The Risk Factors of Lymphedema in Breast Cancer Patients Post Axillary Clearance

Introduction: Breast cancer is the number one malignancy affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence increases annually due to the aid of established screening programs, leading to the discovery of breast cancer in its early stages. Surgical treatment is an integral part of early breast cancer management to achieve local control. Axillary surgical interventions such sentinel lymph node biopsy (SLNB) and axillary lymph node clearance (ALND) aim to stage the axilla as an adjunct to the management of the primary breast tumor. In this paper, we reviewed female breast cancer patients aged 30 - 60 who underwent surgical treatment of SLNB and/or ALND with reporting the prevalence of lymphedema and other associated complications and risk factors. Methodology: A cross-sectional non-interventional study, with a sample size of 250 including breast cancer cases from 2016 to 2019 at National Guard Hospital (NGH) in Jeddah, Saudi Arabia. Results: A total of 253 breast cancer cases were included in this study, with a mean age of 53 years, 52.7% were postmenopausal and positive family history was present among 21% of cases. Further, 90.9% of the cases had unilateral disease. Staging was as follows: stage I 14.5%, stage II 45.2%, stage III 37.1%, and stage IV 3.2%. Mastectomy was done in 73.4% cases and lumpectomy was performed in 34.1% of cases. In addition, 93.3% of patients had SLNB and 49% of them were positive. Axillary dissection was performed in 69.6% of our patients. Radiotherapy and chemotherapy were given to 71.8% and 80.4% of cases respectively. Among the chemotherapy (chemo) recipients, 40.2% received adjuvant chemo, 54.5% received neoadjuvant chemo, and the remaining 5.3% received both. Further, the most prevalent complication was pain accounting for 42.1% of total complications, and the least prevalent was cellulitis 4%. Also, seroma developed in 18.3% cases, paresthesia noted in 5.6% of cases, winged scapula was reported as 2%, weakness and necrosis were seen in 6% and 13.1% of cases respectively. Axillary vein thrombosis and lymphangiosarcoma were reported in none of the patients (0%). Lymphoedema accounted for 16.1% of overall complications, 85% of the patients who developed lymphedema had undergone ALND, and 12.9% and 14.4% received radiotherapy and chemotherapy respectively. Lymphedema was observed in breast cancer stages as follows: stage I 1.2%, stage II 7.2%, and stage III 5.2%. Patients with body mass index (BMI) of 30 - 39 kg/m2 had 7.2% prevalence of lymphedema compared to other BMI groups. Overall mortality was 8.3%. Conclusion: The findings of our study suggest that the prevalence of lymphedema was higher in ALND patients with locally advanced tumors, and higher BMI, compared to patients with stage I breast cancer and low BMI. Further, the prevalence of lymphedema in patients who underwent ALND was significantly lower than those who were treated by lumpectomy 10.3% (p-value = 0.034) in comparison to mastectomy 19.3%.

Isolated axillary tumor deposit consistent with primary breast carcinoma:A case report

BACKGROUND We all know that lymph-node metastasis is an important factor for poor clinical outcome in breast cancer prognosis.Tumor deposit refers to a discrete collection of cancer cells that is found in the lymph nodes or other tissues adjacent to the primary tumor site.These tumor deposits are separate from the primary tumor and are often considered as a manifestation of lymph node metastasis.In gastric and colorectal cancer,tumor deposits in the lymph node drainage area have been included as independent prognostic factors.The question arises whether tumor deposits should also be considered as prognostic factors in breast cancer patients.This article aims to provoke some thoughts on this matter through a case study and literature review.CASE SUMMARY A 70-year-old female patient was found to have a right breast lump for over 2 years.On January 3,2023,a core needle biopsy of the right breast lump was performed,and the pathology report indicated invasive carcinoma.Subsequently,on January 17,2023,the patient underwent right breast-conserving surgery,sentinel lymph node biopsy,and right axillary lymph node dissection.The postoperative pathological staging was determined as stage IIB.The patient received chemotherapy,radiotherapy,and endocrine therapy.At present,nearly one year after the surgery,no obvious signs of metastasis have been observed in the follow-up examinations,but the long-term prognosis is still unknown.CONCLUSION There is a need for increased focus on the matter of tumor deposits in the lymph node drainage region,as well as a requirement for further clinical investigation to ascertain the relevance of tumor deposits in the prognosis of individuals with breast carcinoma.

