"Topical Tranexamic Acid With Flap Fixation: A Novel Approach to Minimize Post-operative Drainage and Surgical Site Infection in Patients Undergoing Modified Radical Mastectomy"
"Topical Tranexamic Acid With Flap Fixation: A Novel Approach to Minimize Post-operative Drainage and Surgical Site Infection in Patients Undergoing Modified Radical Mastectomy"
Seroma (a collection of fluid under the skin) is a common problem after breast cancer surgery, especially after modified radical mastectomy (MRM), where lymph nodes from the armpit are also removed. This can happen because surgery may damage small blood and lymph vessels. Doctors use different methods to reduce this fluid buildup, such as special glues, drains, and stitching techniques, but results are not always the same.
Tranexamic acid (TXA) is an affordable medicine that can help reduce bleeding, bruising, and fluid collection after surgery. A study at Mayo Hospital (2023-2024) looked at whether applying TXA directly to the surgical wound, along with a stitching method called flap fixation, could improve healing after breast cancer surgery.
In this study, 62 patients were divided into two groups. One group received TXA in the wound plus flap fixation, while the other group had flap fixation only. Researchers compared wound infection rates and the amount of fluid collected after surgery.
The results showed that using TXA with flap fixation significantly reduced fluid collection (seroma) and wound infection. This method is safe, simple, and cost-effective, and may help improve recovery for patients undergoing breast cancer surgery.
Seroma is invariably associated with breast cancer surgery and is a recurring, problematic issue that has affected large number of patients. MRM in patients having locally advanced breast cancer has raised serious questions about the methods of prevention and management of subsequent seroma as axillary dissection is a strong risk factor for seroma formation, most likely damaging blood and lymphatic vessels. Various methods like topical fibrin sealants, suction drainage and quilting have been used to reduce its incidence with variable outcomes. Topical tranexamic acid (TXA) was demonstrated as a unique and inexpensive pharmacologic agent capable of decreasing blood loss, hematoma, seroma, and bruising among various general surgical and reconstructive procedures.
A study was conducted to assess the impact of applying tranexamic acid topically in combination with flap fixation on wound outcomes in patients undergoing MRM for breast cancer, focusing on the incidence of surgical site infections and the volume of postoperative drainage on surgical floor, of Mayo Hospital from 2023 to 2024.
After taking approval from ethical committee a total of 62 patients were selected as per inclusion criteria. The patients were randomized into two groups i.e. Group A patients underwent topical application of tranexamic acid along with flap fixation in mastectomy wound. While in group B patients, mastectomy wound was closed without topical application of tranexamic acid with flap fixation.
Data was entered in SPSS 26 version. Comparative analysis of two groups, Group A (with topical tranexamic acid application along with Flap Fixation) and Group B (without topical tranexamic acid application along with Flap Fixation) was done by applying chi-square test for wound infection and independent t-test for drain volume. P value <0.05 will be considered important.
Topical application of tranexamic acid, along with flap fixation has been found to decrease seroma formation and surgical site infection to a significant extent. Not only is this technique cost-effective but it is also easily applicable in patients with breast cancer who are scheduled to undergo MRM.
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