Outcomes in Subfascial Versus Subglandular Planes in Breast Augmentation: A Systematic Review and Meta-analysis.

Breast augmentation is the most commonly performed aesthetic surgery procedure in women worldwide. The use of the subfascial plane has been suggested to decrease the incidence of capsular contracture compared with the subglandular plane, while simultaneously avoiding the complication of animation deformity in the subpectoral plane. The aim of this systematic review and meta-analysis was to compare the adverse outcomes of subfascial vs subglandular planes in breast augmentation. This review was registered a priori on OSF (https://osf.io/pm92e/). A search from inception to June 2023 was performed on MEDLINE, Embase, and CENTRAL. A hand search was also performed. All randomized and comparative cohort studies that assessed the use of the subfascial plane for breast augmentation were included. Outcomes evaluated included the incidences of seroma, hematoma, infection, rippling, capsular contracture, and revision surgery. Ten studies were included in this systematic review. Three randomized controlled trials and 7 comparative cohort studies were used for quantitative synthesis. There was a significant difference favoring subfascial compared with subglandular planes in the incidence of hematoma, rippling, and capsular contracture. All included studies had a high risk of bias. The current evidence suggests that the subfascial plane for breast augmentation decreases the risk of capsular contracture, hematoma, and rippling compared with the subglandular plane. Further randomized evidence with high methodological rigor is still required to validate these findings.

Reducing the incidence of problematic seroma formation and skin necrosis post-lymphadenectomy: Triple action of topical tranexamic acid, negative pressure wound therapy, and prolonged drainage.

BACKGROUND: Axillary and inguinal lymph node dissections are commonly associated with complications that often require additional interventions. METHODS: Patients who underwent axillary or inguinal lymphadenectomy via standard procedures were compared to an intervention cohort of patients who underwent axillary or inguinal lymphadenectomy with the use of topical tranexamic acid (TXA) to the wound cavity, a PICO (Smith&Nephew UK) closed-incision negative pressure dressing, and discharged early with a drain in-situ. RESULTS: Seventy-six patients in the control group (mean age 65.8 years, mean BMI 28.4 kg/m2) underwent open lymphadenectomy without topical TXA and a simple dressing. Seventy-eight patients were included in the intervention group (mean age 67.1 years, mean BMI 28.5 kg/m2). Patients in the intervention group had an inpatient stay of mean 5.6 days fewer than those in the control group (CI 3.09-5.31; p < .0001), an estimated saving to the healthcare trust of £ 3046.40 (US$3723.61) per patient in "bed days." They had longer drain duration (mean 15 days vs. 8.3 days); however, they had a statistically significant lower risk of seroma formation requiring drainage (6.4% vs. 21%; p = .009), and skin necrosis (0% vs. 6.6%; p = .027). They also had a lower risk of infection (17% vs. 29%), wound dehiscence (15% vs. 25%), and readmission (7.7% vs. 14%), although they were not statistically significant. Patients in the control group were more likely to receive antibiotics as inpatients (51% vs. 7.7%; p < .00001) and on discharge (24% vs. 5%; p < .0011) than those in the intervention group. CONCLUSIONS: Topical TXA, PICO dressing, and early discharge with a drain following lymphadenectomy results in a reduced rate of complications.

Influence of Tranexamic Acid in Body Contouring Surgery: Significant Changes on Complication Rates after Abdominoplasty.