Axillary Vessels and Brachial Plexus Traumas in Abidjan: Lesional Aspects and Surgical Difficulties

Introduction-Objectives: Through the presentation of epidemiological, anatomo-clinical and surgical aspects, we report our experience in the management of traumatic axillary lesions. Materials and Methods: A descriptive retrospective study was based on the medical records of patients who suffered vascular axillary and/or brachial plexus trauma and who underwent surgical repair at the Abidjan Cardiology Institute from January 2008 to June 2022. Epidemiological, anatomo-clinical and surgical data were studied. Results: Thirty-four medical files belonging to 33 men and one woman, aged 32 on average, were collected. The circumstances of occurrence were dominated by the stab wound (n = 22). The combinations of injuries were as follows: associated involvement of the axillary artery and vein (n = 4);isolated involvement of axillary artery (n = 3);isolated involvement of the axillary vein (n = 2);associated involvement of the axillary artery and brachial plexus (n = 17);associated involvement of the axillary artery and vein and brachial plexus (n = 08). Anatomic lesions included acute arterial lesions (n = 29) and arteriovenous fistula (n = 1) and false aneurysms (n = 4). All patients were operated on under general anesthesia;vascular repair included direct suturing (n = 16), arterial and venous bypass using a long saphenous graft (n = 9), prosthetic arterial bypass (n = 5) and prosthetic flattening-graft (n = 4). Brachial plexus surgery consisted of an end-to-end anastomosis of each transected bundle in all cases (n = 25). The medium-term postoperative course was marked by success without functional sequelae in 88.24% of cases (n = 30) and by the persistence of distal paralysis of the thoracic limb after 6 months in 05.88% (n = 2) of all patients, i.e., 8% of patients who presented with brachial plexus injury. Conclusion: The concomitant surgical treatment of these axillary vascular and nerve lesions has given good results. However, if paralysis of the thoracic limb persists after 6 to 12 months, the patient should be referred to a specialist in brachial plexus surgery.

Diagnosis and Treatment of Axillary Web Syndrome:An Overview

Axillary web syndrome(AWS)is a self-limiting disease that can occur as an early or possibly late postoperative complication post-axillary surgery.This syndrome is characterized by the spread of the cords of subcutaneous tissue extending from the axilla into the arm and is clinically associated with pain and limited movement of the shoulder in the affected limb.Although its pathophysiology is not well established,the most common cause is surgery-related axillary lymphatic injury.Both the echography and magnetic resonance imaging results support the lymphatic hypothesis.The diagnosis of AWS is based on physical examination.Risk factors may include extensiveness of surgery,younger age,hypertension,lower body mass index,ethnicity,and healing complications.Effective clinical intervention shortens the natural course of AWS and improves the quality of life of patients with AWS.Treatments may include physical therapy,drug therapy,manual drainage,instrument-assisted soft tissue mobilization(IASTM),thoracic manipulation and stretching,manual axial distraction,percutaneous needle cord disruption with fat grafting and Xiaflex injection,and surgical intervention.Routine surgical treatment for AWS may not be recommended.Further research is needed to provide more comprehensive improvements in the diagnosis and treatment of AWS.

Axillary lymph node management in breast cancer with positive sentinel lymph node biopsy

The surgical treatment of localized breast cancer has become progressively less aggressive over the years.The management of the axillary lymph nodes has been modified by the introduction of sentinel lymph node biopsy. Axillary dissection can be avoided in patients with sentinel lymph node negative biopsies. Based on randomized trials data, it has been proposed that no lymph node dissection should be carried out even in certain patients with sentinel lymph node positive biopsies. This commentary discusses the basis of such recommendations and cautions against a general omission of lymph node dissection in breast cancer patients with positive sentinel lymph node biopsies. Instead, an individualized approach based on axillary tumor burden and biology of the cancer should be considered.

