ELECTIVE HAND SURGERY IN THE BREAST-CANCER PATIENT WITH PRIOR IPSILATERAL AXILLARY DISSECTION

Background: We wished to determine if complications after elective han d surgery were greater in women with previous mastectomy and axillary dissection than in those without. Methods: We surveyed records of all women undergoing carpal tunnel release by the senior author (W.J.D.) f rom 1983 to 1993. The postaxillary dissection group (group A) was made up of 15 women; seven had some postdissection lymphedema. Group B was made up of 302 other patients who had not undergone breast surgery or axillary dissection. Anesthetic and surgical techniques were identica l for both groups, with i.v. regional anesthesia used most commonly. R esults: No patient in the axillary dissection group developed any post operative infection or had any worsening of preexisting lymphedema or onset of new arm swelling after ipsilateral carpal tunnel release. The nonaxillary dissection group had a postoperative infection rate of 3. 6%; all infections were superficial and resolved with conservative the rapy, In addition, 31 women experienced other complications, including 13 with hand/finger stiffness and four with reflex dystrophy. Fifteen required formal hand therapy. Conclusions: Women with prior ipsilater al axillary dissection can safely undergo elective upper extremity sur gery, provided strict sterile technique and appropriate anesthetic and surgical precautions are observed. Patients having undergone previous axillary dissection should not be prohibited from future limb manipul ations, including venepunctures, blood pressure measurements, or elect ive surgery.