BACKGROUND: Complications after abdominoplasty remain an unsolved issue in body contouring surgery. The antifibrinolytic drug tranexamic acid (TXA) has gained increasing recognition as a valuable pharmacologic agent within plastic surgery. The aim of this study was to investigate the influence of intravenously administered TXA on complications and patient safety after abdominoplasty. METHODS: Within this retrospective single-center study, patients who underwent abdominoplasty and received intravenous TXA were selected and compared to randomly selected patients who underwent abdominoplasty without administration of TXA. The patient population was divided into two study groups (TXA vs no TXA). Demographic and surgical data as well as complications were evaluated and compared. Appropriate statistical analysis was performed. RESULTS: Fifty-seven female and 3 male patients with a median age of 38 years and a mean BMI of 25.6 ± 3.3 kg/m2 were included in the study. Except smoking history, demographic data showed no statistically significant differences between both groups. The most common complication was seroma formation (n = 16; 23.9%), and its occurrence was statistically significantly lower in the TXA group (p = 0.023). Furthermore, postoperative seroma aspiration was performed in statistically significant lower numbers in the TXA group (p < 0.05). No thromboembolic events or seizures were observed. DISCUSSION: The outcomes of this study showed that the intravenous administration of TXA leads to a significant reduction of seroma formation and postoperative seroma aspiration after abdominoplasty. Simultaneously, no adverse thromboembolic events were detected. Hence we would recommend administration of TXA in body contouring surgery to decrease the incidence of seroma formation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Endoscopic-assisted repair of combined ventral hernias and diastasis recti: minimizing seroma incidence by quilting.

BACKGROUND: To reduce the incidence of seromas, we have adapted the quilting procedure used in open abdominoplasty to the endoscopic-assisted repair of concomitant ventral hernia (VH) and diastasis recti (DR). The aim of this study was to describe the technique and assess its efficacy by comparing two groups of patients operated on with the same repair technique before and after introducing the quilting. METHODS: This retrospective study included data prospectively registered in the French Club Hernie database from 176 consecutive patients who underwent surgery for concomitant VH and DR via the double-layer suturing technique. Patients were categorized into two groups: Group 1 comprised 102 patients operated before introducing the quilting procedure and Group 2 comprised 74 operated after introducing the quilting. To carry out comparisons between groups, seromas were classified into two types: type A included spontaneously resorbable seromas and seromas drained by a single puncture and type B included seromas requiring two or more punctures and complicated cases requiring reoperation. RESULTS: The global percentage of seromas was 24.4%. The percentage of seromas of any type was greater in Group 1 (27.5%) than in Group 2 (20.3%). The percentage of Type B seromas was greater in Group 1 (19.6%) than in Group 2 (5.4%), when the percentage of Type A seromas was greater in Group 2 (14.9) than in Group 1 (7.9%). Differences were significant (p = 0.014). The operation duration was longer in Group 2 (83.9 min) than in Group 1 (69.9 min). Four complications requiring reoperation were observed in Group 1: three persistent seromas requiring surgical drainage under general anesthesia and one encapsulated seroma. CONCLUSION: Adapting the quilting technique to the endoscopic-assisted bilayer suturing technique for combined VH and DR repair can significantly reduce the incidence and severity of postoperative seromas.

A Systematic Review: Fibrin Glue in Drainless Rhytidoplasty.

The following questions guided the study: Can the use of fibrin glue in drainless rhytidoplasty reduce hematoma prevalence, seroma prevalence increase patient satisfaction or decrease the length of hospital in the adult population compared with standard treatment? The following inclusion and exclusion criteria apply: The procedure performed was rhytidoplasty for both groups. Participants were limited to adults who did not have any other procedure performed during the study. The intervention consisted of the use of fibrin glue without drains compared to the control group, in which drains and/or pressure dressing were applied. Databases: clinicaltrials.gov, MEDLINE, COCHRANE, mRCT, PubMed, Google Scholar, Scopus, Embase, VHL, GHL were searched on 03/25/2023 by 2 different investigators. The Cochrane Risk of Bias Tool 2.0 was used. Five studies were included with a total number of 1277 participants (2554 face sides). The cumulative hematoma rate was OR 0.47 (95% CI 0.26-0.84) in favor of using fibrin glue. Insufficient data were available to assess seroma rate, patient satisfaction, and length of hospital stay. The risk of study bias was judged to be low and moderate. The certainty for the use of fibrin sealant versus drainage is high and the importance of outcomes is rated as important in the GRADEpro GDT tool. Fibrin glue use is more beneficial comparing to drainage in patients undergoing rhytidectomy in terms of hematoma prevalence. This study was registered in PROSPERO (CRD42023421475).Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Routine closed-suction drainage reduces seromas following totally extraperitoneal (TEP) inguinal hernia repair: A meta-analysis.