Response of axillary bud development in garlic(Allium sativum L.) to seed cloves soaked in gibberellic acid(GA3) solution

Gibberellins(GAs) are important phytohormones that regulate many developmental processes in plants. Clove, as the reproductive organ of garlic, dramatically affected garlic bulb development. Considering the potential of gibberellins in plant development and our previous studies, we investigated the effect of soaking two types of seed cloves(seed clove-I: without root/shoot sprouting;seed clove-II: with root/shoot sprouting) in GA3 solution on axillary bud development and examined the effect of soaking seed cloves in GA3 solution on bulb development, phytohormone level and sugar content in this study.Results indicated seed clove types, soaking liquids and their interaction significantly affected the number of cloves per bulb and the rate of single-clove bulb. Moreover, soaking seed cloves in 1 mmol L^-1 GA3 solution for 24 h not only promoted axillary bud formation and secondary plant growth(equal to tillering or branching), but also slightly increased the number of cloves per bulb and changed bulb structure with a low yield and marketable quality. On the 40 th day after GA3 treatment(at axillary bud outgrowth stage), zeatin riboside(ZR) and soluble protein in stem were sharply increased with the increase of GA3, sucrose, fructose and soluble protein in leaf. However, GA3, indole-3-acetic acid(IAA), soluble sugar and sucrose in stem(3.52 ng g^-1 fresh weight(FW), 19.88 ng g^-1 FW, 237.3 mg g^-1 FW, and 8.24 mg g^-1 FW, respectively) were significantly decreased on the 40 th day after GA3 treatment, compared to the control of water treatment(5.56 ng g^-1 FW, 32.96 ng g^-1 FW, 263.6 mg g^-1 FW, and 10.37 mg g^-1 FW, respectively). To our knowledge, these novel results indicate seed cloves soaked in GA3 solution promotes axillary bud formation and outgrowth that caused the changes in plant architecture and bulb structure. Meanwhile, our findings suggest that the level of endogenous plant hormone(GA3, IAA and ZR) cooperates with the content of sugar(sucrose and fructose) in leaf and stem to regulate axillary bud outgrowth in garlic.

Accuracy of Measuring Axillary Temperature Using Mercury in Glass Thermometers in Children under Five Years: A Cross Sectional Observational Study

Background: Measuring axillary temperature with mercury in glass thermometers is continued in clinical practice though there are many limitations. This is mainly due to convenience and cost. This study was conducted to ascertain the accuracy of measuring axillary temperature with mercury thermometers in preschool children. Methods: Axillary temperature was measured in 250 preschool children using standardized mercury thermometers. Time taken to record the final temperature and its correlates were assessed. Results: Time taken to record the final temperature extended up to six minutes. This duration varied according to age, body mass index and body temperature, but a significant variation was noted only with age. Conclusions: Measuring axillary temperature with mercury thermometers is subjected to error. They need to be replaced with suitable alternatives.

Percutaneous endovascular management of atherosclerotic axillary artery stenosis:Report of 2 cases and review of literature

With recent advancement in percutaneous endovascular management,most atherosclerotic peripheral arterial diseases are amenable for intervention.However,there is limited published literature about atherosclerotic axillary artery involvement and its endovascular management.We report two cases of atherosclerotic axillary artery stenosis,which were successfully managed with stent angioplasty using self expanding nitinol stents. The associated coronary artery disease was treated by percutaneous angioplasty and stenting.The long term follow-up revealed patent axillary stents in both cases.

Usefulness of Breast MRI for Safe Omission of Axillary Lymph Nodes Dissection in Sentinel Node-Positive Breast Cancer Patients

