application of autologous blood products during modified radical mastectomy

Conditions: Mastectomy

Summary: the purpose of this study is to determine if the application of autologous (your own blood) blood products during mastectomy improves wound healing and decreases complications following surgery compared to mastectomy without the use of autologous blood products.

a frequent complication of mastectomy is seroma formation with rates in the literature reported at 3-50%. although seroma formation can be considered more of a nuisance than a serious complication, the presence of seroma can lead to wound infection, skin flap necrosis, wound dehiscence, nerve injury, and lymphedema in mastectomy patients.various approaches to reduce seroma formation have included the use of external compression dressings, ultrasound cutting devices, suction drainage systems, and bovine thrombin. although some of these interventions have demonstrated efficacy, none has gained widespread acceptance. investigation of alternative interventions during mastectomy procedures that could reduce the rate of postoperative seroma formation, thereby reducing the likelihood of the onset of more serious complications, still has value to the patient and surgeon. the use of autologous blood products (abp), in particular platelet rich plasma (prp), has been advocated for numerous indications. as a surgical tool, abp are typically applied to the surgical site during the latter stages of the procedure in combination with bovine thrombin. the aim of prp application is to accelerate the healing cascade via application of elevated cytokine concentrations released during platelet degranulation. it is hypothesized that the elevated cytokine levels will elucidate an accelerated healing response of the affected tissue. preliminary evidence suggests that this expedited healing response correlates with a reduction in postoperative wound complications. platelet poor plasma, a by-product of prp processing, has been advocated as providing additional hemostasis. the majority of the literature discussing clinical applications of abp to date, has been unblinded and nonrandomized. although useful as demonstrations of the safety of abp, this current literature does not truly investigate the efficacy of these applications. there is a need for well-designed, well-controlled studies investigating the application of abp as surgical tools. it is hypothesized that a significant reduction in postoperative complications, in particular seroma formation, will result due to the use of abp during these procedures.

Eligibility criteria:
inclusion criteria: 1. patient undergoing a modified radical mastectomy, simple mastectomy or axillary lymph node dissection. 2. patient signature of informed consent form exclusion criteria: 1. pregnancy 2. \< 18 years of age 3. history of anemia (hemoglobin \< 11.0) 4. history of any blood disorder, deep vein thrombosis, pulmonary emboli or clotting disorders. 5. un-cooperative patient or patient with neurological disorders who are incapable of following directions or who are predictably unwilling to return for follow-up examinations 6. allergy to bovine products 7. history of mrsa in last 12 months 8. communicable disease or diseases that may limit follow- up (e.g. immunocompromised conditions, hepatitis, active tuberculosis)

Keywords: mastectomy seroma lymph node dissection