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1.
Clin Nucl Med ; 48(3): e143-e144, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36723901

RESUMO

ABSTRACT: Sentinel lymph node biopsy is the standard of care for axillary staging in early, clinically node-negative breast cancer. The lymphatic pathways could be altered after receiving axillary treatments such as radiation and/or axillary lymph node dissection. We report a case of inguinal and contralateral axilla SLNs in breast cancer recurrence.


Assuntos
Neoplasias da Mama , Linfadenopatia , Linfonodo Sentinela , Humanos , Feminino , Neoplasias da Mama/patologia , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Metástase Linfática/patologia , Estadiamento de Neoplasias , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Linfonodos/patologia , Biópsia de Linfonodo Sentinela , Excisão de Linfonodo , Axila/patologia , Axila/cirurgia
2.
J Int Med Res ; 51(1): 3000605231152384, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36694987

RESUMO

Axillary web syndrome (AWS) is characterized by the formation of cords in the axilla. Classically, it develops after surgical biopsy or removal of axillary lymph nodes for breast cancer. It can cause a limited range of motion and may contribute to abnormal shoulder movements or patterns that can cause pain. In this report, an atypical case of AWS presented in a 38-year-old male after physical activity but with no surgical history or breast cancer. This case report highlights that AWS can appear in healthy individuals with no history of breast cancer and/or surgical intervention. It also emphasizes the need to consider AWS in clinical practice as a differential diagnosis of painful shoulder movement and restricted range of motion.


Assuntos
Neoplasias da Mama , Excisão de Linfonodo , Masculino , Humanos , Adulto , Excisão de Linfonodo/efeitos adversos , Ombro/cirurgia , Axila/cirurgia , Axila/patologia , Neoplasias da Mama/patologia , Linfonodos/cirurgia , Dor/patologia
3.
J Surg Res ; 281: 176-184, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36179595

RESUMO

INTRODUCTION: Langer's axillary arch (AA), the most common anatomical variant in the axillary area of definite clinical significance. This is an updated review of the reported variations in the structure, highlighting its morphological diversity and its potential in complicating axillary lymph node biopsy, lymphadenectomy, or breast reconstruction. METHODS: A review of the literature concerning the AA published between 1812 and 2020 was performed using the PubMed, Scopus, Embase, and Cochrane medical databases. The frequency, laterality, morphology, origin, lateral attachment points, vascularization, and neurosis of the AA were the parameters retrieved from the collected data. RESULTS: The prevalence of AA ranged from 0.8% to 37.5%. It is more often unilateral, muscular in nature, and extending from the latissimus dorsi to the pectoralis major. It is vascularized by the lateral thoracic vessels or the subscapular artery and innervated by the thoracodorsal nerve. CONCLUSIONS: Langer's AA, when present, may complicate surgical procedures in the area; therefore, every surgeon performing breast or axillary surgery should be aware of this entity and its variations to ensure maximal effectiveness and safety in the management of patients.


Assuntos
Neoplasias da Mama , Excisão de Linfonodo , Humanos , Feminino , Axila/cirurgia , Músculos Peitorais , Mama/cirurgia , Neoplasias da Mama/cirurgia
4.
Complement Ther Clin Pract ; 50: 101692, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36528984

RESUMO

PURPOSE: Axillary lymph node dissection and radiotherapy have been associated with pain, physical symptoms, and decreased functional abilities in the upper extremity. This study aimed to evaluate the potential effects of the proprioceptive neuromuscular facilitation (PNF) technique on muscle strength, pain and functionality in this patient group in comparison with progressive resistance training (PRT). METHODS: The study was conducted with a randomized clinical trial design. Sixty-six women were included in the study and randomly divided into three groups: the PNF group (n = 22), the PRT group (n = 22), and the control group (n = 22). The participants were evaluated at the baseline and after eight weeks of treatment. Outcome measures were determined as pain (the Visual Analog Scale), upper extremity strength (isokinetic dynamometer), functionality (the Disabilities of the Arm, Shoulder and Hand questionnaire), and perception of change (the Global Rating of Change Scale). TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05288036. RESULTS: The results showed statistically significant changes in both treatment groups in terms of shoulder flexors/extensors, abductor/adductors, internal/external rotators strength/power/endurance measurement, pain, and functionality (p < 0.05). Concerning functionality and perception of change, the PNF group had a statistically significantly higher improvement compared to the remaining two groups (p < 0.05). CONCLUSION: PNF is an effective technique in increasing upper extremity muscle strength, reducing pain during rest and activity, and improving functionality in patients receiving breast cancer treatment.


