Fibrin glue instillation under skin flaps to prevent seroma-related morbidity following breast and axillary surgery

Indo-cyanine green administration to identify loss of lymph after axillary lymph node dissection

Background

Near infrared fluorescence imaging with Indocyanine Green (ICG) is now used for the imaging of lymph nodes and lymphatic vessels. In this work, we investigated the impact of its pre-operative and peri-operative administration on our ability to detect axillary lymphatic loss after breast cancer surgery.

Methods

One subcutaneous injection of ICG was administered in the ipsilateral hand of 109 women who were scheduled to have either a mastectomy with total axillary lymph node dissection (CALND) or a lumpectomy with selective lymphadenectomy (SLN) the day before (n = 53) or the same day of surgery (n = 56). The lymph leakages were assessed by means of the application of a compress in the operated armpit and by the presence or absence of fluorescence on it, as well as in the post-operative axillary drains.

Results

The compress was fluorescent in 28% of SLN patients and 71% of CALND patients. The liquids in the axillary drains were also fluorescent in 71% of patients with CALND. No statistical significance was observed between the ICG injection groups. The association between compressive fluorescent and the presence of fluorescence in the axillary drains is significant in the pre-operative subgroup and in the whole group.

Conclusion

Our research demonstrates that lymphatic leaks aid in the development of seromas and calls into question the effectiveness of the ligatures and/or cauterizations used during surgery. A prospective, multicentric, randomized trial should be conducted to verify the efficacy of this approach.

Comparison between Early and Late Drain Released after Modified Radical Mastectomy Surgery through Observation over Proportion of Percutaneous Aspiration Technique of Seroma Production in Surgical Polyclinic of Dr. Soetomo Hospital, Surabaya

Surgery is the most frequent indication and major therapy in the management of malignancy of breasts. Drain is one method to drainage the seroma formed after the modified radical mastectomy surgery. The drain-release protocol varies in each hospitals. This study aimed to compare the proportion of percutaneous aspiration in patients with early drain release with late drain release in postoperative MRM patients. The present study is a prospective cohort study comparing the proportion of percutaneous aspiration in 30 patients with early drain released with 30 patients with late drain release in Dr. Soetomo hospital The recording of the proportion of aspiration actions was conducted serially on days 3, 7, 10, and 14 after drain release. Recording of age, nutritional status (BMI), tumor histopathology type, stage, shoulder mobilization time, obliterant usage, wound infections surgery, flap necrosis and hematom were analyzed to find out if there was any effect on seroma event In our study we did not find the difference in serum aspiration proportions both in the early and late drain observation group. Age factor, nutritional status (BMI), histopathology type, stage, shoulder mobilization time, obliterant use, presence of surgical wound infection, flap necrosis and hematom did not differ significantly statistically to seroma events. Statistically, there was no difference in the proportion of percutaneous aspiration in a group of observed patients with early and late drain release. Late drain release can be avoided to potentially harm the patient in decreasing the lives’ quality of the patients.

Fibrin sealant use in pilonidal sinus: Systematic review

AIM: To review the current data about the success rates of fibrin sealant use in pilonidal disease.

METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients (84% male, mean age 24.2 ± 7.8).

RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates (9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies (mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients.

CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.