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Randomized Controlled Clinical Trial for Mastectomy Skin Flaps: Pre-Mammary Fascial Plane Versus a Thin Skin Flap Between Small and Large Fat Lobules and Flap Raised by Scalpel Versus Electrodiathermy

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Abstract

Mastectomy serves as the main surgical treatment for both invasive and in situ breast carcinoma and large phyllodes tumors. It is associated with skin necrosis, seroma, and surgical site infection in up to 30% of patients. In the present trial, we compared the complications in patients undergoing skin flap elevation by one of the 4 techniques: thick skin flap raised by scalpel(group1), thin skin flap raised with scalpel (group 2), thick skin flap raised with diathermy (group 3), and thin skin flap raised with diathermy (group 4). A randomized trial with superiority hypothesis and 2 × 2 factorial design was conducted at All India Institute of Medical Sciences New Delhi. Mastectomy skin flap necrosis (MSN) was recorded as the main outcome of interest. MSN was noted in 2.5% in group1, 10% in group 2, 7.5% in group 3, and 30% in group 4. MSN was observed in 5% cases with thick flap compared to 20% cases with a thin skin flap (p = 0.007). Raising the flap with scalpel was associated with MSN in 6.25% compared to 18.75% in the diathermy group (p = 0.029). We conclude that raising a thick flap with scalpel is associated with lowest risk of skin flap necrosis.

Trial Registration: Clinical Trial Registry- India CTRI/2014/09/004978

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Data Availability

The data used to support the findings of the study are included in this publication. Any related further data will be made available upon request to the authors.

References

  1. Patty DH, Dyson WH (1948) The prognosis of carcinoma of the breast in relation to the type of operation performed. Br J Cancer 2(1):7

    Article  Google Scholar 

  2. Roses DF, Harris MN, Gumport SL (1977) Total mastectomy with axillary dissection - a MRM. Am J Surg 134:674–677

    Article  CAS  PubMed  Google Scholar 

  3. Krohn IT, Cooper DR, Bassett JG (1982) Radical mastectomy: thick vs thin skin flaps. Arch Surg 117:760–763

    Article  CAS  PubMed  Google Scholar 

  4. Ranjan P, Meena R, Puri G et al (2022) FISH Mastectomy Incision: an Innovative AIIMS Technique. Indian J Surg 84(Suppl 3):799–802. https://doi.org/10.1007/s12262-020-02705-x

  5. Kumar C, Ranjan P, Kataria K et al (2021) (2021) Anurag’s interfascial mastectomy: a new postulate in breast cancer surgery. Indian J Surg. https://doi.org/10.1007/s12262-021-02800-7

    Article  PubMed  Google Scholar 

  6. Vitug AF, Newman LA (2007) (2007) Complications in breast surgery. Surg Clin North Am 879(2):431–451

    Article  Google Scholar 

  7. Garwood ER, Moore D, Ewing C, Hwang ES, Alvarado M, Foster RD, Esserman LJ (2009) Total skin-sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients. Ann Surg 249(1):26–32

    Article  PubMed  Google Scholar 

  8. Moyer HR, Losken A (2012) Predicting Mastectomy skin flap necrosis with indocyanine green angiography: the gray area defined. Plast Reconstr Surg 129(5):1043–1048

    Article  CAS  PubMed  Google Scholar 

  9. Rao R, Saint-Cyr M, Ma AMT, Bowling M, Hatef DA, Andrews V et al (2009) Prediction of postoperative necrosis after mastectomy: a pilot study utilizing optical diffusion imaging spectroscopy. World J Surg Oncol 7:91

    Article  PubMed  PubMed Central  Google Scholar 

  10. Murray JD, Jones GE, Elwood ET, Whitty LA, Garcia C (2012) Laser angiography as predictor of mastectomy flap necrosis after breast reconstruction. Plast Reconstr Surg 129(6):1017–1018

    Article  Google Scholar 

  11. Gorai K, Inoue K, Saegusa N, Shimamoto R, Takeishi M, Okazaki M, Nakagawa M (2017) Prediction of Skin necrosis after mastectomy for breast cancer using indocyanine green angiography imaging. Plast Reconstr Surg Glob Open 5(4):1321

