Guidelines for Complications of Cancer Treatment Vol VIII Part B

mastectomies with axillary node clearance were randomizedto undergo suturing of skin flaps to underlying muscle orconventional skin closure. Duration of closed suction drainage,72 h, and shoulder exercises, commencing on the first postoperativeday, were standardized for both groups. Closedsuction drainage was significantly less (P < 0.05) in the groupthat had flaps sutured 272 +/- 46 ml vs 393 +/- 39 ml. Alsofewer patients in the flap sutured group developed seromas, 5(25%) vs 17 (85%) chi 2 = 12.2 P < 0.001. Three patients inthe group that had conventional skin closure had breakdownof wound edges, two developing a prolonged serous discharge,while none occurred in the sutured group. A functional rangeof shoulder motion was attained at 6 months in 14 (70%)patients in the flap sutured group compared with nine (45%)in the conventional skin closure group (P = NS). These resultsconfirm the value of suturing skin flaps to underlying musclein reducing local morbidity after mastectomy and suggest thatthis technique should be included in the closure of allmastectomy wounds.PMID: 8491318 [PubMed - indexed for MEDLINE]19. Early versus delayed shoulder motion followingaxillary dissection: a randomized prospective study.Lotze MT, Duncan MA, Gerber LH, et al. Ann Surg. 1981Mar;193(3):288-95.The role and timing of physical therapy following axillarydissection for melanoma, or in conjunction with modifiedradical mastectomy has not been extensively studied. Aprospective randomized clinical trial was carried out over an18-month period in the Surgery Branch, National CancerInstitute (NCI) and Department of Rehabilitation Medicine,Clinical Center, in which patients were assigned to receiveone of two postoperative physical therapy regimens. Patientswere assigned to receive graduated increases in allowed rangeof motion (ROM), either beginning on postoperative day 126