early and late.Early autoinflation of the breast is commonly due to haematoma.Late autoinflation of the breast is an uncommon complication and its true incidence is not known due to the paucity of its reporting.Methods:A retrospective review was performed of the available charts for 2,772 consecutive bilateral primary,secondary augmentation mammoplasties and mastopexy with augmentation mammoplasties by the author between April 1999 and February 2015.Each breast was taken as a single unit for a total of 5,544 breasts.Results:There were 2,334 patients in primary augmentation mammoplasty,258 in secondary augmentation mammoplasty and 180 in simultaneous mastopexy with augmentation mammoplasty.There were three autoinflation of breasts due to late seromas identified in the series.All patients presented at least six months following augmentation mammoplasty and all had textured implants place in muscle splitting submuscular pocket.There was no late seroma noted in secondary augmentation mammoplasty or simultaneous mastopexy with augmentation mammoplasty.All patients were treated conservatively without a recurrence.Conclusion:Late autoinflation of the breast due to seroma is an uncommon clinical complication and can be treated conservatively in the first instance.展开更多
文摘Background Seroma formation is one of the most common complications after breast cancer surgery. Various risk factors have been evaluated for their associations with the development of seromas in Western populations. However, similar data are not available in Chinese series. Therefore, we sought to investigate the potential risk factors for Chinese breast cancer patients. Methods A prospective study of female breast cancer patients undergoing surgery was carried out in Cancer Hospital of Fudan Unversity, Shanghai, China. Univariate analyses were performed by chi-square test or Student＇s t test or Mann-Whitney test and multivariate analyses by stepwise Logistic regression. The logistic model included age （years）, total serum protein concentration （g/L）, drainage volume on postoperative day 3 （POD 3; ml） and time to daily drainage volume not more than 30 ml （TTV30; days）. Results A total of 158 patients with breast cancer were studied. The mean age at diagnosis was （52.14±10.77） years （range 25-92）. During the follow-up period, 24 （15.2%） patients developed seromas. Calculated as continuous variables in the stepwise Logistic regression, age （0R=1.090, 95% CI 1.028-1.155, P=0.004）, total serum protein concentration （OR=0.886, 95% Cl 0.791-0.992, P=0.036）, drainage volume on POD3 （OR=1.013, 95% Cl 1.002-1.023, P=0.017） and TTV30 （OR=1.273, 95% CI 1.039-1.561, P=0.020） were independent risk factors for seroma formation. Additionally, significant difference in daily drainage volume was substantiated in the analysis by seroma formation （P=0.034） rather than by type of surgery （P=0.713）. Conclusions Although the pathogenesis of seroma remains controversial, such risk factors as age, nutritional status, drainage volume on POD3 and TTV30 should be considered for prediction and prevention of seroma formation in Chinese breast cancer patients.
文摘Background:Postoperative complications,particularly those involving lymphatic drainage,remain a significantchallenge for patients undergoing axillary lymphadenectomy(ALND)as part of breast cancer surgery.Thesecomplications can delay the initiation of adjuvant therapies,increase healthcare costs,and negatively affectpatients’quality of life.This study evaluated the use of a latex-based tissue adhesive(LTA)as an intraoperativestrategy to prevent seroma formation and prolonged lymphorrhea following axillary dissection.Methods:In this prospective study,65 female patients diagnosed with stage Ⅱb-Ⅲ breast cancer and clinicallyconfirmed axillary lymph node involvement were enrolled.Participants were divided into two groups.The studygroup(n=33)received an intraoperative application of LTA without drainage,while the control group(n=32)underwent standard ALND with placement of a silicone vacuum drain.Postoperative outcomes assessed includedlymphatic drainage volume,number of aspirations,duration of lymphorrhea,length of hospital stay,and incidence of complications.Results:Use of the LTA significantly reduced both the volume and duration of postoperative lymphorrhea.Bypostoperative day 10,the average wound exudate volume in the LTA group was 8.2±3.3 mL,compared to54.1±3.9 mL in the control group—an 84.8%reduction.The LTA group also experienced shorter hospital staysand fewer cases of postoperative seroma requiring intervention.Conclusion:LTA appears to be a safe,effective,and practical intraoperative technique for preventing lymphaticcomplications after ALND.Its use may reduce dependence on drainage systems,shorten hospitalization,andsupport earlier initiation of adjuvant therapies,ultimately improving surgical outcomes and patient recovery.