BACKGROUND: The value of prophylactic closed-suction drainage in totally extraperitoneal inguinal hernia repair (TEP) is still a matter of controversy. We conducted a meta-analysis of studies examining postoperative seroma rates in patients with or without routine placement of closed-suction drainage tubes. METHODS: A systematic literature search was conducted for trials comparing the outcome of TEP with or without routine drainage placement. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The odds ratio and standardized mean differences with 95% confidence intervals were calculated. RESULTS: Four studies were identified, involving a total of 1626 cases (Drain: n = 1251, no Drain: n = 375). There was a statistically significant difference noted between the 2 groups regarding postoperative seroma formation favoring the Drain group (odds ratio = 0.12; 95% confidence intervals [0.05, 0.29]; P < .001; 4 studies; I2 = 72%). For the remaining secondary endpoints postoperative urinary retention, recurrence, mesh infection and in-hospital length of stay no statistically significant difference was noted between the 2 study groups. CONCLUSION: Current evidence suggests that patients who underwent TEP with routine closed-suction drain placement developed significantly fewer seromas without any additional morbidity or prolongation of in-hospital stay.

Complications of Aesthetic and Reconstructive Breast Implant Capsulectomy: An Analysis of 7486 Patients Using Nationwide Outcomes Data.

BACKGROUND: Despite increasing demand for breast capsular surgery to treat various benign and malignant implant-related pathologies, high-quality evidence elucidating complication profiles of capsulectomy and capsulotomy is lacking. OBJECTIVES: The aim of this study was to provide the largest-scale analysis of associated outcomes and complications using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, and to investigate clinical scenarios that may subject patients to increased risks for complications, most notably extent of capsular surgery (complete vs partial) and index indication of implantation (aesthetic vs reconstructive). METHODS: An analysis of the TOPS database from 2008 to 2019 was performed. CPT codes were used to identify complete capsulectomy and partial capsulectomy/capsulotomy cases. Breast implant exchange procedures constituted procedural controls. RESULTS: In total, 7486 patients (10,703 breasts) undergoing capsulectomy or capsulotomy were assessed. Relative to controls, capsulectomy (4.40% vs 5.79%), but not capsulotomy (4.40% vs 4.50%), demonstrated higher overall complication rates. Both capsulectomies (0.83% vs 0.23%) and capsulotomies (0.56% vs 0.23%) also had greater rates of seroma relative to controls. Subgroup analyses demonstrated that reconstructive patients, relative to aesthetic patients, experienced greater overall complications (6.76% vs 4.34%), and increased risks for seroma (1.06% vs 0.47%), dehiscence (0.46% vs 0.14%), surgical site infections (1.03% vs 0.23%), and implant loss (0.52% vs 0.23%). A detailed synthesis of 30-day outcomes, including all patient- and breast-specific complications, for both capsulectomy and capsulotomy, stratified according to all potential confounders, is presented herein. CONCLUSIONS: Surgeries on the breast capsule are safe overall, although complete capsulectomies and reconstructive patients are associated with significantly increased operative risks. The present findings will enhance patient selection, counseling, and informed consent.

Laparoscopic intraperitoneal onlay mesh (IPOM) with fascial repair (IPOM-plus) for ventral and incisional hernia: a systematic review and meta-analysis.

