External compression dressing versus standard dressing after axillary lymphadenectomy

BACKGROUND: Closed-catheter drainage after axillary lymph node dissection ( ALND) for breast cancer may constitute a significant inconvenience to the r ecovering patient, and may also serve as portals of entry for bacteria. Any intervention that could reduce the volume and duration of postoperative dr ainage would be beneficial. The purpose of this study was to determine whet her an external compression dressing after ALND would decrease postoperativ e drainage, afford earlier drain removal, and reduce subsequent seroma form ation. PATIENTS AND METHODS: One hundred thirty-five women undergoing definitive s urgical treatment for breast cancer were randomized to receive a compressio n dressing (n = 66) or standard dressing (n = 69). They were also stratifie d for modified radical mastectomy (MRM; n = 74) or breast conservation ther apy (BCT; n = 61). All patients had ALND. The compression dressing consiste d of a circumferential chest wrap of two 6-inch Ace bandages, held in place by circumferential Elastoplast bandage, and it was applied by the same nur se. This dressing remained intact until postoperative day 4. Patients in th e standard dressing group (control) were fitted with a front-fastening Surg ibra only. Drains were removed when the total daily amount was <50 cc. Post operative drainage volume, total days with drain, and frequency of seroma f ormation were recorded for each patient. RESULTS: After 4 days, wound drainage in both groups was nearly identical ( compression = 490 cc, standard = 517 cc; P = 0.48). Total days with drain w ere also similar (compression = 6.4 days, standard = 6.1 days; P = 0.69). T he compression dressing did not reduce seroma formation. In fact, there was a statistically significant increase in the number of seroma aspirations p er patient in the compression group (compression = 2.9, standard = 1.8; P < 0.01), The increase in seroma aspirations was more significant in MRM patie nts (compression 3.1, standard = 1.7; P <0.01) than in BCT patients (compre ssion = 2.6, standard = 1.8; P = 0.20). CONCLUSIONS: External compression dressing fails to decrease postoperative drainage and may increase the incidence of seroma formation after drain rem oval. Thus, routine use of a compression dressing to reduce postoperative d rainage after ALND for breast cancer is not warranted. (C) 1999 by Excerpta Medica, Inc.