基金financial support from the National Health and Medical Research Council(NHMRC),Australia(APP1061791)an NHMRC Career Development Fellowship(APP1087114)
文摘Studies have shown that a combined application of several ion channel inhibitors immediately after central nervous system injury can inhibit secondary degeneration. However, for clinical use, it is necessary to determine how long after injury the combined treatment of several ion channel inhibitors can be delayed and efficacy maintained. In this study, we delivered Ca^2＋ entry-inhibiting P2X7 receptor antagonist oxidized-ATP and AMPA receptor antagonist YM872 to the optic nerve injury site via an iPRECIO-@ pump immediately, 6 hours, 24 hours and 7 days after partial optic nerve transection surgery. In addition, all of the ion channel inhibitor treated rats were administered with calcium channel antagonist lomerizine hydrochloride. It is important to note that as a result of implantation of the particular pumps required for programmable delivery of therapeutics directly to the injury site, seromas occurred in a significant proportion of animals, indicating infection around the pumps in these animals. Improvements in visual function were observed only when treatment was delayed by 6 hours; phosphorylated Tau was reduced when treatment was delayed by 24 hours or 7 days. Improvements in structure of node/paranode of Ranvier and reductions in oxidative stress indicators were also only observed when treatment was delayed for 6 hours, 24 hours, or 7 days. Benefits of ion channel inhibitors were only observed with time-delayed treatment, suggesting that delayed therapy of Ca^2＋ ion channel inhibitors produces better neuroprotective effects on secondary degeneration, at least in the presence of seromas.
文摘Introduction: A seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound breakdown. Infection developing within seroma increases morbidity and often results in the need for re-admission, re-imaging, drainage and antibiotic usage. Numerous methods to reduce post-mastectomy seroma formation have been tried with no consistent success. Methods: 24 consecutive patients undergoing mastectomy and axillary clearance were recruited before and after a departmental change in practice. At the point of skin closure, patients either underwent “axillary exclusion” or not. Total drain outputs were recorded by community district nursing staff for all patients. At the first post-operative visit, the presence and severity of seroma was recorded. Results: 24 patients were included (study group 14, control group 10). Age, size of tumour, and number of positive lymph nodes and laterality were comparable between groups. Mean drain output for the entire group was 471 ml (3 - 1030 ml) over 5.21 days. The control group had a drain output of 763.5 ml (95%CI 674.2 - 852.8) while the study group had a mean drainage of 262.2 ml (95%CI 161.9 - 362.5), a reduction of over 65%, p < 0.001. 15 (62.5%) out of 24 patients developed seroma. 42.9% of the study group and 90% of the control group developed seroma, p < 0.01. Conclusion: Seromas are a common complication following mastectomy and axillary clearance. Our technique of axillary exclusion has resulted in significantly reduced drainage volumes and fewer seromas.
基金Supported by Grants-in-Aid from JSPS KAKENHI,No.JP 21K10715 and No.JP 20K10404Northern Advancement Center for Science&Technology,No.T-2-2+9 种基金the Yasuda Medical Foundation,No.31010316the Okawa Foundation for Information and Telecommunications,No.41111042Taiju Life Social Welfare Foundation,No.50811490Japan Keirin Autorace Foundation,No.2023M-378Project Mirai Cancer Research Grants,No.31010269Takahashi Industrial and Economic Research Foundation,No.50411278Sapporo Doto Hospital,No.50311211Noguchi Hospital,No.40310551Doki-kai Tomakomai Hospital,No.40710739Tsuchida Hospital,No.50811478.