PURPOSE: Despite advancements in laparoscopic ventral hernia repair (LVHR) using the intraperitoneal onlay mesh technique (sIPOM), recurrence remains a common postoperative complication. The objective of this systematic review and meta-analysis is to compare the efficacy of defect closure (IPOM-plus) versus non-closure in ventral and incisional hernia repair. The aim is to determine which technique yields better outcomes in terms of reducing recurrence and complication rates. METHODS: A comprehensive literature review was conducted in the PubMed, Web of Science, Cochrane Library, Embase, and ClinicalTrials.gov databases from their inception until October 1, 2022, to identify all online English publications that compared the outcomes of laparoscopic ventral hernia repair with and without fascia closure. RESULTS: Three randomized controlled trials (RCTs) and eleven cohort studies involving 1585 patients met the inclusion criteria. The IPOM-plus technique was found to reduce the recurrence of hernias (OR = 0.51, 95% CI [0.35, 0.76], p < 0.01), seroma (OR = 0.48, 95% CI [0.32, 0.71], p < 0.01), and mesh bulging (OR = 0.08, 95% CI [0.01, 0.42], p < 0.01). Subgroup analysis revealed that body mass index (BMI) (OR = 0.43, 95% CI [0.29, 0.65], p < 0.0001), type of article (OR = 0.51, 95% CI [0.35, 0.76], p = 0.0008 < 0.01), geographical location (OR = 0.54, 95% CI [0.36, 0.82], p = 0.004 < 0.01), follow-up time (OR = 0.50, 95% CI [0.34, 0.73], p = 0.0004 < 0.01) had a significant influence on the postoperative recurrence of the IPOM-plus technique. CONCLUSION: The IPOM-plus technique has been shown to greatly reduce the occurrence of recurrence, seroma, and mesh bulging. Overall, the IPOM-plus technique is considered a safe and effective procedure. However, additional randomized controlled studies with extended follow-up periods are necessary to further evaluate the IPOM-plus technique.

Comparison of Different Acellular Dermal Matrix in Breast Reconstruction: A Skin-to-Skin Study.

BACKGROUND: Since the early 2000s, acellular dermal matrix has been a popular adjunct to prepectoral breast reconstruction to enhance outcomes. OBJECTIVES: The aim of this study was to investigate the differences in the postoperative course of 2 standard acellular dermal matrix products, AlloDerm SELECT Ready To Use and DermACELL. METHODS: A prospective, patient-blind study of patients undergoing bilateral nipple and/or skin-sparing mastectomies with either tissue expander or silicone implant insertion between 2019 and 2022 were selected for this study. The study design used patients as their own controls between 2 products randomly assigned to the left or right breast. Outcomes between the products included average time for drain removal, infection rate, seroma rate, and incorporation rates. RESULTS: The prospective clinical data of 55 patients (110 breasts) were recorded for 90 days. There were no significant differences between drain removal time, average drain output, or seroma aspiration amount. A higher percentage of seromas was recorded in the breasts with AlloDerm (30.91%) compared with breasts containing DermACELL (14.55%, P < .05), and a statistically significant difference between the incorporation rates of AlloDerm (93.4%) and DermACELL (99.8%, P < .05) was observed. CONCLUSIONS: Irrespective of patient demographic disparities, both products had a 94.55% success rate for reconstruction outcomes. AlloDerm was determined to have a higher incidence of seromas as a postoperative complication and a trend to lower incorporation.

Efficacy of Drainless Total Thyroidectomy in Intrathyroidal Lesions of Thyroid

Abstract Introduction There is difference of opinion about the placement of the drain in thyroid surgeries, and, to the best of our knowledge, the efficacy of drainless total thyroidectomy regarding various parameters of thyroid lesions has not been well-established. Objective To report our experience with drainless total thyroidectomy, and to define an appropriate patient population for its performance. Methods This is a retrospective case analysis of the patients who underwent total thyroidectomy for intrathyroidal lesions with or without central neck dissection in a tertiary referral hospital (number = 74). The patients, who had undergone total thyroidectomy without any drain insertion, were analyzed, and the relationships among various parameters of thyroid lesions were noted in relation to seroma and hematoma formation. Results Seroma formation was noted only in 5 out of 74 patents (6.75%). All of the seromas that occurred were observed in patients with thyroid lesions < 4 cm, and 4 out of 5 seromas were observed in patients with a malignant pathology. There was no statistically significant difference in seroma formation between patients younger or older than 50 years of age. The nature of the lesion, whether benign or malignant, did not affect the formation of seroma. Of interest is the fact that none of the 10 patients who had central neck dissection performed as part of their treatment developed seroma. Conclusions Drainless total thyroidectomy is safe across all age groups for patients harboring either benign or malignant thyroid pathologies. However, caution is to be observed in opting for drainless total thyroidectomy in patients with large lesions (> 5 cm)

