ELECTROCAUTERY AS A FACTOR IN SEROM...

ELECTROCAUTERY AS A FACTOR IN SEROMA FORMATION FOLLOWING MASTECTOMY

K Porter et al The American Journal of Surgery Vol 176 (July 1998) 8-11

Researchers estimate that almost 200000 strange cases of breast cancer will be diagnosed in 1998 steady with the trend toward breast conservation in the treatment of breast cancer, as many as 70% of women diagnosed with breast cancer will bear a mastectomy.

The most numerous common early complication of mastectomy is seroma, with reported rates of 3% to 60% Seromas usually are painless, yet have been linked to grief infection, wound healing complications, and lymphedema. in the greatest degree seromas require aspiration, and, consequently more follow-up office visits. Many factors have been examined to determine the cause of seromas, including patient age, obesity, symbol of mastectomy, type of detriment drain, and the surgeon's experience. Electrocautery is an additional factor. This meditation reports the results of a randomized, prospective trial that compared seroma formation in postmastectomy patients following skin flap dissection with electrocautery and scalpel.

Seventy-five consecutive patients requiring mastectomy were randomly assigned to pass through dissection of cutaneous flaps and breast with pectoral fascia using either electrocautery or scalpel. Patients undergoing modified radical and simple mastectomy were eligible for the cogitation Control of small bleeding bottoms with the electrocautery was allowed for either form into groups At the end of the operation surgeons inserted drains of their choice--one beneath the skin flap and a inferior in the axilla of patients with modified radical mastectomy. Patients were discharged within 24 hours with drain care instructions. Drains were remov in the surgeon's office when drainage for each drain was les than 30 mL in 24 hours.

Medical records were reviewed for variables in age, height, weight, experience of surgical resident, pathologic staging, use of neoadjuvant therapy, drain pattern duration of drain use, amount of drainage, morbidity, detail of stay, and type of mastectomy. Seroma was defined as any clinically ascertained collection of fluid under skin flaps. The number of aspirations required for resolution and amount of drainage were recorded, and hematoma, cellulitis, and grief infection were defined.

issues were analyzed using PC-SAS statistical package. Chi-square proof for homogeneity and Student's t trial were used to test for difference in continuous variables. Mantel-Haensel summary statistic was used to examine independent tenors of drain type and dissection way Multivariate logistic regression analysis was used to repress for other confounding factors.

issues Seventy-four patients were studied--68 underwent unilateral mastectomy and six underwent bilateral performances for a total of 80 mastectomies. Thirty-eight patients were randomly assigned to scalpel dissection and 42 to electrocautery dissection. harm complications included seroma (ie, 21) superficial skin flap necrosis (ie, seven) cellulitis (ie, three) hematoma (ie, one) and detriment abscess (ie, two).

Incidence of seroma was 30% in the electrocautery dispose and 9% in the scalpel collection Self-regulating suction drainage devices were associated with higher incidence of seroma compared to gravity drains. No relationship was seen in age, carcass mass index, type of mastectomy, resident surgeon experience, preoperative chemotherapy, or tumor stage. The fulness of time the drains were in place, total drainage, and amount of drainage onward the day of removal were similar between hurts that developed seroma and those that did not.

These rates are similar to those reported in literature. The researchers conclud that the use of electrocautery to create skin flaps in mastectomy reduc descendants loss but increased the rate of seroma formation. The researchers generally are conducting a prospective randomized clinical trial comparing self-regulating suction drainage devices and gravity drains after mastectomy and axillary dissection.

Perioperative nursing implications. Electrocautery is a valuable surgical tool. Safe use of electrocautery always is a primary matter for the perioperative nurse. This contemplation brings to light other implications in the use of electrocautery. to be paid to shortened lengths of stay for surgical patients, this meditation serves to remind perioperative nourishs of the complications associated with mastectomy and could be of use in patient education.

AMY L REICHERT RN MSN CNOR NURSING RESEARCH COMMITTEE

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