Assuntos
Neoplasias da Mama , Exercícios de Alongamento Muscular , Humanos , Feminino , Ombro , Axila/patologia , Axila/cirurgia , Extremidade Superior/patologia , Excisão de Linfonodo/efeitos adversos , Neoplasias da Mama/cirurgia , Dor/etiologia
6.
BMC Surg ; 22(1): 436, 2022 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-36544128

RESUMO

BACKGROUND: In locally advanced breast cancer, axillary lymph node dissection remains a pivotal component of surgical therapy. Apart from this, it has been mostly replaced by sentinel node biopsy. Complications after axillary dissection include wound infection, neuropathy, lymphedema and-most frequently-seroma. In this retrospective multi-centre study, we compared the use of LigaSureTM with monopolar electrocautery regarding perioperative outcome. METHODS: A retrospective data analysis from female breast cancer patients who underwent axillary dissection at two breast centres in Austria that are using two different surgical techniques was performed for this study. We compared the rate of complications and re-operations, length of hospital stay, time to drain removal, total drain fluid, seroma formation after drain removal, number of seroma aspirations and total seroma fluid. RESULTS: Seventy one female patients with a median age of 63 (30-83) were included in this study. In 35 patients LigaSureTM and in 36 monopolar cautery was used for axillary dissection. There was no significant difference regarding intraoperative complications and rate of re-operations between the two groups (2.9 vs. 5.6%; p = 1 and 2.9 vs. 13.9%; p = 0.199). The time to drain removal and the length of hospital stay was similar in both groups. A significant difference in the occurence of postoperative wound infection could also not be shown. However, we found a significantly smaller total drain fluid in the LigaSureTM-group compared to the cautery-group (364.6 ml vs. 643.4 ml; p = 0.004). Seroma formation after drain removal was more frequent in the LigaSureTM-group (68.6 vs. 41.7%; p = 0.032) with a higher number of outpatient seroma aspirations (2.0 vs. 0.9; p = 0.005). CONCLUSION: LigaSureTM and monopolar cautery provide equivalent techniques in axillary lymph node dissection with comparable postoperative outcomes.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/patologia , Estudos Retrospectivos , Seroma/epidemiologia , Seroma/etiologia , Excisão de Linfonodo/métodos , Drenagem/métodos , Axila/cirurgia , Axila/patologia
7.
Medicine (Baltimore) ; 101(43): e31634, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316850

RESUMO

Seroma is the most common wound complication due to dead space remaining after mastectomy and axillary dissection. Seroma formation, which causes pain and tension, together with the limitations of shoulder and arm movements, can cause wound healing problems that can progress to wound dehiscence and flap necrosis. The aim of our study was to investigate the effects of continuous drainage and negative pressure wound therapy (NPWT) in breast cancer patients with refractory postmastectomy seroma. This retrospectively designed study was conducted with 27 patients who were referred to our center between 2018 and 2021 due to refractory seroma after mastectomy. The inclusion criteria of the study were the cases who were planned minimally invasive debridement and NPWT due to having refractory seroma formation with at least 200 cc and having interventions more than 1 month after modified radical mastectomy (MRM), despite conventional treatment methods. All patients' demographics, disease stage, history of possible neoadjuvant therapy, comorbidities, body mass index (BMI), number of wound dressings with NPWT, and total amount of NPWT accumulation were enrolled and compared statistically. Twenty-seven patients included in the study underwent continuous drainage after debridement, and 5 (3-9) dressings were treated with NPWT. None of the patients experienced complications after debridement and NPWT administration. In refractory seroma cases seen after postmastectomy, NPWT especially for the management of debridement and dead space can be evaluated as an appropriate treatment method in patients with high flow rate seroma.


