(1)Upper limb edema after radical mastectomy, due to upper back by the lymphatic and blood disorder caused by upper extremity edema easy, the incidence of upper extremity edema Gejia reported from 5% to 40% range. In recent years, the incidence of severe upper extremity edema has been a marked decline, no more than 5%. Upper back causing a serious obstacle to the reasons:
1.Axillary dissection range of inappropriate and undermines the local collateral circulation. In the past to the lymph fat around the axillary vein anatomy, often at the same time the axillary sheath be removed, will also affect the postoperative lymphatic flow, thus surgery if no significant swelling large lymph nodes when the axillary vascular sheath is bound to set aside from time except, in fact violations of axillary lymph nodes if axillary sheath, often have non-surgical cure can fully meet the purpose.
2.Axilla district effusion or infection, causing local congestion, fibrosis, scar formation hampered the establishment of collateral circulation.
3.Clavicle after the upper and lower areas and axillary radiation therapy area, causing localized edema, connective tissue hyperplasia, followed by local fibrosis caused by edema.
Upper extremity edema may result, after a few days after a few years, swelling and often part of the upper arm, forearm or back of the hand can also be. Upper extremity function after regular exercise, avoid heavy manual work carried out upper and avoid infection of the upper extremity can reduce the incidence of upper extremity edema. Upper extremity edema and can only be applied once the symptomatic treatment appears to reduce the edema.
(2)The upper limb and hand muscle atrophy often a result of surgery or brachial plexus injury caused by its sheath, common with hypothenar muscle atrophy.
(3)Bleeding is a common complication of surgery. Line tumor resection or radical resection may have such complications. Often cause bleeding as follows:
1.Intraoperative bleeding is not complete, the remaining are active bleeding point;
2.After application of continuous negative pressure due to drainage, postural change, or severe coughing and other reasons so that coagulation of the blood clot, or ligation of the thread slip off, causing drainage of hemorrhage;
3.Preoperative chemotherapy or hormone drugs to make easy oozing wounds.
Surgery to stop bleeding completely, especially the breastbone next to the ligation of intercostal artery perforator wait on them; right muscle stump and the profile of the bleeding points should be noted, ligation or electrocoagulation; surgery completed flushing out the wound and carefully checked for active bleeding ; Note the location of drainage tube placement, appropriate compression bandage to help prevent postoperative bleeding; In addition, patients should pay attention to negative-pressure drainage tube patency and drainage volume, drainage fluid in nature and there is bad blood coagulation mechanisms of patients should address the causes of timely symptomatic treatment.
(4)Fluid-finger flap and the chest wall or armpit between the accumulation of liquid, resulting in flap does not close on the wound. It is also a common complication after breast cancer is one. Common reasons are:
1.Poor drainage so that the wound exudate leads to the accumulation of fluid can not be timely;
2.Wound to form a clot of blood coagulation and can not drain out, after the liquefaction of the formation of effusion;
3.Anatomic axillary lymph veins around the fat, some small lymphatic vessels ligation injury without the formation of effusion with poor drainage, generally occurred in the axillary lateral;
4.Electric knife anatomy axillary vein that occurs when fluid more often than the use of scalpel as more likely to electric surgical knives on wound healing to a certain extent, and by the electric knife anatomy of lymphatic vessels after some small temporary closure in the vacuum attractive as there are open, resulting in effusion;
5.In addition, the Ambassador of flap tension is too difficult to cover the wound as well as the early removal of drainage tubes, also have a certain relationship.
When axillary dissection patients found to have a small effusion should be neutered, to reduce the tension flap, maintaining negative pressure smooth, proper pressure bandage will help reduce the occurrence of fluid. In case of fluid, if the amount of which could be repeated when there are fewer empty needle aspiration; if a larger or more times the amount of suction is invalid, it is desirable to reset the vacuum aspiration or drainage and compression bandage skin.
(5)Fkin flap necrosis is a common complication after breast cancer, due to delayed healing of skin graft necrosis may affect the follow-up treatment. Radical mastectomy which require the removal of more skin, combined with a larger range of flap separation, peeling skin flap too thin or uneven thickness will lead to the destruction of dermal capillaries, affecting the blood supply of flap; or skin flaps when the tension is too large, postoperative wound effusion can also cause skin flap ischemic necrosis; and sometimes the use of electric knife local skin burns caused by improper operation or embolization of vascular coagulation are also easily lead to flap necrosis. Flap necrosis after 24 hours in general will see the pale skin of ischemia, and gradually was black and blue swelling, the surface of a small bubble, 3 ~ 7 days to gradually clear the boundaries of necrotic area, the skin gradually black hard scab-like.
Rational design of pre-operative incision, avoiding the side of the flap was too long; attention to the level of separation flaps to reduce skin flap tension, if necessary, be grafting; to avoid the fluid, appropriate bandaging and other measures will help to reduce skin flap necrosis . If flap necrosis occurs in the necrotic area boundaries may be evident after the removal of necrotic flap. As for the incision marginal necrosis, with an area of less than 2cm, after debridement to be wet packing, dressing, often can be self-healing; necrosis of large area should be grafting; if the necrotic area is large and when the patient was unwilling to accept the skin graft, often so delayed wound healing, and the subsequent growth of the white skin Changchengnongxing paltry easy to break after friction.