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Invited Critique |

Axillary Padding as an Alternative to Closed Suction Drain for Ambulatory Axillary Lymphadenectomy—Invited Critique

Constantine P. Karakousis, MD, PhD
Arch Surg. 2002;137(2):173. doi:10.1001/archsurg.137.2.173.
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Classe et al evaluate the results of axillary lymphadenectomy in a prospective cohort of 207 patients with early breast cancer. Their aim was to eliminate the use of axillary drains and reduce the hospital stay to that of an ambulatory procedure or to a 1- to 2-day stay. On the basis of selection criteria and patient preference, 103 patients were assigned to an OD group and 104 patients were assigned to a T group of 1 to 2 days. Of the 103 patients in the OD group, 87 were discharged within 6 hours after the procedure and 16 stayed overnight. The overall incidence of axillary seroma requiring aspiration was 22.2%. Classe and colleagues used a "functional" axillary lymphadenectomy, which preserved the medial cutaneous nerve of the arm, the 2 intercostobrachial nerves, and the pedicle of the external mammary artery and vein. The "padding" of the axilla was performed through the placement of 3 sutures between the 2 edges of the axillary fascia and the pectoralis major muscle border anteriorly, the serratus anterior muscle in the middle, and the latissimus dorsi posteriorly; this procedure obliterates the dead space in the axilla. Classe et al have demonstrated that, for a limited axillary node dissection (average number of retrieved nodes, 8.3-9.0) for early breast cancer, it is possible to eliminate the use of suction drainage by using their technique.

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