Ita Michael, Koh Kevin, Butt Abeeda, KaimKhani Shaheed, Kelly Louise, O'Sullivan Martin J, Redmond Henry Paul, Corrigan Mark A
Cork Breast Cancer Research Centre, Cork University Hospital, Cork, Ireland.
Department of Academic Surgery, University College Cork, Cork, Ireland.
Ir J Med Sci. 2018 Nov;187(4):901-906. doi: 10.1007/s11845-018-1772-7. Epub 2018 Mar 21.
Cosmetic outcomes and scar lengths remain important considerations in breast cancer surgery. Suturing techniques should decrease scar tissue formation and provide good cosmetic results. The use of an accordion suturing technique may result in decreased surgical wound lengths and better cosmetic outcomes. We compared the outcomes of the accordion suturing technique with the standard suturing technique in breast cancer surgeries.
Female patients undergoing wide local excision of breast cancers were randomised to undergo closure of their surgical wound by either the accordion or the non-accordion (standard) suturing techniques between the months of May and October 2015. Pre-closure and post-closure wound lengths were measured intra-operatively. The primary outcome was a reduction of the surgical wound length at 6 weeks. The secondary outcome was a composite of the absence of hypertrophic scar tissue formation and optimal cosmesis.
Thirty eligible women for wide local excision of breast tumours were randomly assigned to the accordion and non-accordion groups (15 accordion and 15 non-accordion). Seven women were excluded from the study because they underwent re-excision of margins for their breast tumours before the end of 6 weeks, and one woman was lost to follow-up. We therefore compared the outcomes of 12 women who underwent closure of their surgical wound by way of the accordion suturing technique to the outcomes of 10 women who underwent closure with the non-accordion (standard) suturing technique. The percentage reduction of wound length at 6 weeks was significantly greater in the accordion group than in the non-accordion group (M = 24.4, SD = 10.2 vs. M = 8.6, SD = 11.5, p = 0.0026). There was no significant difference in the cosmetic outcome between both groups using the James Quinn's wound evaluation score.
The accordion suturing technique was associated with a significant reduction in surgical wound lengths in breast conserving surgery at 6 weeks without compromising the cosmetic result.
在乳腺癌手术中，美容效果和瘢痕长度仍是重要的考量因素。缝合技术应减少瘢痕组织形成并提供良好的美容效果。使用手风琴式缝合技术可能会缩短手术伤口长度并带来更好的美容效果。我们比较了手风琴式缝合技术与标准缝合技术在乳腺癌手术中的效果。
2015年5月至10月期间，接受乳腺癌广泛局部切除的女性患者被随机分为两组，分别采用手风琴式或非手风琴式（标准）缝合技术闭合手术伤口。术中测量闭合前后的伤口长度。主要结局是6周时手术伤口长度的缩短。次要结局是无肥厚性瘢痕组织形成且美容效果最佳。
30名符合条件的接受乳腺肿瘤广泛局部切除的女性被随机分配到手风琴组和非手风琴组（每组15人）。7名女性因在6周结束前对乳腺肿瘤边缘进行了再次切除而被排除在研究之外，1名女性失访。因此，我们比较了12名采用手风琴式缝合技术闭合手术伤口的女性与10名采用非手风琴式（标准）缝合技术闭合伤口的女性的结局。手风琴组6周时伤口长度的减少百分比显著高于非手风琴组（M = 24.4，SD = 10.2 vs. M = 8.6，SD = 11.5，p = 0.0026）。使用詹姆斯·奎因伤口评估评分，两组在美容效果上无显著差异。
手风琴式缝合技术在6周时与保乳手术中手术伤口长度的显著缩短相关，且不影响美容效果。