Assuntos
Neoplasias da Mama , Desbridamento , Mastectomia , Tratamento de Ferimentos com Pressão Negativa , Seroma , Retalhos Cirúrgicos , Feminino , Humanos , Neoplasias da Mama/cirurgia , Desbridamento/efeitos adversos , Desbridamento/métodos , Mastectomia/efeitos adversos , Mastectomia/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Seroma/etiologia , Seroma/cirurgia , Pele , Axila/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/cirurgia , Drenagem/métodos
8.
Cancer ; 128(24): 4185-4193, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36259883

RESUMO

BACKGROUND: The need for axillary dissection (AD) is declining, but it is still essential for many patients with nodal involvement who risk developing breast-cancer-related lymphedema (BCRL) with lifelong consequences. Previous nonrandomized studies found axillary reverse mapping and selective axillary dissection (ARM-SAD) a safe and feasible way to preserve the arm's lymphatic drainage. METHODS: The present two-arm prospective randomized clinical trial was held at a single comprehensive cancer center to ascertain whether ARM-SAD can reduce the risk of BCRL, compared with standard AD, in patients with node-positive breast cancer. Whatever the type of breast surgery or adjuvant treatments planned, 130 patients with nodal involvement met our inclusion criteria: 65 were randomized for AD and 65 for ARM-SAD. Twelve months after surgery, a physiatrist assessed patients for BCRL and calculated the excess volume of the operated arm. Lymphoscintigraphy was used to assess drainage impairment. Self-reports of any impairment were also recorded. RESULTS: The difference in the incidence of BCRL between the two groups was 21% (95% CI, 3-37; p = .03). A significantly lower rate of BCRL after ARM-SAD was confirmed by a multimodal analysis that included the physiatrist's findings, excess arm volume, and lymphoscintigraphic findings, but this was not matched by a significant difference in patients' self-reports. CONCLUSIONS: Our findings encourage a change of surgical approach when AD is still warranted. ARM-SAD may be an alternative to standard AD to reduce the treatment-related morbidity.


Assuntos
Linfedema Relacionado a Câncer de Mama , Neoplasias da Mama , Linfedema , Humanos , Feminino , Axila/cirurgia , Linfedema/etiologia , Estudos Prospectivos , Metástase Linfática , Excisão de Linfonodo/efeitos adversos , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/complicações , Neoplasias da Mama/complicações , Biópsia de Linfonodo Sentinela/efeitos adversos , Linfonodos/cirurgia
9.
Biomed Res Int ; 2022: 5600450, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36212718

RESUMO

Axillary defect coverage is often challenging after radical excision of chronic inflammatory skin lesions, such as complicated epidermoid cysts and hidradenitis suppurativa. This retrospective case series aims to demonstrate our experience with axillary reconstruction using the modified keystone perforator island flap (KPIF) technique, emphasizing its tension-reducing effects. All patients who presented for axillary reconstruction after radical excision of chronic inflammatory skin lesions between May 2019 and December 2020 were identified using the medical record database. Eleven patients ranging in age from 17 to 71 years underwent modified KPIF axillary reconstruction. Four types of modifications (modified type II KPIF, omega variation closure, Sydney melanoma unit modification, and hemi-KPIF) were used. All defects (size range, 2.5 × 3 cm2 to 8 × 13 cm2) were successfully covered using these modified KPIF techniques. All flaps (size range, 3.5 × 3.5 cm2 to 11 × 30 cm2) fully survived without complications. All patients exhibited favorable functional outcomes, and no cases of recurrence or limitations in joint range of motion were observed during the follow-up period (range, 4-5 months). Modified KPIF techniques may represent a reliable, effective alternative reconstructive modality for managing axillary defects.