Técnica fenol alcohol para el tratamiento de uñas encarnadas. Tiempo medio de curación y complicaciones para una muestra de entre 10-65 años / Phenol alcohol technique for treating ingrown toenails. Average healing time and complications for a sample of between 10-65 years

Introducción La matricectomía química por fenol alcohol es una técnica quirúrgica usada para el tratamiento definitivo de la uña encarnada. Objetivos: Los objetivos del estudio fueron: 1.-Cuantificar el tiempo medio de curación de los pacientes de la muestra sometidos a una matricectomía parcial del la uña por técnica fenol alcohol y 2.-Calcular la frecuencia de aparición de las principales complicaciones de este procedimiento en nuestra muestra. Métodos: Se seleccionó una muestra de 62 pacientes intervenidos de uña encarnada durante el período de tiempo comprendido entre el 1 de enero del 2007 y el 1 de enero del 2012, y se calculó el tiempo medio de curación. El siguiente paso fue la realización de unas tablas con las complicaciones que aparecieron entre los 0-60 días, y entre los 61-365 días, y se calculó la frecuencia de aparición de cada una de ellas en nuestra muestra. Resultados: Se obtuvo que el tiempo medio de curación fue de 28 días. Las complicaciones fueron escasas, siendo el seroma una de las principales complicaciones. Destacar el bajo índice de recidivas que se obtuvo del 1,61%. Conclusiones. Es una técnica muy estudiada y controvertida, que ha sufrido numerosas variaciones. La realización de la técnica tal y como la describimos en nuestro estudio nos proporciona unos resultados muy satisfactorios, con un bajo índice de complicaciones y recidivas. Por ello podemos concluir que es una técnica válida y eficaz para el tratamiento de la uña encarnada

Introduction: The phenol alcohol chemical matricectomy is a surgical technique used for the definitive treatment of ingrown toenail. Aims: The objectives of the study were: 1.-Quantify the average healing time of patients in the sample subjected to matricectomy the nail art of phenol alcohol and 2.-Calculate the frequency of major complications of this procedure in our sample. Methods: To a sample of 62 patients for undergoing ingrown toenail from January 1, 2007 to January 1, 2012, and calculated the average healing time. The next step was to hold a draw with the complications that appeared between 0-60 days, and between 61-365 days, and calculated the frequency of occurrence of each of them in our sample. Results: It was found that the average healing time was 28 days. The complications were rare, being seroma the major complication. Highlighting the low rate of recurrence of 1.61% was obtained. Conclusions: Is a technique widely studied and controversial, it has undergone many changes. The performance of the technique as we described in our study provides very satisfactory results, with a low rate of complications and recurrences. Therefore we can conclude that it is a valid and effective for the treatment of ingrown toenail

Implantes mamarios en España: resultados de encuesta a cirujanos plásticos / Breast implants in Spain: results of a survey to plastic surgeons

