Flap fixation reduces seroma in patients undergoing mastectomy: a significant implication for clinical practice

BACKGROUND: Seroma formation is a common complication following mastectomy for invasive breast cancer. Mastectomy flap fixation is achieved by reducing dead space volume using interrupted subcutaneous sutures. METHODS: All patients undergoing mastectomy due to invasive breast cancer or ductal carcinoma in situ (DCIS) were eligible for inclusion. From May 2012 to March 2013, all patients undergoing mastectomy in two hospitals were treated using flap fixation. The skin flaps were sutured on to the pectoral muscle using polyfilament absorbable sutures. The data was retrospectively analysed and compared to a historical control group that was not treated using flap fixation (May 2011 to March 2012). RESULTS: One hundred and eighty patients were included: 92 in the flap fixation group (FF) and 88 in the historical control group (HC). A total of 33/92 (35.9 %) patients developed seroma in the group that underwent flap fixation; 52/88 (59.1 %) patients developed seroma in the HC group (p = 0.002). Seroma aspiration was performed in 14/92 (15.2 %) patients in the FF group as opposed to 38/88 (43.2 %) patients in the HC group (p < 0.001). CONCLUSIONS: Flap fixation is an effective surgical technique in reducing dead space and therefore seroma formation and seroma aspirations in patients undergoing mastectomy for invasive breast cancer or DCIS

Reducing seroma formation and its sequelae after mastectomy by closure of the dead space:The interim analysis of a multi-center, double-blind randomized controlled trial (SAM trial)

Objective: The main objective of this double-blind randomized controlled trial (RCT) was to assess seroma formation and its sequelae in patients undergoing mastectomy. Patients were randomized into one of three groups in which different wound closure techniques were applied: 1) conventional wound closure without flap fixation (CON) 2) flap fixation using sutures (FF-S) and 3) flap fixation using an adhesive tissue glue (FF-G). Background: Seroma formation is still a bothersome complication after mastectomy. Flap fixation seems promising in reducing seroma formation. Various flap fixation techniques remain to be analyzed, including long-term outcome measures. Methods: This trial was conducted in three different hospitals between June 2014 and November 2016. Patients were allocated to one of three groups. The primary outcome was the number of seroma needle aspirations. Secondary outcomes were (surgical site) infections, number of outpatient clinic visits, shoulder function, postoperative pain, patient-reported cosmesis and skin dimpling. Results: A total of 187 patients were randomly assigned to CON (n = 61), FF-S (n = 64) and FF-G (n = 62). The number of seroma aspirations was significantly higher in CON when compared to both flap fixation groups (p = 0.032), with no difference between FF-S and FF-G. Secondary outcomes showed no statistical differences between all groups. The higher number of outpatient clinic visits in CON was considered to be of clinical importance (CON = 27 (44.3%), FF-S = 19 (30.6%) and FF-G = 21 (34.4%)). Conclusions: Mastectomy followed by flap fixation with either sutures or adhesive tissue glue reduces the number of seroma aspirations when compared to simple wound closure. (C) 2019 Elsevier Ltd. All rights reserved

Densities in the left innominate vein after removal of an implantable venous device: a case report

Abstract Introduction Pericatheter calcifications are unusual and rare after removal of indwelling central venous catheters with few reports in the literature. We present a case of a woman with calcifications in her left innominate vein after removal of an implantable venous device. Case presentation A venous access port was surgically placed for intravenous chemotherapy in a 19-year-old Caucasian woman who had been diagnosed with acute lymphoblastic leukemia. She developed a fever three and a half years after placement, and the venous access port was removed as it was seen as the only focus for her fever. In the year following its removal, a computed tomography scan was ordered due to a clinical suspicion of deep venous thrombosis of her left arm. The computed tomography scan revealed a hyperdense structure in the left innominate vein with thrombosis. It was concluded that this was a foreign body, a retained catheter fragment after removal of the catheter. After three-dimensional reconstructions were performed, it was determined that these hyperdense structures were calcifications in the left innominate vein that resembled a foreign body. Conclusions Differentiating between intravenous thrombotic calcification and a retained catheter tip after removal can be challenging, even with modern day diagnostic tools. Care should be taken to document the length of the catheter upon placement and upon removal. In this manner, unnecessary surgical exploration can be avoided. We would like to highlight the importance of these diagnostic considerations for radiologists and oncologists.</p

Sentinel lymph node mapping with superparamagnetic iron oxide for melanoma:a pilot study in healthy participants to establish an optimal MRI workflow protocol

BACKGROUND: Current pre-operative Sentinel Lymph Node (SLN) mapping using dual tracing is associated with drawbacks (radiation exposure, logistic challenges). Superparamagnetic iron oxide (SPIO) is a non-inferior alternative for SLN mapping in breast cancer patients. Limited research has been performed on SPIO use and pre-operative MRI in melanoma patients to identify SLNs. METHODS: Healthy participants underwent MRI-scanning pre- and post SPIO-injection during 20 min. Workflow protocols varied in dosage, massage duration, route of administration and injection sites. The first lymph node showing a susceptibility artefact caused by SPIO accumulation was considered as SLN. RESULTS: Artefacts were identified in 5/6 participants. Two participants received a 0.5 ml subcutaneous injection and 30-s massage, of which one showed an artefact after one hour. Four participants received a 1.0 ml intracutaneous injection and two-minute massage, leading to artefacts in all participants. All SLNs were observed within five minutes, except after lower limb injection (30 min). CONCLUSION: SPIO and pre-operative MRI-scanning seems to be a promising alternative for SLN visualization in melanoma patients. An intracutaneous injection of 1.0 ml SPIO tracer, followed by a two-minute massage seems to be the most effective technique, simplifying the pre-operative pathway. Result will be used in a larger prospective study with melanoma patients. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05054062) - September 9, 2021