Assuntos
Melanoma , Retalho Perfurante , Adolescente , Adulto , Idoso , Axila/cirurgia , Humanos , Melanoma/cirurgia , Pessoa de Meia-Idade , Retalho Perfurante/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Wounds ; 34(10): 245-249, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36219710

RESUMO

INTRODUCTION: Wide excision of affected skin tissue and the apocrine glandular region is the standard treatment for advanced HS. Various flap types have been used for coverage. OBJECTIVE: This study was conducted to assess the use and outcomes of propeller parascapular flaps for unilateral or bilateral axillary defects after excision in patients with advanced axillary HS. MATERIALS AND METHODS: This retrospective case series reports on 11 patients with unilateral (7 patients) or bilateral (4 patients) advanced HS treated with propeller parascapular flap surgery between July 1, 2016, and December 31, 2018. Flap dimensions were measured. Patients were evaluated in terms of 2 main postoperative complications: postoperative recurrence and flap viability. In addition, other complications such as bleeding, infection, dehiscence, contracture, and hypertrophic scarring were noted. RESULTS: The average flap area was 160 cm2. One flap dehisced; no infection, partial necrosis, or total flap loss occurred, and no recurrence was observed. The mean follow-up period was 18 months. At final follow-up, no patient had contractures that caused restricted movement of the shoulder joint. CONCLUSION: Parascapular flaps should be the first choice in patients with advanced HS owing to low donor area morbidity, low recurrence rate, wide rotation arc, and sufficient flap size.


Assuntos
Contratura , Hidradenite Supurativa , Retalho Perfurante , Axila/cirurgia , Contratura/cirurgia , Hidradenite Supurativa/cirurgia , Humanos , Estudos Retrospectivos , Transplante de Pele/métodos , Retalhos Cirúrgicos
11.
Medicine (Baltimore) ; 101(37): e30742, 2022 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-36123869

RESUMO

This study aimed to compare and analyze the prognosis after lipectomy with respect to the difference in time required for indocyanine green (ICG) to reach the axilla in patients with advanced unilateral upper extremity lymphedema. The study population was divided into 2 groups, according to the time required by ICG to reach the axilla after injection, that is, <1 hour (<1 hour; n = 9) and over 1 hour (>1 hour; n = 8). The patient's arm volume was examined before surgery and up to 12 months after surgery. The volume difference between the 2 groups was compared using the excess volume ratio. Statistically significant differences were not observed before surgery (P = .847) and 1 month (P = .336), 3 months (P = .630), and 6 months after surgery (P = .124) between the excess volume ratio values of the < 1 hour and > 1 hour groups. A statistically significant difference was confirmed 12 months after surgery (P = .034). The difference in the time when ICG reached the axilla in patients with lymphedema was associated with prognosis after lipectomy. The difference in time could possibly be used as a variable to classify the progress of lymphedema in the future.


Assuntos
Lipectomia , Linfedema , Axila/cirurgia , Humanos , Verde de Indocianina , Linfedema/cirurgia , Estudos Retrospectivos , Extremidade Superior/cirurgia
12.
Surg Oncol ; 44: 101847, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36126348

RESUMO

AIMS AND OBJECTIVES: The purpose of this study was to assess the feasibility of using the single-incision round block technique in breast-conserving surgery with sentinel lymph node (SLN) retrieval for breast cancer without compromising oncological safety. MATERIALS AND METHODS: A retrospective observational case-control study was conducted from January 2017 to October 2021. The study population consisted of two groups. In both groups, breast-conserving surgery was carried out through the round-block technique. In group A, SLN retrieval was performed using the round-block incision (study group), while in group B, SLN retrieval was conducted through a second skin incision in the axilla (control group). The study was approved by the local ethics committee Zurich (BASEC-Nr. 2020-02857), and written informed consent was obtained from all participants. RESULTS: Overall, 134 patients met the inclusion criteria, of whom 86 women underwent breast-conserving surgery and SLN retrieval using the single-incision approach (group A), and 48 women underwent conventional surgery, using two independent incisions for tumour resection and SLN retrieval (group B). The overall success rate in group A regarding SLN retrieval was 97.7%, whereas most tumours were located in the upper outer (47.7%) and upper inner quadrant (27.9%). Although the technique was equally successful in the other quadrants, the share of tumours in the lower outer, and the lower inner quadrant, and the retroareolar region was smaller, representing 17.4%, 3.5% and 3.5%, respectively. The median number of dissected lymph nodes was two, with a positivity rate of 24.4%. The occurrence of axillary neuralgia and axillary skin retraction was significantly higher in group B along with tendentially more axillary seroma formation. There were no significant differences regarding reintervention rates, in terms of complications, resection margins, locoregional recurrences, or deaths with a mean follow-up of 11 months. CONCLUSIONS: The single-incision method through the round block technique is as safe and effective as the standard two-incision approach regarding nodal staging and resection margins, and seems to be applicable for tumours in all breast quadrants.


