title: Preventing seroma formation after axillary dissection for breast cancer: a randomized clinical trial.
abstract: BACKGROUND
  Seroma formation after axillary dissection remains the most common early sequel to breast cancer surgery. Different surgical approaches have been performed to reduce seroma collection. Therefore, we aimed to assess the outcome of patients operated on using an ultrasound scalpel according to a standardized operative technique before accepting it as a routine procedure.
  
  
  METHODS
  A randomized controlled trial was designed to compare the outcome of patients undergoing breast surgery and axillary dissection using either standard scalpel blades, scissors, ligations, and electrocautery or the ultrasound scalpel only. Each arm of the trial consisted of 30 patients.
  
  
  RESULTS
  A statistically significant benefit in terms of axillary and chest wall drainage volume, the number of axilla seromas, intraoperative bleeding, and hospitalization stay was recorded in the harmonic scalpel group. No significant differences were found between the 2 groups in terms of operative time. Finally, no postoperative hematoma, wound infections, and chest wall seroma were observed.
  
  
  CONCLUSIONS
  The use of the harmonic scalpel was shown to reduce the magnitude of seromas in axilla and hospitalization stay. The harmonic scalpel can be used alone in axillary dissection with a safe and effective hemostasis. Our results must be confirmed by larger series.
authors.affiliation: Department of Surgery, Second University of Naples, Piazza Miraglia 1, 80138 Naples, Italy. francesco.iovino@unina2.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Iovino
authors.forename: Pasquale Pio
authors.initials: PP
authors.lastname: Auriemma
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferraraccio
authors.forename: Giulio
authors.initials: G
authors.lastname: Antoniol
authors.forename: Alfonso
authors.initials: A
authors.lastname: Barbarisi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000295:instrumentation / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D049291:Seroma / Q000209:etiology / Q000517:prevention & control*; D016037:Single-Blind Method; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*