Quilting prevents seroma formation following breast cancer surgery: closing the dead space by quilting prevents seroma following axillary lymph node dissection and mastectomy.
BACKGROUND
Seroma is a frequent problem after mastectomy (ME) and axillary lymph node dissection (ALND). Seroma is associated with pain, discomfort, impaired mobilisation and repeated aspirations, often resulting in a surgical site infection (SSI). It has already been demonstrated that minimizing dead space through fixation of the skin flaps to the underlying muscles (quilting) lowers the incidence of seroma. The aim of this study was to evaluate the effect of quilting on the incidence of seroma, and SSI.


METHODS
Two consecutive groups with a total of 176 patients following ME and/or ALND were retrospectively compared. Endpoints were the incidence of seroma, and number and volume of aspirations and SSIs. Analysed risk factors were age, ME, lymph node dissection, neoadjuvant therapy, body mass index (BMI) and hypertension.


RESULTS
The quilted group (n = 89) scored significantly better on all endpoints compared with the conventional group (n = 87). The incidence of seroma decreased from 80.5 % to 22.5 % (p < 0.01), the mean number of aspirations from 4.86 to 2.40 (p = 0.015), the volume of aspirations from 1660 ml to 611 ml (p = 0.05) and the SSIs from 31.0 % to 11.2 % (p < 0.01). Increasing age and lymph node dissection were found to be risk factors for seroma; quilting was a protective factor.


CONCLUSIONS
Quilting is an effective method for preventing seroma and its complications.
Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands, britt_Tenwolde@hotmail.com.
Britt
B
ten Wolde
Frits J H
FJ
van den Wildenberg
Mariel E
ME
Keemers-Gels
Fatih
F
Polat
Luc J A
LJ
Strobbe
D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D049291:Seroma / Q000209:etiology / Q000517:prevention & control*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013536:Suture Techniques; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*
D014014:Tissue Adhesives