Assuntos
Neoplasias da Mama , Mastectomia Segmentar , Axila/patologia , Axila/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Excisão de Linfonodo/métodos , Metástase Linfática , Margens de Excisão , Mastectomia Segmentar/métodos , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/métodos
13.
BMJ Open ; 12(9): e063305, 2022 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-36130744

RESUMO

INTRODUCTION: Breast cancer is the most common malignant tumour in women, with more than 2 million new cases annually worldwide. One of the most frequent and well-known surgical and post-actinic sequelae is post-mastectomy lymphoedema. The axillary web syndrome is another sequela that limits the functionality of the patient and delays the protocol time of administering cancer treatments; and in many cases, this sequela is misdiagnosed. This surgical sequela usually disappears spontaneously after the third month of appearance, but this implies a long period of discomfort and limitations for the patient, at the same time, it may delay the application of radiotherapy within the indicated protocol deadline (due to a need for body posture). METHODS AND ANALYSIS: With the present quasi-experimental study, we intend to show the application of physiotherapy and stretching from the beginning of the appearance of the axillary cord, in a controlled and scheduled way by the physiotherapist. It is possible to reduce the time in which the lymphatic thrombus is present and, therefore, recover functionality and mobility, reduce pain and be able to apply treatments within the established deadline. We intend to apply this therapy into the intervention group and compare thrombus evolution time with the control group. ETHICS AND DISSEMINATION: This trial has the approval of the Andalucía Ethics Committee (PEIBA code 1909-N1-21, reg. number 171.21). TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT05115799).


Assuntos
Neoplasias da Mama , Manipulações Musculoesqueléticas , Axila/patologia , Axila/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Progressão da Doença , Feminino , Humanos , Mastectomia/efeitos adversos , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Thyroid ; 32(10): 1211-1219, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35943878

RESUMO

Background: Operations for pediatric thyroid nodules are more complicated, and usually lead to longer scars, which may impair life quality in the long term. Bilateral axillo-breast approach robotic thyroidectomy (BABA RT) may provide a better alternative to conventional open thyroidectomy (COT) for pediatric thyroid nodules. Our study aimed at comparing the surgical and oncological outcomes of BABA RT and COT in pediatric patients. Methods: The data of 49 pediatric patients who consecutively underwent BABA RT or COT (20:29) between July 1998 and November 2021 in our center were retrospectively analyzed, including demographics, surgery extent, surgical outcomes, pathological characteristics, and oncological outcomes. Results: All BABA RT procedures were completed successfully without conversion to open operation. The BABA RT group consisted of 5 benign and 15 malignant cases, while the COT group consisted of 19 benign and 10 malignant cases. The operation time, drain removal time, and number of lymph nodes harvested by central lymph node dissection or lateral lymph node dissection were equivalent in the BABA RT and COT groups. Notably, the postoperative hospital stay of the BABA RT group was shorter than that of the COT group (8.5 [interquartile ranges (IQRs): 3] vs. 11 [IQR: 8] days, p = 0.008). The aesthetic score of the BABA RT group was much higher than that of the COT group (9 [IQR: 1] vs. 6 [IQR: 1], p < 0.001). There was no significant difference between the BABA RT and COT groups in hypoparathyroidism rate (transient, 5 vs. 4; permanent, 1 vs. 0). There was one case of chyle leakage in the COT group and no other complications in any group, such as recurrent laryngeal nerve injury. With a median follow-up of 101 (IQR: 189) months, one case of local relapse and one case of pulmonary metastasis in the COT group were documented. Conclusion: In the hands of experienced surgeons, robotic BABA thyroidectomy can be a safe and effective option for both benign and malignant thyroid nodules in children, including those with lymph node metastasis. Robotic BABA thyroidectomy can offer a better and faster postoperative course and a much better cosmetic result, which is crucial for pediatric thyroid patients.


