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Elective hand surgery in the breast cancer patient with prior ipsilateral axillary dissection

Identifieur interne : 00C624 ( Main/Exploration ); précédent : 00C623; suivant : 00C625

Elective hand surgery in the breast cancer patient with prior ipsilateral axillary dissection

Auteurs : William J. Dawson ; Douglas R. Elenz [États-Unis] ; David P. Winchester ; Joseph L. Feldman

Source :

RBID : ISTEX:1F09F30E1E1D21D9BA137D3E475833FFD0BAA64B

Descripteurs français

English descriptors

Abstract

Abstract: Background: We wished to determine if complications after elective hand 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.) from 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 identical for both groups, with i.v. regional anesthesia used most commonly. Results: No patient in the axillary dissection group developed any postoperative 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 therapy. 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 ipsilateral axillary dissection can safely undergo elective upper extremity surgery, 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 manipulations, including venepunctures, blood pressure measurements, or elective surgery.

Url:
DOI: 10.1007/BF02303628


Affiliations:


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Le document en format XML

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<term>Aged</term>
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<term>Axilla</term>
<term>Breast Neoplasms (surgery)</term>
<term>Carpal Tunnel Syndrome (rehabilitation)</term>
<term>Carpal Tunnel Syndrome (surgery)</term>
<term>Elective Surgical Procedures</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Lymph Node Excision (adverse effects)</term>
<term>Lymphedema (etiology)</term>
<term>Mastectomy, Modified Radical (adverse effects)</term>
<term>Mastectomy, Radical (adverse effects)</term>
<term>Mastectomy, Segmental (adverse effects)</term>
<term>Middle Aged</term>
<term>Nerve Block</term>
<term>Physical Therapy Modalities</term>
<term>Postoperative Complications</term>
<term>Surgical Wound Infection (etiology)</term>
<term>Tourniquets</term>
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<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Aisselle</term>
<term>Bloc nerveux</term>
<term>Complications postopératoires</term>
<term>Femelle</term>
<term>Garrots</term>
<term>Humains</term>
<term>Infection de plaie opératoire (étiologie)</term>
<term>Interventions chirurgicales non urgentes</term>
<term>Lymphadénectomie (effets indésirables)</term>
<term>Lymphoedème (étiologie)</term>
<term>Mastectomie partielle (effets indésirables)</term>
<term>Mastectomie radicale (effets indésirables)</term>
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<term>Follow-Up Studies</term>
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<term>Adulte d'âge moyen</term>
<term>Aisselle</term>
<term>Bloc nerveux</term>
<term>Complications postopératoires</term>
<term>Femelle</term>
<term>Garrots</term>
<term>Humains</term>
<term>Interventions chirurgicales non urgentes</term>
<term>Sujet âgé</term>
<term>Sujet âgé de 80 ans ou plus</term>
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<div type="abstract" xml:lang="en">Abstract: Background: We wished to determine if complications after elective hand 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.) from 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 identical for both groups, with i.v. regional anesthesia used most commonly. Results: No patient in the axillary dissection group developed any postoperative 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 therapy. 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 ipsilateral axillary dissection can safely undergo elective upper extremity surgery, 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 manipulations, including venepunctures, blood pressure measurements, or elective surgery.</div>
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