Flap Fixation; Post-Mastectomy Seroma Prevention in University of Benin Teaching Hospital, Nigeria

Abstract

Background: Post mastectomy seroma is the accumulation of serous fluid under the skin flap or axilla following mastectomy. It is a common complication post mastectomy. Several techniques have been attempted in preventing seroma following mastectomy including flap fixation. Flap fixation involves fixing the skin flaps to underlying pectoralis major muscle. The objective was to determine the efficacy of flap fixation in addition to conventional flap closure in the prevention of seroma formation post mastectomy at the University of Benin Teaching Hospital (UBTH).

Methods: This was a prospective comparative randomized study done over 12 months in UBTH. Sixty-four (64) breast cancer patients who had Auchincloss modified radical mastectomy (MRM) were randomized into two (2) groups in this study. Group A patients had flap fixation to the pectoralis major muscle with vicryl 2/0 suture followed by simple interrupted flap closure with prolene 0 while group B had simple interrupted flap closure with prolene 0 suture. Both Groups were followed up for one (1) month, examining for seroma, number of times seroma was aspirated and volume of seroma aspirated. The results were presented in tables and figures. P-value was set at < 0.05.

Results: The incidence of seroma was lower in group A (15.6%) compared to group B (28.1%), (p = 0.365). Most patients who had seroma (80%) in group A were aspirated once while most patients (55.6%) in group B had multiple aspirations (p = 0.001). The mean volume of seroma aspirated was lower in group A (32.33 ± 12.01mls) compared to group B (249.50 ± 207.04mls), (p=0.028). The mean duration of surgery in group A was prolonged (p=0.008). Patient’s satisfaction with scar outcome was not statistically significant in both groups (p = 0.676).

Conclusion: Flap fixation reduced the incidence of seroma formation. Flap fixation significantly reduced the volume of seroma and the number of times seroma was aspirated. However, it significantly prolonged the duration of operation.