Coveney E C, O'Dwyer P J, Geraghty J G, O'Higgins N J
University Department of Surgery, St Vincent's Hospital, Dublin, Ireland.
Eur J Surg Oncol. 1993 Apr;19(2):143-6.
To evaluate the effect of closing dead space on seroma formation after mastectomy, 39 patients undergoing 40 mastectomies with axillary node clearance were randomized to undergo suturing of skin flaps to underlying muscle or conventional skin closure. Duration of closed suction drainage, 72 h, and shoulder exercises, commencing on the first post-operative day, were standardized for both groups. Closed suction drainage was significantly less (P < 0.05) in the group that had flaps sutured, 272 +/- 46 ml vs 393 +/- 39 ml. Also fewer patients in the flap sutured group developed seromas, 5 (25%) vs 17 (85%) chi 2 = 12.2 P < 0.001. Three patients in the group that had conventional skin closure had breakdown of wound edges, two developing a prolonged serous discharge, while none occurred in the sutured group. A functional range of shoulder motion was attained at 6 months in 14 (70%) patients in the flap sutured group compared with nine (45%) in the conventional skin closure group (P = NS). These results confirm the value of suturing skin flaps to underlying muscle in reducing local morbidity after mastectomy and suggest that this technique should be included in the closure of all mastectomy wounds.
为评估关闭死腔对乳房切除术后血清肿形成的影响，对39例行40次乳房切除术并腋窝淋巴结清扫术的患者进行随机分组，一组将皮瓣缝合至其下方肌肉，另一组采用传统皮肤缝合。两组均将闭式负压引流时间标准化为72小时，并于术后第一天开始进行肩部锻炼。皮瓣缝合组的闭式负压引流量明显较少（P<0.05），分别为272±46ml和393±39ml。皮瓣缝合组发生血清肿的患者也较少，分别为5例（25%）和17例（85%），χ2=12.2，P<0.001。传统皮肤缝合组有3例患者伤口边缘裂开，2例出现长期浆液性渗出，而缝合组无此情况。皮瓣缝合组14例（70%）患者在6个月时达到了肩部运动的功能范围，而传统皮肤缝合组为9例（45%）（P=无显著性差异）。这些结果证实了将皮瓣缝合至其下方肌肉在降低乳房切除术后局部并发症发生率方面的价值，并表明该技术应纳入所有乳房切除术后伤口的缝合中。
