RESUMEN
BACKGROUND: An important complication following mastectomy is seroma formation. Quilting, in which skin flaps are sutured to the underlying muscle, is reported to reduce seroma incidence, but might induce pain and impair shoulder function. Main objective is to compare quilting with conventional wound closure, regarding seroma incidence, health care consumption, and patient discomfort. METHODS: In a combined prospective and retrospective study, 254 patients undergoing mastectomy and/or axillary lymph node dissection (ALND) were included. Patients received quilting sutures or conventional closure. Primary outcome was clinical significant seroma (CSS). In prospectively included patients shoulder function and analgesic use was observed. RESULTS: CSS incidence was 12.9% in the quilted versus 62.3% in the nonquilted cohort (p < 0.001). Surgical site infections were reported significantly less in the quilted cohort. Duration of hospital stay was shorter and outpatient clinic visits were less in the quilted cohort. Surgical procedure required 10 additional minutes for quilting. No significant differences were observed in postoperative shoulder function and analgesic use. CONCLUSION: Quilting following mastectomy reduces CSS incidence. Quilting requires 10 additional minutes during surgery. It facilitates day treatment and results in less additional outpatient clinic visits culminating in reduced health care consumption. Shoulder function and pain are not affected by quilting.
Asunto(s)
Neoplasias de la Mama/cirugía , Mastectomía/efectos adversos , Comodidad del Paciente , Complicaciones Posoperatorias/prevención & control , Seroma/prevención & control , Técnicas de Sutura , Anciano , Atención Ambulatoria/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Femenino , Humanos , Incidencia , Tiempo de Internación , Escisión del Ganglio Linfático/efectos adversos , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Estudios Retrospectivos , Seroma/epidemiología , Colgajos Quirúrgicos , Resultado del TratamientoRESUMEN
BACKGROUND: Quilting, a technique in which skin flaps are sutured to the underlying muscle, reduces seroma after mastectomy and/or axillary lymph node dissection. The aim of this study was to assess the effect of different quilting techniques on the formation of clinically significant seroma. METHODS: This was a retrospective study including patients undergoing mastectomy and/or axillary lymph node dissection. Four breast surgeons applied the quilting technique based on their own discretion. Technique 1 was performed using Stratafix in 5-7 rows placed at 2-3â cm distance. Technique 2 was performed using Vicryl 2-0 in 4-8 rows placed at 1.5-2â cm distance. Technique 3 was performed using Vicryl 0/1 in 3 rows placed at 3-4â cm distance. Technique 4 was performed using Vicryl 0 in 4-5 rows placed at 1.5â cm distance. The primary outcome was clinically significant seroma. RESULTS: A total of 445 patients were included. Clinically significant seroma incidence was 4.1 per cent (six of 147) for technique 1, which was significantly lower than that for the other techniques (25.0 per cent (29 of 116), 29.4 per cent (32 of 109), and 33 per cent (24 of 73) for techniques 2, 3, and 4 (P < 0.001) respectively). The duration of surgery was not significantly longer for technique 1 compared with the other three techniques. The length of hospital stay, number of additional visits to the outpatient clinic, and reoperations did not differ significantly between the four techniques. CONCLUSION: Quilting using Stratafix and placing 5-7 rows with 2-3â cm distance between the stitches associates with low clinically significant seroma incidence without adverse effects.