A method for reducing lymphorrhea in the postoperative period after axillary lymphadenectomy for metastatic lesion in patients with skin melanoma

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Abstract

Objective. Prevention of prolonged lymphorrhea, postoperative lymphocysts in patients with melanoma metastases after axillary lymph node dissection.

Material and methods. Patients with metastases of melanoma in axillary lymph nodes (n = 67) who underwent axillary lymph node dissection were studied. Patients were divided into two groups – comparisons (n = 35), which, after surgical intervention in the armpit, installed an active aspiration system according to Redon and the main (n = 32), patients of which, in addition to the draining system, installed an elastic rubber ball with water, which provided additional pressure on the skin. A significant difference (p<0.001) was established between the main and comparison groups in the number of hospital days spent by patients in the hospital. For a statistical comparison, the Mann-Whitney test was used, the distribution form was checked using the Kolmogorov-Smirnov test. The median and interquartile range (Me [Q25%–Q75%]) were determined as measures of the average tendency and spread.

Results. In the main group, patients with lymphorrhea stopped faster, drainage was removed earlier and the average hospital stay was 3 days shorter than in patients in the comparison group, and lymphocyst formation was not observed in comparison with the comparison group in which this complication was observed 11.4%.

Discussion. The duration of patients’ stay in the hospital directly depended on the date of drainage removal, the time of tissue adhesion and the end of lymphorrhea, the formation of a lymphocyst in the postoperative period, which directly depended on the application of a new technique of additional pressure on the tissues besides vacuum drainage.

Conclusion. the installation of hydraulics immediately after the operation leads to a faster gluing of the separated tissues, a reduction in lymphorrhea, and, accordingly, a shorter use of drainage, early removal and discharge of the patient from the hospital, and prevention of the formation of lymphocytes with the corresponding medical and economic effect. Priority certificate No. 2019109858 dated 04/03/2019 was received for the method used.

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About the authors

S. A. Yargunin

Krasnodar cancer center #1

Author for correspondence.
Email: sdocer@rambler.ru
Russian Federation, 350040, Krasnodar

Y. N. Shoyhet

Altay State Medical University

Email: sdocer@rambler.ru
Russian Federation, 656038, Barnaul

A. F. Lazarev

Altay State Medical University

Email: sdocer@rambler.ru
Russian Federation, 656038, Barnaul

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Supplementary files

Supplementary Files
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1. Fig. 1. A postoperative wound was sutured and vacuum drainage installed

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2. Fig. 2. Hydraulic

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3. Fig. 3. Hydraulic is installed in the armpit and covered with a napkin

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4. Fig. 4. Additional fixation by the adhesive material of the roller in the armpit

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5. Fig. 5. The beginning of bringing the shoulder to the body

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6. Fig. 6. The shoulder is fully brought to the body with the creation of pressure through the roller to the armpit

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