    Article  Google Scholar 

  12. Woodworth PA, McBoyle MF, Helmer SD, Beamer RL (2000) Seroma formation after breast cancer surgery: incidence and predicting factors. Am Surg 66:444–450

    Article  CAS  PubMed  Google Scholar 

  13. Brayant M, Baum M (1987) Postoperative seroma following mastectomy and axillary dissection. Br J Surg 74:1187

    Article  Google Scholar 

  14. Kottayasamy Seenivasagam R, Gupta V, Singh G (2013) Prevention of seroma formation after axillary dissection – a comparative randomized clinical trial of three methods. Breast J 19(5):478–484

    PubMed  Google Scholar 

  15. Chintamani, Singhal V, Singh JP, Bansal A, Saxena S (2005) Half versus full vacuum suction drainage after modified radical mastectomy for breast cancer- a prospective randomized clinical trial[ISRCTN24484328]. BMC Cancer 5:11. https://doi.org/10.1186/1471-2407-5-11

  16. Van Heurn LW, Brink PR (1995) Prospective randomized trial of high versus low vacuum drainage after axillary lymphadenectomy. Br J Surg 82:931–932

    Article  PubMed  Google Scholar 

  17. Bonnema J, van Geel AN, Ligtenstein DA, Schmitz PI, Wiggers T (1997) A prospective randomized trial of high versus low vacuum drainage after axillary dissection for breast cancer. Am J Surg 173:76–79

    Article  CAS  PubMed  Google Scholar 

  18. Keogha GW, Doughty JC, McArdle CS, Cookea TG (1998) Seroma formation related to electrocautery in breast surgery: a prospective randomized trial. Breast 7:39–41

    Article  Google Scholar 

  19. Porter KA, O’Connor S, Rimm E, Lopez M (1998) Electrocautery as a factor in seroma formation following mastectomy. Am J Surg 176:8–11

    Article  CAS  PubMed  Google Scholar 

  20. Sheen-Chen SM, Chou FF (1993) A comparison between scalpel and electrocautery in modified radical mastectomy. Eur J Surg 159(9):457–459

    CAS  PubMed  Google Scholar 

  21. Chavan RN, Chikkala B, Mondal P, Sarkar DK (2017) Comparison study between scalpel and electrocautery, in causation of seroma after modified radical mastectomy. Indian J Surg 79(5):423–426

    Article  PubMed  Google Scholar 

  22. Classen DC, Evans RS, Pestotnik SL et al (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326:281

    Article  CAS  PubMed  Google Scholar 

  23. Van Kasteren ME, Mannien J, Ott A et al (2007) Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Clin Infect Dis 44:921

    Article  PubMed  Google Scholar 

  24. Purkait B, Srivastava A, Kataria K et al (2018) Measurement of depth of premammary fascia and breast parenchyma by sonography and histological quantitation. Indian J Surg. https://doi.org/10.1007/s12262-018-1791-7

    Article  Google Scholar 

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Funding

This study is funded by AIIMS Intramural.

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Authors and Affiliations

  1. Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre and HBCH, Varanasi, Uttar Pradesh, India

    Swapnil Patel

  2. Department of Surgical Disciplines, All India Institute of Medical Sciences New Delhi, New Delhi, India

    Kamal Kataria, Piyush Ranjan, Anita Dhar, Vuthaluru Seenu & Anurag Srivastava

  3. Department of Biostatistics, All India Institute of Medical Sciences New Delhi, New Delhi, India

    Ravindra Mohan Pandey

Authors
  1. Swapnil Patel
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  2. Kamal Kataria
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  3. Piyush Ranjan
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  4. Anita Dhar
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  5. Vuthaluru Seenu
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  6. Ravindra Mohan Pandey
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  7. Anurag Srivastava
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Correspondence to Anurag Srivastava.

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Presented in European Breast Cancer Conference EBCC-10 held in Amsterdam March 9-11,2016

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Patel, S., Kataria, K., Ranjan, P. et al. Randomized Controlled Clinical Trial for Mastectomy Skin Flaps: Pre-Mammary Fascial Plane Versus a Thin Skin Flap Between Small and Large Fat Lobules and Flap Raised by Scalpel Versus Electrodiathermy. Indian J Surg 86, 385–393 (2024). https://doi.org/10.1007/s12262-023-03885-y

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