Assuntos
Procedimentos Cirúrgicos Robóticos , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Humanos , Criança , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Estudos Retrospectivos , Nódulo da Glândula Tireoide/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Axila/cirurgia , Axila/patologia , Recidiva Local de Neoplasia/cirurgia , Mama/patologia , Mama/cirurgia , Resultado do Tratamento
15.
Surg Laparosc Endosc Percutan Tech ; 32(5): 537-541, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36044331

RESUMO

BACKGROUND: We aimed to investigate the potential advantages of bilateral axillo-breast approach (BABA) robotic thyroidectomy over conventional open surgery and to determine whether it is a safe and complete surgical procedure compared with open surgery in patients with papillary thyroid cancer. PATIENTS AND METHODS: We retrospectively reviewed the records of 315 consecutive patients (robotic, n=54; open, n=261) who underwent total thyroidectomy and central neck dissection for papillary thyroid cancer from March 2013 to June 2014. Postoperative complication rate and surgical completeness were analyzed between patients who underwent BABA robotic thyroidectomy (robotic group) and those who chose open thyroidectomy (open group) after propensity score matching according to age, sex, body mass index, tumor size, extrathyroidal extension, and lymph node (LN) metastasis. RESULTS: Transient hypoparathyroidism was higher in the open group than in the robotic group (13.0% vs. 1.9%; P =0.029). No difference was observed in the mean number of retrieved LNs and metastatic LNs. The mean level of stimulated thyroglobulin was acceptably low in both groups, and there was no difference in the proportion of patients who had stimulated thyroglobulin levels <1 ng/mL between the groups ( P =0.543). CONCLUSIONS: Our results show that the outcomes of BABA robotic thyroidectomy may be comparable to those of conventional open thyroidectomy, with possibly better preservation of blood supply to the parathyroid glands, without sacrificing surgical completeness.


Assuntos
Carcinoma Papilar , Procedimentos Cirúrgicos Robóticos , Neoplasias da Glândula Tireoide , Axila/cirurgia , Carcinoma Papilar/cirurgia , Humanos , Metástase Linfática , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Tireoglobulina , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Resultado do Tratamento
16.
Asian Pac J Cancer Prev ; 23(8): 2873-2878, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-36037146

RESUMO

BACKGROUND: Breast cancer is one of the most common cancers in Iran and round the globe. Seroma formation is the most common primary complication after mastectomy (partial/radical). Nowadays, drainage is used as a routine method to reduce seroma formation after mastectomy, although there is no consensus about the appropriate time to perform drainage after this surgery. This study evaluated the effects of short-term and long-term drainage after mastectomy along with removal of axillary lymph nodes. METHODS: This randomized clinical trial was performed on 88 women who underwent mastectomy with ALND in hospitals in Yazd (were randomly divided into two groups). Suction drains were inserted for all patients at completion of surgery. The data collection tool was a researcher-made form based on variables. In the first group, the drain was removed 24 hours after surgery and the patients were discharged, but the second group was discharged with the drain in place after 24 hours and the drain was removed 5 days after surgery. Data were analyzed with SPSS18 using T-Test, Chi square, and Mann-Whitney U test. RESULTS: The results showed that 28 (31.8%) participants had formed seroma, of whom 22 (50%) were in the 1-day drainage group and 6 (13.6%) were in the 5-day drainage group. There was a statistically significant correlation among seroma frequency, mean aspiration volume, mean number of aspirations, mean seroma volume in sonography one week after surgery, and mean seroma volume in sonography between the two groups three weeks after surgery (P<0.05). CONCLUSION: Based on the results, it can be concluded that long-term drainage reduces the risk of seroma formation after mastectomy with removal of axillary lymph nodes compared to short-term drainage. Complementary study be performed by considering other underlying factors such as comorbidities to obtain the best drain removal time in breast cancer patients.


