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- W2517024582 abstract "Grant support received from: American Foundation for Surgery of the Hand Salary: Deputy editor for JHS; updates editor for Elsevier (Wolf)Royalty: Biomet (Gaston)Receipt of Intellectual Property Rights/Patent Holder: Biomet (Gaston)Consulting Fee: BME, Biomet, Endo Pharmaceuticals, Smith and Nephew (Gaston) We hypothesized that there is no clinically relevant difference defined as less than or equal to 5% in the incidence of lymphedema or surgical complication rates between patients undergoing upper extremity surgery without a brachial tourniquet (Group 1) and with a brachial tourniquet (Group 2). A prospective, multi-center, ASSH-funded study was undertaken to evaluate the rate of lymphedema and peri-operative complications in patients undergoing elective hand surgery with a history of breast cancer and ipsilateral lymph node dissection. Procedures were varied and ranged from trigger finger release to metastatic cancer excision from the brachial plexus. Validated volumetric measurements of the limb were obtained pre and post surgery and all complications were recorded. Forty-four patients have completed follow up with 24 having had surgery with a tourniquet and 20 without a tourniquet. Mean patient age of 61 years was not different between groups (P = 0.85). The median time from mastectomy for patients without tourniquet was 10.8 years [IQR 2.2-18.5], compared to 8.0 years [IQR 3.7-15.7 years] (P = 0.94). The median number of lymph nodes dissected in patients without tourniquet was 10 [IQR 5.5-19], compared to 12 [IQR 4-18.5] in patients in which a tourniquet was used (P = 0.78). Overall, 47% of patients had previous radiation (P = 0.92) and 30% of patients had a previous history of lymphedema with similar rates between the two groups (P = 0.86). Five percent of patients had been previously advised by their oncologist to never have surgery on the involved limb. Standard descriptive statistics were calculated. Groups were compared using Fishers Exact and Wilcoxon tests. There were no cases of lymphedema at 3 month and 6 month follow up. One patient, in the no tourniquet group, had lymphedema at the 2 week follow up visit only. There were no complications noted in any patients. Patient satisfaction between the two groups was high and not statistically different (P = 0.92) at 3 months (Tourniquet: 9.0, No Tourniquet: 8.4, P = 0.21) or 6 months (Tourniquet: 8.9, No Tourniquet: 8.7, P = 0.98). Procedures using a tourniquet were on average twice as long as those that were not, yet no difference in the incidence of lymphedema or complications was noted. •Elective hand surgery appears safe in patients having undergone previous ipsilateral surgery for breast cancer with lymph node dissection including those with previous radiation and history of lymphedema.•The use of a tourniquet does not appear to increase the risks of lymphedema or complications in this patient population. This research was supported by a 2010 Clinical Research grant from the American Foundation for Surgery of the Hand." @default.
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- W2517024582 date "2016-09-01" @default.
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- W2517024582 title "Lymphedema Following Elective Hand and Wrist Surgery in Women who are Post Axillary Lymph Node Dissection: A Prospective, Cohort Study" @default.
- W2517024582 doi "https://doi.org/10.1016/j.jhsa.2016.07.004" @default.
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