Morbidity After Inguinal Lymph Node Dissections: It Is Time for a Change
Identifieur interne : 000D80 ( Main/Exploration ); précédent : 000D79; suivant : 000D81Morbidity After Inguinal Lymph Node Dissections: It Is Time for a Change
Auteurs : Marloes Faut [Pays-Bas] ; Rianne M. Heidema [Pays-Bas] ; Harald J. Hoekstra [Pays-Bas] ; Robert J. Van Ginkel [Pays-Bas] ; S. Lukas B. Been [Pays-Bas] ; Schelto Kruijff [Pays-Bas] ; Barbara L. Van Leeuwen [Pays-Bas]Source :
- Annals of Surgical Oncology [ 1068-9265 ] ; 2016.
Abstract
Inguinal lymph node dissection (ILND) for stage 3 melanoma is accompanied by high wound complication rates. During the past decades, several changes in perioperative care have been instituted to decrease the incidence of these complications. This study aimed to evaluate the effect of these different care protocols on wound complications after ILND.
A retrospective analysis of prospectively collected data was performed with 240 patients who underwent an ILND in the University Medical Center Groningen between 1989 and 2014. Four groups with different treatment protocols were analyzed: A (≥10 days of bed rest with a Bohler Braun splint), B (10 days of bed rest without a splint), C (5 days of bed rest), and D (1 day of bed rest). The effect of early mobilization, abolishment of the Bohler Braun splint and postural restrictions, and the introduction of prophylactic antibiotics were analyzed.
One or more wound complications occurred in 51.2 % of the patients including wound infection (29.8 %), seroma (21.5 %), wound necrosis (13.6 %), and hematoma (5 %). In consecutive periods, respectively 44.4, 60.3, 44.9 and 55.2 % of the patients experienced wound complications. None of the instituted changes in protocols led to a decrease in wound complications.
Changes in perioperative care protocols did not affect the rate of wound complications. Perhaps a change in the surgical procedure itself can lead to the necessary reduction of wound complications after ILND.
Url:
DOI: 10.1245/s10434-016-5461-3
PubMed: 27519351
PubMed Central: 5215190
Affiliations:
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Heidema</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region><settlement type="city">Groningue (ville)</settlement></placeName><orgName type="university">Université de Groningue</orgName></affiliation></author><author><name sortKey="Hoekstra, Harald J" sort="Hoekstra, Harald J" uniqKey="Hoekstra H" first="Harald J." last="Hoekstra">Harald J. Hoekstra</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region><settlement type="city">Groningue (ville)</settlement></placeName><orgName type="university">Université de Groningue</orgName></affiliation></author><author><name sortKey="Van Ginkel, Robert J" sort="Van Ginkel, Robert J" uniqKey="Van Ginkel R" first="Robert J." last="Van Ginkel">Robert J. Van Ginkel</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region><settlement type="city">Groningue (ville)</settlement></placeName><orgName type="university">Université de Groningue</orgName></affiliation></author><author><name sortKey="Been, S Lukas B" sort="Been, S Lukas B" uniqKey="Been S" first="S. Lukas B." last="Been">S. Lukas B. Been</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region><settlement type="city">Groningue (ville)</settlement></placeName><orgName type="university">Université de Groningue</orgName></affiliation></author><author><name sortKey="Kruijff, Schelto" sort="Kruijff, Schelto" uniqKey="Kruijff S" first="Schelto" last="Kruijff">Schelto Kruijff</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region><settlement type="city">Groningue (ville)</settlement></placeName><orgName type="university">Université de Groningue</orgName></affiliation></author><author><name sortKey="Van Leeuwen, Barbara L" sort="Van Leeuwen, Barbara L" uniqKey="Van Leeuwen B" first="Barbara L." last="Van Leeuwen">Barbara L. Van Leeuwen</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Surgical Oncology, Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen</wicri:regionArea><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region><settlement type="city">Groningue (ville)</settlement></placeName><orgName type="university">Université de Groningue</orgName></affiliation></author></analytic><series><title level="j">Annals of Surgical Oncology</title><idno type="ISSN">1068-9265</idno><idno type="eISSN">1534-4681</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Inguinal lymph node dissection (ILND) for stage 3 melanoma is accompanied by high wound complication rates. During the past decades, several changes in perioperative care have been instituted to decrease the incidence of these complications. This study aimed to evaluate the effect of these different care protocols on wound complications after ILND.