ABSTRACT
Background: Modified radical mastectomy still remains the most common surgical procedure employed in definitive management of breast cancer. Post mastectomy problems include skin flap necrosis, prolonged axillary drainage, seroma formation, wound gaping etc., among all seroma is commonest. Drainage usage and dressing applied after this procedure is debatable due to varying recommendations.Methods: A prospective randomized control trial was conducted on 84 FNAC/TRUECUT biopsy proven cases of early and locally advanced breast cancer patients admitted in surgery department, GSVM Medical College, Kanpur over a period of two years. Aiming to compare full suction drainage and compression dressing (n=42) (group 1) with half suction drainage and non-compression dressing (n=34) (group 2), in terms of post-operative morbidities like skin flap necrosis, prolonged axillary drainage, seroma formation, wound gaping and length of hospital stay. Romsons 16 number Romovac drains were used for suction and 2 elastic 6” crape bandage were used for compression.Results: During follow-up there was significant lower incidence of seroma formation in group 1 patients compared to group 2 patients (p<0.0019). Full compression dressing patients have increased incidence of superficial skin necrosis compared to non-compression dressing patients (p<0.022). Patients with half suction drainage and non-compression dressing has early drain removal than patients with full suction drainage and compression dressing (p<0.05), the length of hospital stay was less in group 2 compared to group 1.Conclusions: There is markedly lesser incidence of post-operative seroma formation along with reduced morbidity in the form of patients discomfort and flap necrosis in post MRM patients with full suction drainage and compression dressing, but it requires a greater hospital stay and has slightly higher risk of superficial skin necrosis which can be easily managed with topical ointments, compared to patients with half suction drainage and non-compression dressing.
ABSTRACT
The focus of this review is to provide state-of-the-art knowledge on the involvement of oxygen free radicals (OFR) in carcinogenesis with a particular reference to skin model system as the process of cancer development is best understood in this organ. However, a brief description of the role of OFR in other organs is also provided. The term OFR refers to forms of oxygen exhibiting high reactivity and having at least one unpaired electron. The role of OFR in different stages of carcinogenesis such as initiation, promotion and progression is described. Out of many mechanisms described for the chemical initiation of tumorigenesis, a number of them may involve free radicals in the cascade of reactions. Evidences that support the involvement of free radicals in tumor promotion include (i) a number of free radical-generating compounds are found to be tumor promoters in various animal model systems, (ii) ROS generating systems can mimic the biochemical action of tumor promoters, (iii) some tumor promoters stimulate the production of ROS, (iv) tumor promoters modulate the cellular antioxidant defense systems, and (v) free radical scavengers, detoxifiers and antioxidants inhibit the process of tumor promotion. The role of ROS in the progression stage of carcinogenesis is evident from the fact that a number of different free radical generating compounds enhance the malignant conversion of benign papillomas into carcinoma and their effectiveness may be related to the type of radicals produced into the biological system.