Surgical treatment of breast tumors is a form of body surgery, but due to the extensive and invasive nature of the surgery, many complications can occur after surgery. The common surgical complications related to breast tumor are.
1. Bleeding is one of the common complications after surgery.
This complication can occur after lumpectomy or radical resection. The causes of hemorrhage are often
1. incomplete intraoperative hemostasis, leaving active bleeding spots.
2, postoperative bleeding from drainage due to the application of continuous negative pressure drainage, change in position or violent coughing, which causes the clot of electrocoagulation to dislodge or the ligated silk to slip.
3, preoperative application of chemotherapy or hormonal drugs make the wound easy to bleed.
Intraoperative complete hemostasis, especially the intercostal vessel penetration branch next to the sternum should be ligated; attention should be paid to the bleeding point of muscle stump and dissection, ligation or electrocoagulation; after surgery, rinse the wound and carefully check whether there is out active bleeding; pay attention to the position of drainage tube placement, appropriate pressure bandage can help prevent postoperative bleeding; in addition, postoperative attention should be paid to the patency of negative pressure drainage tube and drainage flow, the nature of drainage fluid, for patients with coagulation Patients with poor coagulation mechanism should be treated symptomatically and in a timely manner according to the cause.
Fluid accumulation refers to the accumulation of fluid between the flap and the chest wall or axilla, causing the flap to be unable to adhere to the wound surface. It is also one of the common complications after breast tumor surgery.
The common causes are.
1. poor drainage so that exudate from the trauma surface cannot be drained out in time and accumulate.
2. coagulation of blood in the trauma surface to form clots which cannot be drained out and later liquefied to form effusion.
3, when dissecting the lymphatic fat around the axillary vein, some small lymphatic vessels are damaged and not ligated along with poor drainage to form effusion, which usually occurs in the lateral axilla.
4.The chance of fluid accumulation when dissecting axillary vein with electric knife is more than when using scalpel, maybe the electric knife has some influence on the healing of the wound, and some small lymphatic vessels are temporarily closed after dissection by electric knife but open after negative pressure suction, resulting in fluid accumulation.
5, in addition, the flap tension is too large to cover the wound easily and the drainage tube is removed too early, etc. also have a certain relationship.
The axillary dissection at the time of surgery should be ligated when a small exudate is found, to reduce the tension of the flap, keep the negative pressure unobstructed, and appropriate pressure dressing will help to reduce the occurrence of effusion. If fluid accumulation occurs, if the amount is small, it can be repeatedly aspirated with an empty needle; if the amount is large or if repeated aspiration is ineffective, it is advisable to reset the negative pressure suction or skin piece drainage and pressure bandaging.
Necrosis of the skin flap is also a common postoperative complication of breast cancer, which may affect the subsequent treatment due to delayed healing of the skin flap.
Radical surgery of breast cancer often requires removal of more skin, plus the flap separation is large, and the flap is too thin or unevenly peeled, which may destroy the capillaries in the dermis and affect the blood supply of the flap after surgery; or the tension of the flap suture is too high, which may cause ischemic necrosis of the flap when the wound accumulates fluid after surgery; sometimes the improper operation of the electric knife causes local skin burns or vascular coagulation embolism, which may also lead to flap necrosis. The flap necrosis can also be caused by local skin burns or vascular coagulation embolism caused by improper use of the electric knife. The necrosis of the flap is usually seen 24 hours after surgery, when the ischemic skin becomes pale, gradually bruised and edematous, with small blisters on the surface, and the boundaries of the necrotic area gradually become clear after 3-7 days, and the skin gradually becomes black and crusty.
Before surgery, the incision should be designed reasonably to avoid over-length of one flap; pay attention to the level of flap separation, reduce flap tension, and give skin grafting if necessary; avoid fluid accumulation, and appropriate dressing will help to reduce flap necrosis. If flap necrosis occurs, the necrotic flap can be removed after the necrotic area is clearly defined. If the necrosis is marginal and the area is less than 2 cm, it can often heal by itself with wet dressing and drug change after debridement; if the area of necrosis is large and the patient is unwilling to accept the implant, the wound healing is often delayed and the epidermis grown later is often white and thin, which is easily broken after friction.
The incidence of upper limb edema varies from 5% to 40% as reported by various countries. In recent years, the incidence of severe upper extremity edema has decreased significantly and does not exceed 5%. Causes of severe upper extremity reflux disorders.
1, the scope of axillary clearance is inappropriate, which destroys the local collateral circulation. In the past, the lymphatic fat around the axillary vein was dissected and the axillary sheath was often removed at the same time, which also affected the postoperative lymphatic reflux. Therefore, if no obvious enlarged lymph nodes were seen during surgery, the axillary vascular sheath may not be removed.
2.The axillary area has fluid accumulation or infection, causing local congestion, fibrosis and scar formation which prevent the establishment of collateral circulation.
3.Postoperative radiotherapy in the supraclavicular and infraclavicular regions and axillary region causes local edema, connective tissue hyperplasia, local fibrosis followed by edema.
Upper limb edema can appear several days or even years after surgery, and the swelling is often in the upper arm, but also in the forearm or the back of the hand. The occurrence of upper extremity edema can be reduced by frequent exercise of upper extremity function, avoiding excessive physical work on the upper extremity and avoiding infection of the upper extremity after surgery. Once edema occurs in the upper limb, only symptomatic treatment can be applied to reduce edema.
V. Muscle atrophy of the upper limb and hand is often caused by injury to the brachial plexus nerve or its sheath during surgery, and atrophy of the lesser interosseous muscle is common.