文摘BACKGROUND Surgical site infections(SSIs)increase mortality,hospital stays,additional medical treatment,and medical costs.Subcutaneous drains prevent SSIs in gynecological and breast surgeries;however,their clinical impact in abdominal surgery remains unclear.AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis.METHODS The database search used PubMed,MEDLINE,and the Cochrane Library.The following inclusion criteria were set for the systematic review:(1)Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains;and(2)Studies that described clinical outcomes,such as SSIs,seroma formation,the length of hospital stays,and mortality.RESULTS Eight studies were included in this meta-analysis.The rate of total SSIs was significantly lower in the drained group(54/771,7.0%)than in the control group(89/759,11.7%),particularly in gastrointestinal surgery.Furthermore,the rate of superficial SSIs was slightly lower in the drained group(31/517,6.0%)than in the control group(49/521,9.4%).No significant differences were observed in seroma formation between the groups.Hospital stays were shorter in the drained group than in the control group.CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation.The timing of drain removal needs to be reconsidered in future studies.
文摘Background: Radical lymph node dissection (RLND) is the treatment of choice in stage III melanoma patients. Over half of the observed complications were related to post-operative serum collection affecting wound healing. The aim of this study was to evaluate the use of the LigaSureTM Small Jaw (LSJ) on postoperative drainage fluid volume and drainage permanence in patients undergoing RLND. Study design: This was a prospective single-center study in which consecutive melanoma patients underwent nodal dissection using the LSJ. Daily drainage volume and duration of drainage were recorded in post-operative course on days 3, 10 or 15 and day 20. Results: A total of 70 patients were included. Mean postoperative drainage volume was lower. Around two-thirds of patients had a drainage fluid volume of less than 50cc at 10 days. Mean time to drainage removal was 14.5 days. Conclusions: This is the first report of nodal dissection in patients with cutaneous melanoma using an electrothermal bipolar vessel sealing system. The technique was feasible, safe, and effective and resulted in reduced drainage fluid volume and drainage permanence.
文摘Background and Purpose: Seroma formation is a common complication following a mastectomy and axillary surgery. Decreasing the dead space is believed to decrease seroma formation. The aim of this study is to compare the incidence of seroma formation with the use of Glubran-2 versus normal saline during the wound closure in participants undergoing mastectomy with or without axillary dissection. Methods: This multicentre, prospective, double-blinded, randomised controlled trial, enrolled women 18 years of age or older with breast cancer, who were underwent total or partial mastectomy, with or without axillary dissection. Participants were randomised to Glubran-2 or Saline arm. The primary outcome was the volume and duration of wound seroma. Secondary outcome was post-operative wound infection. Results: A total of 76 women were randomised and there was no loss to follow-up or mortality. The total seroma volume was higher in the Glubran-2 arm. The duration of seroma was higher in the mastectomy and axillary dissection group in the Glubran-2 arm (P = 0.69). Elderly and participants with higher BMI had a higher volume of seroma. Post-operative infection rate was higher in the Glubran-2 arm (13.2% vs. 5.6%;P = 0.26). There was no statistically significant difference between the groups. Conclusion: Our study did not show any benefit with the use of Glubran-2 in mastectomy and axillary surgery in reducing the risk of seroma formation. In elderly and obese participants the use of Glubran-2 showed an increase in seroma formation and post-operative wound infection.
文摘Study Objective: To evaluate the imaging characteristics and healing following application of an absorbable biocompatible hydrogel into the excision cavity following breast conservation surgery. Design: Non-randomized study evaluating hydrogel application feasibility, post-operative hydrogel imaging characteristics, cavity healing following hydrogel absorption and the resulting breast cosmesis. Setting: Teaching hospital University of Essen, Germany. Patients: Seven (7) patients underwent unilateral or bilateral breast conservation surgery to remove cancerous or benign tumors. Interventions: All patients received hydrogel application following primary tumor excision. Imaging performed in the first postoperative week included ultrasound, MRI and CT. Breast cosmesis scores were obtained at one and three months following surgery. Measurements and Main Results: While preliminary, a relationship between percent cavity filling and drainage was observed, with 30% or more cavity filling resulting in decreased drainage. Additionally, the hydrogel was readily visible under ultrasound, MRI and CT imaging modalities. Finally, patients were satisfied and surgeons felt that patient cosmesis was improved relative to their prior experience. Conclusion: Initial data suggest that hydrogel filling may reduce excision cavity drainage, which may reduce seroma or hematoma formation. Additionally, these gels may improve cavity visibility and stability, furthering the use of partial breast irradiation. Finally, while more studies are required, these materials may have a role in improving long term patient cosmesis.
