Evaluation of the Quilting Technique for Reduction of Postmastectomy Seroma: A Randomized Controlled Study

Abstract

Background. Postmastectomy seroma causes patients' discomfort, delays starting the adjuvant therapy, and may increase the possibility of surgical site infection. Objective. To evaluate quilting of the mastectomy flaps with obliteration of the axillary space in reducing postmastectomy seroma. Methods. A randomized controlled study was carried out among 120 females who were candidates for mastectomy and axillary clearance. The intervention group (N = 60) with quilting and the control group without quilting. All patients were followed up routinely for immediate and late complications. Results. There were no significant differences between the two groups as regards the demographic characteristics, postoperative pathological finding, and the immediate postoperative complications. The incidence of seroma was significantly lower in the intervention group compared with the control group (20% versus 78.3%, P < 0.001). Additionally, the intervention group had a shorter duration till seroma resolution (9 days versus 11 days, P < 0.001) and a smaller volume of drainage (710 mL versus 1160 mL, P < 0.001) compared with the control group. Conclusion. The use of mastectomy with quilting of flaps and obliteration of the axillary space is an efficient method to significantly reduce the postoperative seroma in addition to significantly reducing the duration and volume of wound drainage. Therefore we recommend quilting of flaps as a routine step at the end of any mastectomy.

A quilting subcutaneous suture pattern to reduce seroma formation and pain 24 hours after midline celiotomy in dogs: A randomized controlled trial

“…The mechanism of action most likely involves is reduction in dead space; however, the reduction in postoperative discomfort could have reduced patient interference with the incision and, thus, prevented seroma formation. These findings are similar to those identified in human patients after abdominoplasty and mastectomy procedures, in which quilting suture patterns have been shown to reduce the incidence of postoperative seroma substantially …”

“…This technique anchors the subcutaneous tissues to the abdominal wall. The proposed benefits of quilting include the elimination of dead space, thereby reducing seroma formation and surgical site infection (SSI) . Potential disadvantages include increased postoperative discomfort and prolonged surgery with no benefit to the patient.…”

Role of quilting technique of mastectomy flap in prevention and reduction of seroma complication in breast cancer patients

“…Regarding the amount of seroma required aspiration among patients treated with both arm technique, this study was comparable with several authors who showed significantly less drainage in the quilting group when compared to the nonquilting group [28][29][30]. There was significant association between presence of seroma and level of clearance this may be due to removal of a larger number of lymph nodes which results in greater injury of the lymph vessels.…”

“…The technique of obliteration of dead space, therefore seem to be advantageous by tacking of mastectomy flaps to the pectoralis muscle and fascia. Several authors also reported that the incidence of seroma was significantly lower in the quilting group compared with the non-quilting group [28][29][30].…”

Vacuum-assisted closure in the treatment of seroma after axillary lymph node dissection

“…Several strategies have been attempted and described in order to reduce the incidence of seroma [8][9][10][11]. Some of the most commonly applied strategies are watchful waiting, compressive dressings or puncture and aspiration [12].…”