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The Postoperative Radical-Mastectomy Syndrome: Its Treatment with Stellate Ganglion Block

The Postoperative Radical-Mastectomy Syndrome: Its Treatment with Stellate Ganglion Block Abstract The postoperative radical-mastectomy syndrome is caused by the extensive surgery necessary in the efforts to cure a malignancy of the breast. The most characteristic sign of this syndrome is edema of the arm, but, in addition, one or more of the following signs and symptoms are usually present: accumulation of fluid under the skin flaps and in the axilla, delayed wound healing, pain in the arm and/or the chest, lymphangitis, induration of the arm and/or the chest wall, limitation of motion of the shoulder girdle and the arm, and hypertrophic cicatrix formation (Fig. 1). The following factors, either individually or in combination, have been cited as the cause of the edema of the arm and could be responsible for the other signs and symptoms of the syndrome: (1) venous obstruction; (2) lymphatic-vessel destruction; (3) infection; (4) mechanical obstruction of the vessels by scar formation, metastatic tumors, and/or fat fold; (5) References 1. Hoopes, B. F., and McGraw, A. B.: The Halsted Radical Mastectomy, 5-Year Results in 246 Consecutive Operations at the Same Clinic , Surgery 12:892-905, 1942. 2. Halsted, W. S.: Swelling of the Arm After Operations for Cancer of the Breast—Elephantiasis Chirurgica—Its Cause and Prevention , Bull. Johns Hopkins Hosp. 32:309-313, 1921. 3. Treves, N.: Management of the Swollen Arm in Carcinoma of the Breast , Am. J. Cancer 15:271-276, 1931. 4. Devenish, E. A., and Jessop, W. H. G.: Nature and Cause of Swelling of the Upper Limb After Radical Mastectomy , Brit. J. Surg. 28:222-238, 1940.Crossref 5. Veal, J. R.: Pathologic Basis for Swelling of the Arm Following Radical Amputation of the Breast , Surg. Gynec. & Obst. 67:752-760, 1938. 6. Neumann, C. G., and Conway, H.: Evaluation of Skin Grafting in the Technique of Radical Mastectomy in Relation to Function of the Arm , Surgery 23:584-590, 1948. 7. Holman, C.; McSwain, B., and Beal, J. M.: Swelling of the Upper Extremity Following Radical Mastectomy , Surgery 15:757-765, 1944. 8. Oberhelman, H. A.: Diagnosis and Treatment of Carcinoma of the Female Breast , S. Clin. North America 26:116-129, 1946. 9. Adair, F. E. A.: Consideration of Recent Additions to Clinical and Experimental Knowledge of Breast Conditions , West. J. Surg. 48:645-661, 1940. 10. Schoregge, C. W.: Simple Versus Radical Mastectomy in Carcinoma of the Breast , Journal-Lancet 61:203-208, 1941. 11. Gratzek, F. R., and Stenstrom, K. W.: Roentgen Therapy of Mammary Carcinoma: Survival Study Based on 731 Cases , Radiology 44:44-57, 1945. 12. Guthrie, D., and Gagnon, G.: Prevention and Treatment of Postoperative Lymphedema of the Arm , Ann. Surg. 123:925-936, 1946. 13. Lobb, A. W., and Harkins, H. N.: Postmastectomy Swelling of the Arm with a Note on the Effect of Segmental Resection of the Axillary Vein at the Time of Radical Mastectomy , West J. Surg. 57:550-557, 1949. 14. Leriche, R.: Surgery of Pain , translated and edited by A. Young, Baltimore, William Wood Company (Division of Williams & Wilkins Company), 1939. 15. Hanelin, H. A.; Williams, J. M.; Wolffson, S. M., and Wernick, E. D.: Treatment of Postoperative Swelling of the Arm Following Mastectomy , Arch. Surg. 55:723-731, 1947. 16. Feldman, S.: Suggested Therapy Section , Mod. Med. 18:18, 1950. 17. Arnulf, G.: L'Infiltration stellaire: Technique—indications—résultats , Paris, Masson & Cie, 1947. 18. Moore, D. C., and Bridenbaugh, L. D.: Anterior Approach to the Stellate Ganglion: Use Without a Serious Complication in 2000 Blocks , J. A. M. A. 160:158-162, 1956. 19. Moore, D. C.: Stellate Ganglion Block: Techniques—Indications—Uses , Springfield, Ill., Charles C Thomas, Publisher, 1954. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