文摘Introduction: Seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound dehiscence. Seroma management can be difficult and frustrating for both the patient and surgeon. Numerous methods to reduce post-mastectomy seroma formation have been tried with no consistent success. Methods: Sixty patients were prepared for modified radical mastectomy. Of those, the study group contains 30 patients and the control group contains 30 patients. Study group had axillary space obliteration while the other had the conventional procedure;total drain outputs were recorded daily for all patients prior to drain removal. The drains were removed when the daily drainage was less than 30 ml. Results: This study contains 60 patients, and the study group contains 30 patients, and the control group contains 30 patients. Age, tumor size, No. of positive lymph nodes were of no significant differences to be more concise on the effect of axillary space obliteration. The mean of day of drain removal in the control group was 13.2 ± 1.0 days (9 - 18 days) with a mean of total drain output of (4700 ± 90.3 ml) (3722 - 4930) while the mean in the study group of day of drain removal was 7.1 ± 1.3 days (6 - 12) with a mean of total drain output of 1530 ± 422 ml (range 600 - 2100 ml) p < 0.001. Conclusion: Obliteration of axillary space is a valuable procedure that significantly decreases seroma after mastectomy and axillary dissection.
基金the National Natural Science Foundation of China(81501668)Two-hundred Talent(20161424),Shanghai“Rising Stars of Medical Talent”Youth Development Program(Outstanding Youth Medical Talents),and Shanghai Jiao Tong University“Chenxing”Youth Development Program(Associate Professor Type A).
文摘Background:Use of internal filling ports in tissue expander–based reconstructions are advantageous because of easier self-care,lower infection rates,and fewer instances of capsule formation.The appearance of periprosthetic fluid accumulation after internal-port tissue expander implantation is a common complication that warrants treatment.In this study,we introduced a noninvasive method using fine-needle aspiration(FNA)to remove fluids accumulated after implantation of a remote internal-port tissue expander.Methods:In this study,245 patients who underwent implantation of remote internal-port tissue expanders in our hospital from July 1,2012,to July 1,2019,were included and divided into two groups.In the control group,patients underwent tissue expander implantation before July 1,2016,and large quantities of fluids were removed with surgical aspiration procedures in most cases.In the FNA group,the patients underwent implantation after July 1,2016,and large quantities of fluids were removed first with the FNA procedure.Patients’demographic data,indications for FNA application,and related complications were collected and analyzed.Results:Overall,395 expanders were placed in 245 patients.Postoperative management was similar in both groups.Fluids were managed with 23 expanders in the control group and with 31 expanders in the FNA group.There was no difference in the fluid aspiration rate between the two groups.The surgical aspiration rate was 11.1%(23/208)in the control group.The success rate of FNA was 90.3%(28/31).In the FNA group,the surgical aspiration rate was 1.6%(3/187),which was significantly lower than that in the control group.There were no significant differences in complications between the two groups.Conclusion:FNA can be used for periprosthetic fluid removal after the implantation of a remote internal-port tissue expander in most cases.This method is more convenient and safer than surgical aspiration for the postoperative management of internal-port tissue expander implantation.
