Clinical Implication Of Internal Fixation Of Flap Combined With Single-layer Suture In Modified Radical Mastectomy Of Breast Cancer

BackgroundBreast cancer(BC)is the most common malignant tumor among females and the leading cause of cancer-related death worldwide.As the basic treatment of breast cancer,surgical treatment has undergone a very long process of development.Although breast conserving surgery(BCS)and sentinel lymph node biopsy(SLNB)are widely used,complete mastectomy combined with axillary lymph node dissection,which was defined as modified radical mastectomy,still remains a viable option for breast cancer,especially those with clinical positive axillary lymph node.Postoperative seroma is a common complication after modified radical mastectomy,which is associated with significant impact on patient outcomes and healthcare costs.Mechanisms leading to seroma involve inflammatory reactions,lymphatic vessels section,and the presence of dead space after the removal of mammary gland.However,the optimal approach for seroma prevention remains unknown but some evidence suggests that quilting suture of the dead space between the flap and pectoralis major could lower the incidence of seroma.The manner in which an incision is closed and managed can influence cosmetic outcome postoperatively.Researches show that worse scar could lead to psychological burden as well as the loss of confidence.Therefore,surgeons should make efforts to improve the cosmetic outcome of surgical incisions.Currently,the common manner of suturing incision is double-layer style which include subcutaneous vertical mattress suture and intradermal continuous suture.However,there are still some patients bearing bad cosmetic outcome of incisions.Objective:The aim of this trial is to compare seroma formation using internal fixation of flap method versus conventional method in patients undergoing mastectomy.At the same time,we also compare the cosmetic outcome of wound by two different ways of incision closure.Methods:345 breast cancer patients about to undergo mastectomy for breast cancer were enrolled in this prospective,randomized controlled trial and were randomly divided into four groups,including flap fixation group,single-layer suture group,combined group and conventional group.We conducted an observational comparison of the incidence of postoperative seroma formation between flap fixation group and conventional group,as well as the cosmetic outcome of wound between single-layer suture group and conventional group.Moreover,we also comparedcombined group and conventional group by evaluating the postoperative complications and cosmetic outcome of surgical incisions.Results:1.The incidence of seroma and the mean drained volume were significantly lower in flap fixation group compared with the conventional group(P<0.01).The mean duration of surgical procedure was not statistically different in the lap fixation group versus conventional group(P>0.05).2.Both the mean VAS cosmetic outcome scores and mean m HCS cosmetic outcome total scores for single-layer suture group were better than conventional group(P<0.05).Suture time of single-layer suture group were shorter than that of conventional group(P<0.01)3.The mean duration of surgical procedure was not statistically different in the combined group versus conventional group(P>0.05).The incidence of seroma and the mean drained volume were significantly lower in combined group compared with the conventional group(P<0.01).The cosmetic outcome including VAS and m HCS scores of combined group were better than conventional group(P<0.05)Conclusion:1.The use of internal fixation of flap after mastectomy seems to reduce seroma formation,and drained volume.2.Patients underwent single-layer suture had significantly better cosmetic outcome than those with conventional manner.3.The combination of flap fixation and single-layer suture is associated with significantly less frequent seroma and better cosmetic outcome of would than conventional manner.