The Postoperative Radical-Mastectomy Syndrome: Its Treatment with Stellate Ganglion Block

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References (21)

Publisher
American Medical Association
Copyright
Copyright © 1957 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1957.01280180078010
Publisher site
See Article on Publisher Site

Abstract

Abstract The postoperative radical-mastectomy syndrome is caused by the extensive surgery necessary in the efforts to cure a malignancy of the breast. The most characteristic sign of this syndrome is edema of the arm, but, in addition, one or more of the following signs and symptoms are usually present: accumulation of fluid under the skin flaps and in the axilla, delayed wound healing, pain in the arm and/or the chest, lymphangitis, induration of the arm and/or the chest wall, limitation of motion of the shoulder girdle and the arm, and hypertrophic cicatrix formation (Fig. 1). The following factors, either individually or in combination, have been cited as the cause of the edema of the arm and could be responsible for the other signs and symptoms of the syndrome: (1) venous obstruction; (2) lymphatic-vessel destruction; (3) infection; (4) mechanical obstruction of the vessels by scar formation, metastatic tumors, and/or fat fold; (5) References 1. Hoopes, B. F., and McGraw, A. B.: The Halsted Radical Mastectomy, 5-Year Results in 246 Consecutive Operations at the Same Clinic , Surgery 12:892-905, 1942. 2. Halsted, W. S.: Swelling of the Arm After Operations for Cancer of the Breast—Elephantiasis Chirurgica—Its Cause and Prevention , Bull. Johns Hopkins Hosp. 32:309-313, 1921. 3. Treves, N.: Management of the Swollen Arm in Carcinoma of the Breast , Am. J. Cancer 15:271-276, 1931. 4. Devenish, E. A., and Jessop, W. H. G.: Nature and Cause of Swelling of the Upper Limb After Radical Mastectomy , Brit. J. Surg. 28:222-238, 1940.Crossref 5. Veal, J. R.: Pathologic Basis for Swelling of the Arm Following Radical Amputation of the Breast , Surg. Gynec. & Obst. 67:752-760, 1938. 6. Neumann, C. G., and Conway, H.: Evaluation of Skin Grafting in the Technique of Radical Mastectomy in Relation to Function of the Arm , Surgery 23:584-590, 1948. 7. Holman, C.; McSwain, B., and Beal, J. M.: Swelling of the Upper Extremity Following Radical Mastectomy , Surgery 15:757-765, 1944. 8. Oberhelman, H. A.: Diagnosis and Treatment of Carcinoma of the Female Breast , S. Clin. North America 26:116-129, 1946. 9. Adair, F. E. A.: Consideration of Recent Additions to Clinical and Experimental Knowledge of Breast Conditions , West. J. Surg. 48:645-661, 1940. 10. Schoregge, C. W.: Simple Versus Radical Mastectomy in Carcinoma of the Breast , Journal-Lancet 61:203-208, 1941. 11. Gratzek, F. R., and Stenstrom, K. W.: Roentgen Therapy of Mammary Carcinoma: Survival Study Based on 731 Cases , Radiology 44:44-57, 1945. 12. Guthrie, D., and Gagnon, G.: Prevention and Treatment of Postoperative Lymphedema of the Arm , Ann. Surg. 123:925-936, 1946. 13. Lobb, A. W., and Harkins, H. N.: Postmastectomy Swelling of the Arm with a Note on the Effect of Segmental Resection of the Axillary Vein at the Time of Radical Mastectomy , West J. Surg. 57:550-557, 1949. 14. Leriche, R.: Surgery of Pain , translated and edited by A. Young, Baltimore, William Wood Company (Division of Williams & Wilkins Company), 1939. 15. Hanelin, H. A.; Williams, J. M.; Wolffson, S. M., and Wernick, E. D.: Treatment of Postoperative Swelling of the Arm Following Mastectomy , Arch. Surg. 55:723-731, 1947. 16. Feldman, S.: Suggested Therapy Section , Mod. Med. 18:18, 1950. 17. Arnulf, G.: L'Infiltration stellaire: Technique—indications—résultats , Paris, Masson & Cie, 1947. 18. Moore, D. C., and Bridenbaugh, L. D.: Anterior Approach to the Stellate Ganglion: Use Without a Serious Complication in 2000 Blocks , J. A. M. A. 160:158-162, 1956. 19. Moore, D. C.: Stellate Ganglion Block: Techniques—Indications—Uses , Springfield, Ill., Charles C Thomas, Publisher, 1954.

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Dec 1, 1957

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