文摘Background： The latissimus dorsi （LD） flap procedure remains a popular and useful breast reconstrtlction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment. Methods： A retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time （i.e. the size of the seroma did not increase） were observed without treatment. The measured outcomes included the incidence ofseromas, the volume and duration of postoperative wound drainage, and other demographic characteristics. Results： Twenty-four patients （53.3%） developed a seroma at the donor site. Of these, 21 patients （87.5%） did not require treatment, and the seroma resolved over time. The mean duration of a sustained serol-na was 6.8 ± 1.4 weeks （range： 4-9 weeks）. Conclusions： This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatnlent.
文摘Background Postoperative radiotherapy after conservative surgery for patients with breast cancer usually includes focal over-irradiation(boost)to the surgical bed(SB).Irradiation planning using computed tomography(CT)is difficult in many cases because of insufficient intrinsic soft tissue contrast.To ensure appropriate radiation to the tumor,large boost volumes are delineated,resulting in a higher dose to the normal tissue.Magnetic resonance imaging(MRI)provides superior soft tissue contrast than CT and can better differentiate between normal tissue and the SB.However,for SB delineation CT images alone remain the pathway followed in patients undergoing breast irradiation.This study aimed to evaluate the potential advantages in boost dosimetry by using MRI and CT as pre-treatment imaging.Methods Eighteen boost volumes were drawn on CT and MRI and elastically co-registered using commercial image registration software.The radiotherapy treatment plan was optimized using the CT volumes as the baseline.The dose distributions of the target volumes on CT and MRI were compared using dose-volume histogram cutoff points.Results The radiation volumes to the SB varied considerably between CT and MRI(conformity index between 0.24 and 0.67).The differences between the MRI and CT boost doses in terms of the volume receiving 98%of the prescribed dose(V98%)varied between 10%and 30%.Smaller differences in the V98%were observed when the boost volumes were delineated using MRI.Conclusion Using MRI to delineate the volume of the SB may increase the accuracy of boost dosimetry.
文摘Hernia repair is the most common general surgical procedure performed in the United States;however,historically,there has been a surprising lack of consensus regarding hernia complications and their management.The development of international,prospectively-collected databases such as the Americas Hernia Society Quality Collaborative has introduced a new era of evidence-based practice around the prevention and management of these complications.This review seeks to equip surgeons with evidence-based techniques for prevention and management of the most common complications of open ventral hernia repair.
文摘Aim:Auricular seroma is a cystic swelling with a collection of serous fluid between the perichondrium and cartilage.The successful treatment of auricular seromas remains a challenge because this disease has a high propensity for recurrence.Methods:A total of 20 patients with auricular seromas were treated by remodeling a corrugated rubber drain.Results:All patients tolerated the procedure well.No patient had any collection of fluid after the removal of the splint.No patient experienced pain,fever,or edema after treatment.The seroma disappeared without disfigurement.There were no recurrences on further follow-up.Conclusion:Aspiration and splint application by remodeling a corrugated rubber drain provides very simple,minimally invasive,and effective management of seromas.It is a cost-effective treatment that prevents patient distress from fluid recollection and social embarrassment.
文摘Aim:Autoinflation of the breast following mammoplasty using breast implants can be divided into early and late.Early autoinflation of the breast is commonly due to haematoma.Late autoinflation of the breast is an uncommon complication and its true incidence is not known due to the paucity of its reporting.Methods:A retrospective review was performed of the available charts for 2,772 consecutive bilateral primary,secondary augmentation mammoplasties and mastopexy with augmentation mammoplasties by the author between April 1999 and February 2015.Each breast was taken as a single unit for a total of 5,544 breasts.Results:There were 2,334 patients in primary augmentation mammoplasty,258 in secondary augmentation mammoplasty and 180 in simultaneous mastopexy with augmentation mammoplasty.There were three autoinflation of breasts due to late seromas identified in the series.All patients presented at least six months following augmentation mammoplasty and all had textured implants place in muscle splitting submuscular pocket.There was no late seroma noted in secondary augmentation mammoplasty or simultaneous mastopexy with augmentation mammoplasty.All patients were treated conservatively without a recurrence.Conclusion:Late autoinflation of the breast due to seroma is an uncommon clinical complication and can be treated conservatively in the first instance.
