title: Effect of Lavage with Gentamicin vs. Clindamycin vs. Physiologic Saline on Drainage Discharge of the Axillary Surgical Bed after Lymph Node Dissection.
abstract: BACKGROUND
  To date, without placement of a drain, seroma formation cannot be avoided after axillary lymph node dissection (ALND). The purpose of this study was to evaluate the effect on drainage volume of pre-closure axillary lavage with physiologic saline, gentamicin solution, or clindamycin solution.
  
  
  METHODS
  A randomized study was performed between January 2013 and October 2014. Inclusion criteria were a diagnosis of breast neoplasm and plans to undergo an elective ALND because of axillary metastases. The patients were randomized into three groups: Two lavages with 500 mL of physiologic saline (Group 1), lavage with 500 mL of saline followed by lavage with 500 mL of a 240-mg gentamicin solution (Group 2), and lavage with 500 mL of saline followed by lavage with 500 mL of a 600-mg clindamycin solution (Group 3).
  
  
  RESULTS
  A total of 51 patients were included. The mean number of days with a drain in place was 7.1±3 in Group 1, 4.1±1.2 in Group 2, and 6.4±2.1 in Group 3 (p<0.001). Total drainage volume before tube removal was 435.3±220.1 mL in Group 1, 155.2±82.4 mL in Group 2, and 352.3±212.9 mL in Group 3 (p=0.03). In a pairwise analysis, irrigation with gentamicin solution achieved a lower drainage volume and a reduction in the number of days of drainage maintenance compared with the other two groups.
  
  
  CONCLUSIONS
  The post-operative output of the axillary drain is substantially lower in patients undergoing lavage of the surgical bed with a gentamicin solution than in patients undergoing lavage with physiologic saline or clindamycin solution.
authors.affiliation: 1 Department of Surgery, Hospital General Universitario de Elche , Alicante, Spain .
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Oller
authors.affiliation: 2 Department of Surgery, Hospital Rey Juan Carlos , Madrid, Spain .
authors.forename: Jaime
authors.initials: J
authors.lastname: Ruiz-Tovar
authors.affiliation: 1 Department of Surgery, Hospital General Universitario de Elche , Alicante, Spain .
authors.forename: Pilar
authors.initials: P
authors.lastname: Cansado
authors.affiliation: 1 Department of Surgery, Hospital General Universitario de Elche , Alicante, Spain .
authors.forename: Lorea
authors.initials: L
authors.lastname: Zubiaga
authors.affiliation: 1 Department of Surgery, Hospital General Universitario de Elche , Alicante, Spain .
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002981:Clindamycin / Q000008:administration & dosage*; D004322:Drainage; D005122:Exudates and Transudates; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D012965:Sodium Chloride / Q000008:administration & dosage*; D013530:Surgical Wound Infection / Q000517:prevention & control; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002981:Clindamycin; D012965:Sodium Chloride