</p></sec><sec><title>Methods</title><p>A retrospective analysis of prospectively collected data was performed with 240 patients who underwent an ILND in the University Medical Center Groningen between 1989 and 2014. Four groups with different treatment protocols were analyzed: A (≥10 days of bed rest with a Bohler Braun splint), B (10 days of bed rest without a splint), C (5 days of bed rest), and D (1 day of bed rest). The effect of early mobilization, abolishment of the Bohler Braun splint and postural restrictions, and the introduction of prophylactic antibiotics were analyzed.</p></sec><sec><title>Results</title><p>One or more wound complications occurred in 51.2 % of the patients including wound infection (29.8 %), seroma (21.5 %), wound necrosis (13.6 %), and hematoma (5 %). In consecutive periods, respectively 44.4, 60.3, 44.9 and 55.2 % of the patients experienced wound complications. None of the instituted changes in protocols led to a decrease in wound complications.</p></sec><sec><title>Conclusion</title><p>Changes in perioperative care protocols did not affect the rate of wound complications. Perhaps a change in the surgical procedure itself can lead to the necessary reduction of wound complications after ILND.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Baas, Pc" uniqKey="Baas P">PC Baas</name></author><author><name sortKey="Schraffordt Koops, H" uniqKey="Schraffordt Koops H">H Schraffordt Koops</name></author><author><name sortKey="Hoekstra, Hj" uniqKey="Hoekstra H">HJ Hoekstra</name></author><author><name sortKey="Van Bruggen, Jj" uniqKey="Van Bruggen J">JJ van Bruggen</name></author><author><name sortKey="Van Der Weele, Lt" uniqKey="Van Der Weele L">LT van der Weele</name></author><author><name sortKey="Oldhoff, J" uniqKey="Oldhoff J">J Oldhoff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Vries, M" uniqKey="De Vries M">M de Vries</name></author><author><name sortKey="Vonkeman, Wg" uniqKey="Vonkeman W">WG Vonkeman</name></author><author><name sortKey="Van Ginkel, 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uniqKey="Prevost A">AT Prevost</name></author><author><name sortKey="Gulliford, Mc" uniqKey="Gulliford M">MC Gulliford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Delman, Ka" uniqKey="Delman K">KA Delman</name></author><author><name sortKey="Kooby, Da" uniqKey="Kooby D">DA Kooby</name></author><author><name sortKey="Ogan, K" uniqKey="Ogan K">K Ogan</name></author><author><name sortKey="Hsiao, W" uniqKey="Hsiao W">W Hsiao</name></author><author><name sortKey="Master, V" uniqKey="Master V">V Master</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Martin, Bm" uniqKey="Martin B">BM Martin</name></author><author><name sortKey="Etra, Jw" uniqKey="Etra J">JW Etra</name></author><author><name sortKey="Russell, Mc" uniqKey="Russell M">MC Russell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jakub, Jw" uniqKey="Jakub J">JW Jakub</name></author><author><name sortKey="Terando, Am" uniqKey="Terando A">AM Terando</name></author><author><name sortKey="Sarnaik, A" uniqKey="Sarnaik A">A Sarnaik</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Pays-Bas</li></country><region><li>Groningue (province)</li></region><settlement><li>Groningue</li><li>Groningue (ville)</li></settlement><orgName><li>Université de Groningue</li></orgName></list><tree><country name="Pays-Bas"><region name="Groningue (province)"><name sortKey="Faut, Marloes" sort="Faut, Marloes" uniqKey="Faut M" first="Marloes" last="Faut">Marloes Faut</name></region><name sortKey="Been, S Lukas B" sort="Been, S Lukas B" uniqKey="Been S" first="S. Lukas B." last="Been">S. Lukas B. Been</name><name sortKey="Heidema, Rianne M" sort="Heidema, Rianne M" uniqKey="Heidema R" first="Rianne M." last="Heidema">Rianne M. Heidema</name><name sortKey="Hoekstra, Harald J" sort="Hoekstra, Harald J" uniqKey="Hoekstra H" first="Harald J." last="Hoekstra">Harald J. Hoekstra</name><name sortKey="Kruijff, Schelto" sort="Kruijff, Schelto" uniqKey="Kruijff S" first="Schelto" last="Kruijff">Schelto Kruijff</name><name sortKey="Van Ginkel, Robert J" sort="Van Ginkel, Robert J" uniqKey="Van Ginkel R" first="Robert J." last="Van Ginkel">Robert J. Van Ginkel</name><name sortKey="Van Leeuwen, Barbara L" sort="Van Leeuwen, Barbara L" uniqKey="Van Leeuwen B" first="Barbara L." last="Van Leeuwen">Barbara L. Van Leeuwen</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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