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Prevention of Seromas in Mastectomy Wounds: The Effect of Shoulder Immobilization

Prevention of Seromas in Mastectomy Wounds: The Effect of Shoulder Immobilization Abstract Objective: To determine if postoperative shoulder immobilization decreases the incidence of postmastectomy seromas. Design and Setting: A prospective randomized trial of three surgeons' experiences at a community hospital. Patients: Thirty-eight patients who underwent modified radical mastectomy from March 1991 through February 1993. Main Outcome Measures: Incidence of postmastectomy seromas and time required for patients to gain 110° of shoulder abduction after surgery. Results: Thirteen (72%) of 18 wounds in the maximum range of motion cohort developed seromas (72%) compared with one (6%) of 17 in the minimum range of motion cohort (P=.0005). The average time required for the patients with maximum range of motion to gain 110° of shoulder abduction was 2.6 weeks, whereas the patients with minimum range of motion required an average of 5.0 weeks (P=.0127). Conclusion: Postmastectomy shoulder immobilization significantly decreases the incidence of wound seromas. Although this protocol resulted in a delay in return to normal shoulder mobility, no patients sustained longterm musculoskeletal dysfunction.(Arch Surg. 1995;130:99-101) References 1. Budd DC, Cochran RC, Sturtz DL, Fouty WJ Jr. Surgical morbidity after mastectomy operations . Am J Surg . 1978;135:218-220.Crossref 2. Guenier C, Coibion M, Badr-elDin A, Nogaret JM, et al. Morbidity of surgical treatment for advanced cancer of the breast after irradiation . Ann Chir . 1990; 44:382-385. 3. Cohn F Jr. Slack HA, Fisher B. Complications and toxic manifestations of surgical adjuvant chemotherapy for breast cancer . Surg Gynecol Obstet . 1968; 127:1201-1209. 4. Feigenburg F, Fer M. Dintsman M. Comparison of postoperative complications following radical and modified radical mastectomy . World J Surg . 1977;1:207-211.Crossref 5. Fitts WT, Keuhnelian JG, Ravdin IS, Schor S. Swelling of the arm after radical mastectomy: a clinical study of its cause . Surgery . 1954;35:460-464. 6. Say CC, Donegan W. A biostatistical evaluation of complications from mastectomy . Surg Gynecol Obstet . 1974;138:370-376. 7. Clark JA, Kent RB III. One-day hospitalization following modified radical mastectomy . Am Surg . 1992;58:239-242. 8. Flew TJ. Wound drainage following radical mastectomy: the effect of restriction of shoulder movement . Br J Surg . 1979;66:302-305.Crossref 9. Lotze MT, Duncan MA, Gerber LH, Woltering EA, Rosenberg SA. Early versus delayed shoulder motion following axillary dissection . Ann Surg . 1980:193: 288-295.Crossref 10. Jansen RFM, van Geel AN, de Groot HGW, Rottier AB, Olthuis GAA, van Putten WLJ. Immediate versus delayed shoulder exercises after axillary lymph node dissection . Am J Surg . 1990;160:481-484.Crossref 11. Dawson I, Stam L, Heslinga JM, Kalsbeek HL. Effect of shoulder immobilization on wound seroma and shoulder dysfunction following modified radical mastectomy: a randomized prospective clinical trial . Br J Surg . 1989;76:311-312.Crossref 12. Petrek JA, Peters MM, Nori S, Knauer R, Kinne DW, Rogatko A. Axillary lymphadenectomy . Arch Surg . 1990;125:378-382.Crossref 13. Coons MS, Folliguet TA, Rodriguez C, Woloszyn TT, Tuchler RE, Marini CP. Prevention of seroma formation after dissection of musculoskeletal flaps . Am Surg . 1993;59:215-218. 14. Aitken R, Hunsaker R, James AG. Prevention of seromas following mastectomy and axillary dissection . Surg Gynecol Obstet . 1984;158:327-330. 15. Lindsey W, Masterson T, Llaneras M. Spotnitz W, Morgan R. Seroma prevention using fibrin glue during modified radical neck dissection in a rat model . Am J Surg . 1988;136:310-313.Crossref 16. Lindsey W, Masterson T, Spotnitz W, Wilhelm M, Morgan R. Seroma prevention using fibrin glue in a rat mastectomy model . Arch Surg . 1990;125:305-307.Crossref 17. Sitzmann JV, Dufresne C, Zuidema GD. The use of sclerotherapy for treatment of postmastectomy wound seromas . Surgery . 1983;93:345-347. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Prevention of Seromas in Mastectomy Wounds: The Effect of Shoulder Immobilization