Introducción y Objetivo. La cirugía de implantes mamarios tiene un impacto social, científico y económico de primer orden. Recientemente se han producido algunas controversias en cuanto a la texturizacíón de los implantes y su relación con ciertas complicaciones, así como en cuanto a sus garantías. Llevamos a cabo una encuesta entre cirujanos plásticos españoles para conocer su opinión sobre ciertos aspectos relacionados con los implantes mamarios: tipos, complicaciones, garantías. Material y Método. Los cuestionarios se repartieron vía internet en un periodo de 15 días en la primera mitad del mes de noviembre del 2016 a 760 cirujanos plásticos, miembros numerarios de la Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE). Resultados. Contestaron 216. No encontramos diferencias significativas en cuanto al tipo de implante usado, siendo el implante anatómico ligeramente más frecuente. Las marcas norteamericanas Allergan(R) y Mentor(R) dominan la cuota de mercado en este segmento, tanto para prótesis anatómicas (60%) como redondas (50%). Un 30% de encuestados habían cambiado de marca recientemente. En cuanto a la garantía ofrecida por los fabricantes, la mayor parte de los cirujanos (68%) están conformes con ella, aunque también la mayoría (56.9%) piensa que debería ser vitalicia y que las pacientes están mal informadas al respecto. Los resultados también muestran una gran desconfianza del profesional frente a la objetividad de la casa fabricante cuando esta ha de evaluar el implante para determinar si la garantía es aplicable. Conclusiones. Existe un predominio de uso de prótesis anatómicas respecto a redondas entre los cirujanos plásticos españoles que contestaron la encuesta. Sin embargo, parece que algunos han cambiado su preferencia ante el miedo a problemas como doble cápsula, seromas e incluso linfoma anaplásico de células gigantes (LACG). Respecto a la garantía, se percibe como un beneficio para la paciente aunque debería durar toda su vida. La información que se tiene acerca de dichos programas se considera pobre. En general hay una gran desconfianza entre los encuestados en relación a los análisis que los propios fabricantes hacen de las prótesis rotas (AU)

Background and Objective. Breast implants surgery has a major social, scientific and economic impact. Recently there have been some controversies regarding the texture of the implants and their relation with certain complications as well as with the guarantees of the implants. A survey was carried out among Spanish plastic surgeons to know their opinion on certain aspects related to breast implants: types, complications, guarantees. Methods. The questionnaires were sent online during the first half of November 2016 to 760 surgeons, all of them members of the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE). Results. There were 216 answers. There was no significant difference in the type of implants used, with the anatomic slightly more frequent in use. American brands Allergan(R) and Mentor(R) dominate the market share in this segment, both for anatomical prostheses (60%) and round (50%). Thirty per cent of respondents had recently changed brands. As for the warranty offered by the manufacturers, most surgeons are satisfied with it (68%), although most think it should be lifelong (56.9%) and that the patient is misinformed about it. The results also show a great distrust of the professional against the objectivity of the manufacturer when they have to evaluate the implant to determine if the guarantee is applicable. Conclusions. There is a predominance of use of anatomical prostheses compared to round among surgeons who have answered the survey. However, it seems that a group has changed their preference for fear of problems like double capsule, seroma and even anaplasic large cell lymphoma (ALCL). Regarding the guarantee, it is perceived as a benefit for the patient although it should last throughout her life. Information about these programs is considered poor. In general there is a great distrust among the respondents in relation to the analysis that the own manufacturers do on the prostheses broken (AU)

Presión negativa multinivel en cobertura tisular compleja / Multilevel negative pressure in complex skin coverage

La pérdida de cobertura cutánea compleja secundaria a traumatismos, úlceras por presión, desforramientos cutáneos, etc, plantea un desafío a la hora de elegir la técnica quirúrgica que solucione el problema. Cualquiera que sea la elegida, conlleva un riesgo asociado de mayor pérdida cutánea, hematoma o seroma. En base a un estudio experimental sobre medición de presiones bajo y sobre colgajos sometidos a aplicación de presión negativa, decidimos aplicar el método a diferentes planos anatómicos de profundidad en pacientes con defectos complejos de cobertura tisular. Presentamos nuestra experiencia con el uso de presión negativa externa e interna (multinivel) como técnica de apoyo y prevención de complicaciones en la resolución de 19 casos de cobertura tisular compleja: desforramientos de piel, hematomas disecantes del tejido celular subcutáneo, úlceras por presión, colgajos complejos, cicatrices extensas y loxocelismo cutáneo, obteniendo resultados satisfactorios (AU)

