RESUMO
BACKGROUND: To reduce the risk of seroma after modified radical mastectomy in breast cancer patients, the use of suction axillary drainage is a standard procedure. The optimal time to remove the drain is not established. Whether the removal or preservation of the pectoral fascia influences the risk of seroma formation or loco-regional recurrence rate remains unclear. METHOD: The trial included 247 patients with breast cancer who underwent modified radical mastectomy in five Swedish hospitals 1993-1997. The median follow-up time was 6 years. One hundred and twenty-two and 125 patients, respectively, were randomised between removal versus preservation of the pectoral fascia. Of these 247 patients a total of 198 patients were also randomised to have the drain removed 24 h postoperatively or to keep the drain in until discharge had decreased to less than 40 ml/24 h. RESULTS: Early removal of the axillary drain was associated with significantly more seromas and a shorter average postoperative hospital stay. There were no differences between the two groups regarding the rate of wound infections and/or hematoma formation. Removal or preservation of the pectoral fascia did not influence the formation of seroma or the amount of peroperative bleeding. A trend towards an increased risk for chest wall recurrence was observed in patients with preserved pectoral fascia (16/125 compared with 8/122; hazard ratio=2.0, 95% confidence interval=0.9-4.7). CONCLUSION: Early removal of axillary drain shortened the duration of hospital stay without any increase in wound complications. However, it yielded a significantly higher incidence of seroma. Seroma formation and the chest wall recurrence rate was not significantly influenced by the preservation of the pectoral fascia or not.
Assuntos
Axila/cirurgia , Neoplasias da Mama/cirurgia , Mastectomia/métodos , Sucção , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Terapia Combinada , Fasciotomia , Feminino , Hematoma/etiologia , Humanos , Tempo de Internação , Linfa , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Músculos Peitorais , Estudos Prospectivos , Receptores de Estrogênio/análise , Sucção/métodos , Infecção da Ferida Cirúrgica/etiologia , Resultado do TratamentoRESUMO
In 20 female performers of classical ballet the range of dorsiflexion of the big toe was found to be significantly decreased. However, in only one case was the decrease sufficiently great to interfere with the dancer's ability to perform. In spite of the severe stress put on the first metatarso-phalangeal joint in dancers the resulting degenerative changes were found to be minor and in most instances without clinical consequences. The results indicate that professional ballet, contrary to what is believed, rarely has harmful effects on the first metatarso-phalangeal joint.
