S. Myint1, T. Lwin1, W. Yee1, H. Thuya1, A. Myat1, Y. Kyaw1, K. Nyunt1, K. Khaing1, T. Lwin1 1University of medicine (1), Yangon,Department Of Surgery,Yangon, YANGON, Myanmar
Introduction: Seroma formation is the most frequent postoperative complication after breast cancer surgery. In 2015 surgery for breast cancer at the Yangon General Hospital amounted to 17.12% (229) of all the elective major operations. In 2016, 244 cases of modified radical mastectomy (MRM) were carried out and 32.38 % of locally advanced breast cancer patients developed seroma post operatively. Seroma cause discomfort, and wound complications.Seroma prolonged hospital stay and delayed adjuvant therapy. It can leads to poor prognosis. We explored whether quilting sutures could reduce seroma occurrence. Quilting sutures aim to prevent shearing between skin flaps and chest wall and to reduce the dead space.
Methods: Twenty five breast cancer patients from 1st July 2017 to 31st December 2017 were included in this descriptive study. All underwent modified radical mastectomy. After MRM quilting sutures were applied to approximate skin flaps to underlying pectoral muscle at an interval of 2 to 3 cm. Customized, strategically placed, multiple alternating interrupted quilting sutures are put with 3/0 vicryl at various parts of the flaps. A close drainage tube was usually inserted into the axilla. The skin was closed with two layer techniques. Drainage tube was removed when the 24 hour drain amount was less than 30mls in two consecutive days. Patients were followed up in the outpatient clinic and the clinically significant seroma were detected by clinical examination and ultrasoung examination.
Results: The average time to insert quilting suture is 12 mins. None of the cases develop permanent skin dimplings one month after operation. Post-operatively,mean amount of drainage tube output is 274.9 ml. Five patients (20%) developed clinically significant seroma in follow-up visits and underwent needle aspiration. The mean number of needle aspiration is 3 times. Mean amount of seroma aspirated is 300 ml. None of the patients develop wound sepsis or wound gaping.
Conclusion:MRM is frequently performed at the Yangon General Hospital and seroma is a common complication. It can prolong hospital stay and can lead to frequent visits to clinic and delay adjuvant therapy. Quilting suture reduced the incidence of seroma formation from 32% to 20%. This technique is cost effective and can be performed by general surgeons. We feel that this may be an important technique for breast cancer surgery in low resource settings and warrants further investigation.
