Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: A prospective randomized study

Schultz, Inkeri; Barholm, Margareta; Gröndal, Staffan

doi:10.1007/bf02303577

Cited by 98 publications

(72 citation statements)

References 10 publications

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“…A reasonable alternative approach endorsed by most breast surgeons is to recommend that patients simply limit motion at the shoulder to abduction no greater than 90 and that active upper extremity physiotherapy be delayed until drainage catheters have been removed. This strategy seems to decrease seroma formation more effectively than early physiotherapy programs and does not adversely affect long-term range-of-motion results [30,31].…”

Section: Seromamentioning

confidence: 99%

Complications in Breast Surgery

Vitug

Newman

2007

Surgical Clinics of North America

151

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The breast is a relatively clean organ comprised of skin, fatty tissue, and mammary glandular elements that have no direct connection to any major body cavity or visceral structures. In the absence of concurrent major reconstruction, breast surgery generally is not accompanied by large-scale fluid shifts, infectious complications, or hemorrhage. Thus, most breast operations are categorized as low-morbidity procedures. Because the breast is the site of the most common cancer afflicting American women, however, a variety of complications can occur in association with diagnostic and multidisciplinary management procedures. Some of these complications are related to the breast itself, and others are associated with axillary staging procedures. This article first addresses some general, nonspecific complications (wound infections, seroma formation, hematoma). It then discusses complications that are specific to particular breast-related procedures: lumpectomy (including both diagnostic open biopsy and breast-conservation therapy for cancer), mastectomy; axillary lymph node dissection (ALND), lymphatic mapping/sentinel lymph node biopsy, and reconstruction. Complications related to reconstruction are discussed in a separate article in this issue. General wound complications related to breast and axillary surgeryBecause it is a peripheral soft tissue organ, many wound complications related to breast procedures are relatively minor and frequently are managed on an outpatient basis. It therefore is difficult to establish accurate incidence rates for these events. As discussed later, however, reported studies

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Section: Seromamentioning

confidence: 99%

Complications in Breast Surgery

Vitug

Newman

2007

Surgical Clinics of North America

151

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“…These include closure of dead space [8,9], use of thrombin [10], compression dressings [11,12] aspiration alone instead of drainage [13], use of collagen tissue sealants [14,15], and delaying postoperative shoulder exercises [16]. Use of ultrasonic shears for breast cancer surgery has been described as early as 2000 by Deo et al [17], in which they showed the feasibility of modified radical mastectomy using ultrasonic shears.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonic Shears Versus Electrocautery in Axillary Dissection for Breast Cancer—A Randomized Controlled Trial

Manjunath

Ramesh

Shivakumar

et al. 2014

Indian J Surg Oncol

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Theoretical advantages of use of Ultrasonic shears include less tissue damage and better sealing of lymphatic vessels. This may play a role in reducing prolonged drainage following axillary dissection for breast cancer. We conducted a prospective randomized controlled study to evaluate efficacy of ultrasonic shears over cautery for axillary dissection. Between April 2011 and April 2013, 92 patients were randomized to undergo axillary dissection with either ultrasonic shears (n=46) or electrocautery (n=46). Primary endpoints were time till drain removal and cumulative axillary drainage. Categorical data were compared by Pearson's chi-squared test. Continuous variables were compared by Independent t test or Mann Whitney U test. Data was analyzed using SPSS version 18.0. Both groups were comparable with respect to clinical and pathologic characteristics. Clinical characteristics of mean age, body mass index, side of tumor, neoadjuvant chemotherapy, and type of surgery (breast conservation or mastectomy) were similar. Pathologic variables (weight of specimen, number of lymph nodes harvested, pathologic T and N status, as well as grade of tumor) were also comparable among the two groups. There was no statistically significant difference in either primary endpoint of time till drain removal (15 vs. 14.5 days, p=0.73) or cumulative axillary drainage (1,260 vs. 1,086.5 ml, p=0.79). Patient and disease characteristics among the two groups were similar. But, there was no difference in either primary endpoint of cumulative axillary drainage or time to drain removal. We conclude that there is no advantage to use of ultrasonic shears over cautery in reducing drainage following axillary dissection for breast cancer.

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“…Mas é importante lembrar que para alguns autores a retirada precoce do dreno -muitas vezes por motivos de acidente, ar no circuito e infecção -pode ser outro fator que colabora para a formação do seroma. É provável que a incidência do seroma também esteja relacionada a outros fatores como técnica cirúrgica, infecção, tempo de cirurgia, tamanho das mamas e linfonodos comprometidos 19,23 . Observamos neste estudo alta incidência de deiscência.…”

Section: Discussionunclassified

“…Entretanto, contrariando a idéia de que o exercício livre provocasse maior afastamento das bordas cirúrgicas quando comparado ao exercício limitado, a incidência de deiscência esteve igualmente distribuída nos dois grupos. Na literatura, a deiscência está possivelmente associada a outros fatores, como presença de infecção, obesidade e idade média maior que 55 anos, condições especiais em que se faz necessário maior tempo para uma correta cicatrização 19,21,23 . Além da obesidade e idade, a presença de linfonodos comprometidos, tempo de cirurgia, diferentes técnicas cirúrgicas utilizadas e radioterapia são outros fatores possivelmente associados às complicações pós-operatórias.…”

Section: Discussionunclassified

Movimento do ombro após cirurgia por carcinoma invasor da mama: estudo randomizado prospectivo controlado de exercícios livres versus limitados a 90º no pós-operatório

Silva¹,

Derchain²,

Rezende³

et al. 2004

Rev. Bras. Ginecol. Obstet.

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. A manipulação da axila pode levar a complicações sensitivas e motoras nos membros superiores ipsilaterais, que acometem mais de 65% das mulheres tratadas com linfadenectomia [3][4][5][6] . Um entre os sintomas mais referidos pela paciente é a limitação no movimento do ombro. Sugden et al. 3 relatam que metade das mulheres submetidas a linfadenectomia associada a mastectomia ou quadrantectomia por carcinoma de mama, apresentam limitação de pelo menos um movimento do ombro 18 meses após a cirurgia. Nagel et al. 4 descrevem uma restrição do movimento do ombro em 24% das mulheres submetidas a axilectomia

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Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: A prospective randomized study

Abstract: The incidence of seromas after modified radical mastectomy for breast cancer is reduced by delaying shoulder exercises one week postoperatively. Earlier postoperative physiotherapy is not necessary to avoid impaired shoulder function.

Cited by 98 publications

References 10 publications

Complications in Breast Surgery

Complications in Breast Surgery

Ultrasonic Shears Versus Electrocautery in Axillary Dissection for Breast Cancer—A Randomized Controlled Trial

Movimento do ombro após cirurgia por carcinoma invasor da mama: estudo randomizado prospectivo controlado de exercícios livres versus limitados a 90º no pós-operatório

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