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1995.01430010101021
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine if postoperative shoulder immobilization decreases the incidence of postmastectomy seromas. Design and Setting: A prospective randomized trial of three surgeons' experiences at a community hospital. Patients: Thirty-eight patients who underwent modified radical mastectomy from March 1991 through February 1993. Main Outcome Measures: Incidence of postmastectomy seromas and time required for patients to gain 110° of shoulder abduction after surgery. Results: Thirteen (72%) of 18 wounds in the maximum range of motion cohort developed seromas (72%) compared with one (6%) of 17 in the minimum range of motion cohort (P=.0005). The average time required for the patients with maximum range of motion to gain 110° of shoulder abduction was 2.6 weeks, whereas the patients with minimum range of motion required an average of 5.0 weeks (P=.0127). Conclusion: Postmastectomy shoulder immobilization significantly decreases the incidence of wound seromas. Although this protocol resulted in a delay in return to normal shoulder mobility, no patients sustained longterm musculoskeletal dysfunction.(Arch Surg. 1995;130:99-101) References 1. Budd DC, Cochran RC, Sturtz DL, Fouty WJ Jr. Surgical morbidity after mastectomy operations . Am J Surg . 1978;135:218-220.Crossref 2. Guenier C, Coibion M, Badr-elDin A, Nogaret JM, et al. Morbidity of surgical treatment for advanced cancer of the breast after irradiation . Ann Chir . 1990; 44:382-385. 3. Cohn F Jr. Slack HA, Fisher B. Complications and toxic manifestations of surgical adjuvant chemotherapy for breast cancer . Surg Gynecol Obstet . 1968; 127:1201-1209. 4. Feigenburg F, Fer M. Dintsman M. Comparison of postoperative complications following radical and modified radical mastectomy . World J Surg . 1977;1:207-211.Crossref 5. Fitts WT, Keuhnelian JG, Ravdin IS, Schor S. Swelling of the arm after radical mastectomy: a clinical study of its cause . Surgery . 1954;35:460-464. 6. Say CC, Donegan W. A biostatistical evaluation of complications from mastectomy . Surg Gynecol Obstet . 1974;138:370-376. 7. Clark JA, Kent RB III. One-day hospitalization following modified radical mastectomy . Am Surg . 1992;58:239-242. 8. Flew TJ. Wound drainage following radical mastectomy: the effect of restriction of shoulder movement . Br J Surg . 1979;66:302-305.Crossref 9. Lotze MT, Duncan MA, Gerber LH, Woltering EA, Rosenberg SA. Early versus delayed shoulder motion following axillary dissection . Ann Surg . 1980:193: 288-295.Crossref 10. Jansen RFM, van Geel AN, de Groot HGW, Rottier AB, Olthuis GAA, van Putten WLJ. Immediate versus delayed shoulder exercises after axillary lymph node dissection . Am J Surg . 1990;160:481-484.Crossref 11. Dawson I, Stam L, Heslinga JM, Kalsbeek HL. Effect of shoulder immobilization on wound seroma and shoulder dysfunction following modified radical mastectomy: a randomized prospective clinical trial . Br J Surg . 1989;76:311-312.Crossref 12. Petrek JA, Peters MM, Nori S, Knauer R, Kinne DW, Rogatko A. Axillary lymphadenectomy . Arch Surg . 1990;125:378-382.Crossref 13. Coons MS, Folliguet TA, Rodriguez C, Woloszyn TT, Tuchler RE, Marini CP. Prevention of seroma formation after dissection of musculoskeletal flaps . Am Surg . 1993;59:215-218. 14. Aitken R, Hunsaker R, James AG. Prevention of seromas following mastectomy and axillary dissection . Surg Gynecol Obstet . 1984;158:327-330. 15. Lindsey W, Masterson T, Llaneras M. Spotnitz W, Morgan R. Seroma prevention using fibrin glue during modified radical neck dissection in a rat model . Am J Surg . 1988;136:310-313.Crossref 16. Lindsey W, Masterson T, Spotnitz W, Wilhelm M, Morgan R. Seroma prevention using fibrin glue in a rat mastectomy model . Arch Surg . 1990;125:305-307.Crossref 17. Sitzmann JV, Dufresne C, Zuidema GD. The use of sclerotherapy for treatment of postmastectomy wound seromas . Surgery . 1983;93:345-347.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1995

References