Efficacy of harmonic focus scalpel in seroma prevention after axillary clearance.

INTRODUCTION: Seroma formation in breast cancer patients who have undergone axillary lymph node dissection (ALND) is a source of significant discomfort and morbidity. We aimed to ascertain seroma incidence after ALND, when Harmonic Focus (HF) scalpel is used for dissection instead of conventional diathermy (CD). METHODS(AND PATIENTS): This retrospective study was carried out in a single hospital over 6 years. Patients were allocated into HF group (HFG) or CD group (CDG). Seroma volume, hospital stay, and complications were evaluated. RESULTS: Of 94 patients, 42 were in the HFG and 52 in the CDG. Two day median seroma volume was 205 ml (IQR 95-265) for HF, and 227.5 ml (IQR 149-385) for CD. The total median seroma output was 270 ml (IQR 160-478) for HF, and 385 ml (IQR 220-558) for CD. No statistically significant differences between HFG and CDG were identified in these data, as well as patient demographics, operative time, and complication rates. Duration of surgery >2.5 h increased seroma formation (p < 0.001). Mastectomy and ALND increased seroma formation compared to wide local excision (WLE) and ALND (p < 0.05). Nodal involvement, number of lymph nodes resected, and extra nodal spread did not influence seroma formation. DISCUSSION(AND CONCLUSION): In our hands, HF use was not superior to CD in limiting seroma formation in ALND for breast cancer. Increased seroma formation in surgeries >2.5 h in duration is commensurate with surgeries involving mastectomy and ALND (>2.5 h in our study), which entails greater and sustained tissue and lymphovascular trauma.

Trends in tracheal intubation: emphasis on the difficult airway.

PURPOSE OF REVIEW: This review will summarize the progress made during the last year in improving difficult-airway management. RECENT FINDINGS: The UK Difficult Airway Society have published extensive guidelines for the management of unanticipated difficult intubation in the unobstructed adult patient. That such an approach is useful has been demonstrated in an independent study which showed that simple guidelines using familiar equipment will solve the majority of intubation difficulties likely to be encountered. However, their limitation lies in the fact that the worst-case scenario (i.e. inability to ventilate or intubate) is so rare that it cannot be studied systematically. It is postulated that a different approach geared to understanding the causes of difficulties with intubation may provide an alternative strategy for providing an evidence base. SUMMARY: Significant steps have been made in our management of the difficult airway, and the majority of the problems encountered can be solved with recourse to simple published guidelines.