Elective hand surgery in the breast cancer patient with prior ipsilateral axillary dissection.
BACKGROUND
We wished to determine if complications after elective hand surgery were greater in women with previous mastectomy and axillary dissection than in those without.


METHODS
We surveyed records of all women undergoing carpal tunnel release by the senior author (W.J.D.) from 1983 to 1993. The postaxillary dissection group (group A) was made up of 15 women; seven had some postdissection lymphedema. Group B was made up of 302 other patients who had not undergone breast surgery or axillary dissection. Anesthetic and surgical techniques were identical for both groups, with i.v. regional anesthesia used most commonly.


RESULTS
No patient in the axillary dissection group developed any postoperative infection or had any worsening of preexisting lymphedema or onset of new arm swelling after ipsilateral carpal tunnel release. The nonaxillary dissection group had a postoperative infection rate of 3.6%; all infections were superficial and resolved with conservative therapy. In addition, 31 women experienced other complications, including 13 with hand/finger stiffness and four with reflex dystrophy. Fifteen required formal hand therapy.


CONCLUSIONS
Women with prior ipsilateral axillary dissection can safely undergo elective upper extremity surgery, provided strict sterile technique and appropriate anesthetic and surgical precautions are observed. Patients having undergone previous axillary dissection should not be prohibited from future limb manipulations, including venepunctures, blood pressure measurements, or elective surgery.
Dawson
W J
WJ
Department of Clinical Orthopaedic Surgery, Northwestern University Medical School, Evanston, IL, USA.
Elenz
D R
DR
Winchester
D P
DP
Feldman
J L
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D002349:Carpal Tunnel Syndrome / Q000534:rehabilitation / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008209:Lymphedema / Q000209:etiology; D015411:Mastectomy, Modified Radical / Q000009:adverse effects; D015409:Mastectomy, Radical / Q000009:adverse effects; D015412:Mastectomy, Segmental / Q000009:adverse effects; D008875:Middle Aged; D009407:Nerve Block; D026741:Physical Therapy Modalities; D011183:Postoperative Complications; D013530:Surgical Wound Infection / Q000209:etiology; D014111:Tourniquets