Complex tissue loss secondary to traumatisms, pressure sores, degloving, etc, are a challenge when we try to choose the surgical technique to solve the problem. Every technique brings a risk of major skin coverage defect, hematoma or seroma. Based on an experimental study to measure pressure over and below a flap submitted to negative pressure, we decided to apply a vacuum system in different anatomic planes in patients with complex tissue loss. We report our experience with the use of negative pressure as external and internal (multilevel) technical support and prevention of complication in resolving 19 clinical cases of complex tissue loss: degloving, subcutaneous hematoma, pressure sores, complex flaps, extensive scarring skin loss, loxoscelism, with successful results (AU)

Fibrin Glue Reduces the Duration of Lymphatic Drainage after Lumpectomy and Level II or III Axillary Lymph Node Dissection for Breast Cancer: A Prospective Randomized Trial

This randomized prospective study investigated the effect of fibrin glue use on drainage duration and overall drain output after lumpectomy and axillary dissection in breast cancer patients. A total of 100 patients undergoing breast lumpectomy and axillary dissection were randomized to a fibrin glue group (N=50; glue sprayed onto the axillary dissection site) or a control group (N=50). Outcome measures were drainage duration, overall drain output, and incidence of seroma. Overall, the fibrin glue and control groups were similar in terms of drainage duration, overall drain output, and incidence of seroma. However, subgroup analysis showed that fibrin glue use resulted in a shorter drainage duration (3.5 vs. 4.7 days; p=0.0006) and overall drain output (196 vs. 278 mL; p=0.0255) in patients undergoing level II or III axillary dissection. Fibrin glue use reduced drainage duration and overall drain output in breast cancer patients undergoing a lumpectomy and level II or III axillary dissection.

Placa axilar compresiva fija para prevenir el seroma persistente postlinfadenectomía: comparación con controles históricos / Compressive axillary plates for persistent seroma after axillary lymphadenectomy

El seroma axilar persistente postlinfadenectomía es una complicación frecuente de la cirugía del cáncer mamario infiltrante, describiéndose diversas técnicas para su control. Para evaluar el beneficio adicional con el uso de placas axilares compresivas fijas se comparó una serie retrospectiva de 30 pacientes en que se usó este dispositivo con una serie histórica seleccionada aleatoriamente y manejada con un tratamiento estándar que consistió en el uso de drenajes aspirativos y compresión axilar con venda elástica. Los dos grupos resultaron homogéneos en las variables edad, estadio clínico y tipo de operación. La serie histórica tuvo una incidencia de seroma persistente de 26,67 por ciento (8/30), mientras que en el grupo con placa fue de un 6,67 por ciento (2/30), diferencia que fue estadísticamente significativa. Concomitantemente, el grupo con placa tuvo una duración del uso de los drenajes significativamente menor. No hubo diferencias en la duración del seroma ni en la aparición de complicaciones locales. No observamos ninguna relación entre la aparición de seroma y la utilización de alguna técnica quirúrgica en particular o de radioterapia preoperatoria.

Background: Persistent axillary post-lymphadenectomy seroma is a frequent complication of breast cancer treatment. Aim: To evaluate the benefit of fixed compressive axillary plates for this complication. Material and methods: Retrospective comparison of 30 patients in whom this technique was used with a randomized historic group of 30 women, handled with a standard technique that included suction drains and external axillary compressive elastic bandages. Results: Both groups had similar age, stage and operation type. Eight patients (27 percent) in the historic group and 2 (7 percent) in the axillary plate group had a persistent axillary seroma (p=0.04). Additionally, the plate group needed drains for a shorter period. There were no differences in the duration of seroma and the appearance of local complications. We did not observe any relationship between seroma appearance and the use of any particular operative technique or preoperative radiotherapy use. Conclusions: The use of fixed compressive axillary plates reduced the incidence of persistent seroma after axillary lymphadenectomy.