Assuntos
Neoplasias da Mama , Drenagem , Excisão de Linfonodo , Mastectomia , Axila/cirurgia , Neoplasias da Mama/cirurgia , Drenagem/efeitos adversos , Drenagem/métodos , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Linfonodos/cirurgia , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Seroma/etiologia
17.
Pediatr Surg Int ; 38(10): 1445-1451, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35852592

RESUMO

AIM: Ectopic breast tissue (EBT) includes a spectrum of disease that entails other entities based on the presence of glandular tissue, nipple, or areola. The diagnosis in adolescents is infrequent. METHODS: A retrospective study was performed including girls with axillary EBT (class IV or V of Kajava's Classification) operated in 2006-2020. Imagining studies, clinical and surgical reports, and histopathology were reviewed. RESULTS: Eleven girls from 13 to 16 years old were included. Two patients (18.2%) presented bilateral EBT. The most frequent clinical manifestation was 2-5 cm mass (100%), associating cyclic pain with menstruation (45%) and fluctuating volume (36%). Bilateral axillary ultrasonography allowed preoperative diagnosis. All of them were treated by open excision, through small incisions located in an axillary y fold. Clinical and aesthetic results were self-assessed as "very good", with normalization of the axillary y hollow and imperceptible scars. No recurrences were observed after one year of follow-up. An immediate postoperative hematoma was reported, which did not require drainage. Histopathology showed mature breast tissue without atypia. CONCLUSIONS: Axillary accessory breasts must be included in differential diagnosis of pediatric axillary masses. Bilateral ultrasonography is recommended for the preoperative diagnosis. Excision through minimal incision at this age seems to be safe and effective.


Assuntos
Neoplasias da Mama , Coristoma , Adolescente , Axila/patologia , Axila/cirurgia , Mama/diagnóstico por imagem , Mama/patologia , Mama/cirurgia , Criança , Coristoma/diagnóstico por imagem , Coristoma/cirurgia , Cicatriz , Feminino , Humanos , Mamilos/patologia , Mamilos/cirurgia , Estudos Retrospectivos
18.
BJS Open ; 6(4)2022 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-35799351

RESUMO

BACKGROUND: Extracervical approaches for thyroidectomy are seldom explored in the western population. The objective of this study was to evaluate the outcomes of hemithyroidectomy via endoscopic unilateral axillo-breast approach (UABA) with gas insufflation. METHOD: Consecutive patients undergoing UABA hemithyroidectomy for symptomatic benign or cytologically indeterminate nodules (Bethesda III lesions) of less than 5 cm from July 2015 to December 2020 at three European institutions were included. Patients were excluded if presenting with a BMI more than 25 kg/m2, had previous neck surgery and/or radiation, had bilateral thyroid lesions, retrosternal goitre, Hashimoto thyroiditis or Graves' disease. Follow-up was carried out at 2 weeks, 3 months and 1 year. Outcomes of interest were surgical (including operating time, mean duration of hospital stay and complications) and self-assessed cosmetic outcomes. RESULTS: Out of 984 patients treated with hemithyroidectomy during the study interval, 253 were selected, including 214 women and 39 men. Patients' mean age was of 46.6 years with a mean BMI of 22.57. Mean operating time was 72.9 minutes. A transient recurrent laryngeal nerve injury was reported in 3.6 per cent of the patients, but none was persistent. Transient pectoral/cervical hypoesthesia was noted in 24.1 per cent of patients, with no permanent hypoesthesia. Skin burns and subcutaneous hematoma developed in 2.4 per cent and 2 per cent of patients but resolved within the third month after surgery. There was no tracheal/oesophageal perforation, conversion to open surgery or reoperation. The final pathology revealed 241 benign nodules, nine underlying papillary thyroid carcinomas, and three cases of follicular carcinoma. Hospital discharge was achieved on the first in 68.8 per cent of the patients and on the second postoperative day in 31.2 per cent of the cases. All patients were satisfied with the cosmetic aspect. CONCLUSION: In selected patients, UABA with gas insufflation for hemithyroidectomy could be performed for the treatment of unilateral thyroid pathologies.


