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Fibrin glue for the axillary fossa was prepared by diluting it to 5 IU/ml with calcium chloride solution (20 mM), a concentration capable of maintaining activation of the wound-healing process through a thick mesh of fibrin fibrils. A compression dressing was applied over the treatment site and kept in place for at least 24-72 hours. Fibrin glue prepared with 5 IU/ml of thrombin was also applied as a spray (2 ml) to the axillary fossa with approximately three minutes' manual compression. For patients in the fibrin glue treatment group, following fitting of the drain, fibrin glue prepared with 500 IU/ml of thrombin was applied as a spray (2 ml, from a distance of 10 cm with 2 bars of pressure) at the site of the quadrantectomy or mastectomy. The harmonic scalpel group received the suction drain without additional treatment, while the other group received fibrin glue (Tisseal ®/Tissucol ®, Baxter Healthcare Corporation, Deerfield, IL, USA). After surgery, all patients were fitted with a suction drain at the axillary fossa, which was activated 10 minutes after stitching the skin. Short-term antibiotic prophylaxis was applied. To be enrolled in the study, patients were required to have no alterations in their blood clotting or immune systems, or at least not be receiving anticoagulant treatment have no history of sensitisation to bovine aprotinin no psychological changes no uncompensated diabetes or advanced liver disease not be severely obese, and not have had previous surgery on the axillary lymphatic system or any immediate reconstructive surgery. The axillary lymphadenectomy was performed in 15 patients with ligations, scissors and electrocautery and in 15 patients with ultrasound scalpel. All patents had N+ breast adenocarcinoma and required either a quadrantectomy or a modified radical mastectomy with level I or II axillary lymphadenectomy, extending from the lower border of the axillary vein superiorly, from the medial border of the smaller pectoral muscle medially, as far as the fourth intercostobrachial nerve inferiorly and to the edge of the latissimus dorsi laterally. This prospective study evaluates the effectiveness of using fibrin glue to reduce seroma formation following axillary lymphadenectomy for breast cancer.īetween January 2010 and December 2012, 30 patients over 60 years were enrolled in the study. Regardless of contradicting opinions, the possibility of reducing the time for which drainage is present during the recovery period, therefore eliminating the need to discharge patients with drainage in situ, may represent a valid solution for reducing seroma formation. Some surgeons believe that it is best to remove the drain on the first day of the post-operative period, some think the drain should be left in place until the drained volume falls below 50 ml/day, while others feel that drainage could in fact prolong and intensify the inflammatory stage of the wound-healing process, with a subsequent increase in seroma formation. To date, no practical guidelines exist on how to conduct suction drainage, and the views of surgeons are varied. These include suction drainage topical application of tetracycline, closing and stitching the axillary fossa, axillary dissection with axilloscopy, external compression, use of harmonic scalpel and application of fibrin glue. Many different methodologies have been used in an effort to reduce seroma formation following axillary lymphadenectomy for breast cancer. However, in all cases where T > 3 cm, and in patients with T1 N1 or with a metastatic sentinel lymph node, conventional axillary lymphadenectomy remains the primary surgical protocol for quadrantectomy and mastectomy. It is possible to avoid axillary dissection in selected patients (T1 N0) using the sentinel lymph node technique. There is still a significant incidence (15-81%) of complications associated with axillary lymphadenectomy, including lymphorrhea, lymphoceles, and in rare cases lymphedema (swelling of the arm). Axillary dissection represents an integral part of the treatment for breast cancer for prognostic and curative purposes.
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