Assuntos
Insuflação , Neoplasias da Glândula Tireoide , Axila/patologia , Axila/cirurgia , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos
19.
Wounds ; 34(2): 43-46, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35801979

RESUMO

INTRODUCTION: Hidradenitis suppurativa can be a debilitating condition, particularly in the pediatric population. Axillary hidradenitis can be particularly challenging because of the risk of scar contracture and limited range of motion after definitive resection and reconstruction. A dermal regeneration template (DRT) and skin grafting have been used to reduce scar contracture in other areas of the body and may benefit this population. OBJECTIVE: This case series retrospectively reviewed and evaluated outcomes using DRT and skin grafting for axillary hidradenitis reconstruction to report the authors' initial experience. MATERIALS AND METHODS: After institutional review board approval, a retrospective review was conducted of a single surgeon's experience for all patients undergoing axillary hidradenitis resection and immediate reconstruction with DRT and skin grafting from 2015 through 2018. Preoperative characteristics, surgical details, and postoperative results were collected. RESULTS: Five patients undergoing 7 procedures were eligible for inclusion. The average age at the time of surgery was 18.2 years. Patients underwent an average of 4.9 negative pressure wound therapy changes prior to skin grafting. No complications, DRT loss, or skin graft loss occurred. All patients were reported to have normal range of motion of the surgically managed extremity after skin grafting. The average follow-up was 273.4 days after the last procedure. As of this writing, no patients had experienced any recurrence of hidradenitis in the surgically managed axilla. CONCLUSIONS: The use of DRT and subsequent skin grafting for the definitive management of axillary hidradenitis resulted in no recurrence and full range of motion of the affected extremity without complications. Surgeons should consider using this method of reconstruction for axillary hidradenitis, particularly in the pediatric population.


Assuntos
Contratura , Hidradenite Supurativa , Axila/cirurgia , Criança , Cicatriz , Contratura/cirurgia , Hidradenite Supurativa/cirurgia , Humanos , Estudos Retrospectivos , Transplante de Pele
20.
Dermatol Ther ; 35(8): e15615, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35656571

RESUMO

BACKGROUND: The glandular fluid secreted by apocrine sweat glands is decomposed by parasitic bacteria on the skin surface and releases a bad smell called axillary osmidrosis. OBJECTIVE: To evaluate the effect of power-assisted rotary cutter with negative pressure suction through small incision for axillary osmidrosis. METHODS: From January 2017 to January 2022, 647 patients with axillary osmidrosis underwent power-assisted rotary cutter with negative pressure suction through small incision surgery to treat for axillary osmidrosis. The operation time (min), intraoperative bleeding (ml) and recovery time (days) were counted. Three months after operation, the amount of underarm sweat, the disappearance of underarm hair, the incidence of operation, the effective rate of operation, and the satisfaction of operation results were evaluated by questionnaire. RESULTS: There were no postoperative complications except five cases of mild axillary pigmentation after 3 months. All patients evaluated good odor elimination. No patient was rated as average or poor. No recurrence. CONCLUSION: Power-assisted rotary cutter with negative pressure suction through small incision is an effective and ideal surgical method to reduce the complications and recurrence of axillary osmidrosis.


Assuntos
Hiperidrose , Glândulas Apócrinas/cirurgia , Axila/cirurgia , Humanos , Hiperidrose/cirurgia , Odorantes , Sucção/métodos
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