Background: Preoperative identification of patients with extensive lymph node metastasis (LNM) is important for safe omission of axillary lymph node dissection (ALND) in sentinel node (SN)-positive (SN+) breast cancer patients. Methods: We evaluated retrospectively the collected data of 758 breast cancer patients who underwent axillary surgery between 2008 and 2017, excluding those who received neoadjuvant chemotherapy. Results: Of the 758 patients, 607 were not suspicious to have LNM by axillary ultrasound (AUS-), but 38 suspicious cases were found by breast magnetic resonance imaging (MRI). Of 15 patients undergoing axillary fine needle biopsy (AFNA) due to second-look axillary ultrasound (AUS), 9 underwent ALND because of a positive AFNA (AFNA+). Among 81 (10.9%) patients undergoing ALND due to SN+ findings, 6 (7.4%) had extensive LNM (LNM ≥ 4). If MRI was not performed, among the 90 of 673 patients undergoing ALND who had SN+ findings, 12 (13.3%) had LNM ≥ 4. Conclusions: The proportion of cases with LNM ≥ 4 was reduced from 13.3% to 7.4% among patients undergoing SN biopsies combined with breast MRI. ALND might be omitted safely in SN+ cases according to detailed preoperative evaluations using additional breast MRI to ultrasound.

Accuracy of Ultrasound Examination of Loco-Regional Lymph Nodes in Breast Cancer Follow-Up and Its Role in the Axillary Surgical Management

Objective: Major international guidelines have not standardized the sequence of diagnostic examinations during the follow-up of a patient with a diagnosed breast cancer. The aim of this study is to investigate the accuracy of sonography in the diagnosis of loco-regional lymphatic recurrences in comparison to the core needle biopsy results. Materials and Methods: Among 6455 patients who were followed up with clinical examination, mammography and ultrasound between January 2004 and November 2011, 125 (1.93%) patients had to be investigated with a core needle biopsy of a sonographically suspicious loco-regional lymph node. Results: Among the whole series, a total of 142 ultrasound-guided core needle biopsies were performed. Follow-up for the primary tumor lasted for a median time of 6.1 years (range 1 - 27 years). Ultrasound of suspicious loco-regional lymph nodes showed a sensitivity of 89.5%, a specificity of 87.1% and a positive predictive value of 89.5%. Conclusions: In our experience, ultrasound of suspicious loco-regional lymph nodes showed good accuracy and it should be a part of the standard examinations performed during follow-up for breast cancer.

Early Results of Omitting Completion Axillary Lymph Node Dissection in Sentinel Lymph Node Metastasis-Positive Breast Cancer Patients

Background: We investigated the early results of omitting completion axillary lymph node dissection (ALND) for axillary node metastasis-negative (N0), sentinel node (SN) metastasis-positive breast cancer patients. Patients and Methods: 489 patients had invasive N0 breast cancer treated without completion ALND, regardless of their SN metastasis status. Analyses included the associations between the SN metastasis status, clinicopathological findings and recurrence, between recurrence and clinicopathological findings, and recurrence-free survival. Results: 430 patients were SN biopsy (SNB)-negative, and 59 were SNB-positive. The SNB-positive patients received significantly more potent adjuvant therapy than the SNB-negative patients. Median follow-up was 3.7 years, and the axillary node recurrence was seen in 6 patients (1.2%) and recurrence in 21 patients. The SN status showed no associations with the clinicopathological findings or recurrence. Univariate analysis showed recurrence was associated with absence of hormonal therapy, ER-negative, PgR-negative, HER2-positive or triple-negative (TNBC) disease, a tumor ≥2.1 cm and higher nuclear grade. Multivariate analysis showed recurrence was associated with absence of hormonal therapy and a tumor ≥2.1 cm. Cox proportional hazards model showed recurrence was extremely early in ER-negative and TNBC patients. Conclusion: Completion ALND can be skipped in N0 breast cancer patients even if they are SNB-positive, but adjuvant therapy is essential.

Comparison of Patient Satisfaction between Brachial Plexus Block (Axillary Approach) and General Anesthesia for Surgical Treatment of Distal Radius Fractures: A Historical Cohort Study

Background: Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). Whether anesthesia type affects patient outcomes is unclear. This study retrospectively compared patient satisfaction between GA and NB after surgery. Methods: This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively. Results: After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p = 0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: -1.27 and -0.77, p = 0.00074 and p = 0.0388, respectively), as was surgery duration (effect size: -0.84, p = 0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p = 0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively. Conclusions: Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.

Programmed 6-Step Approach of Improved Liposuction-Curettage for Axillary Bromhidrosis

Background Liposuction-curettage is a long-standing and effective treatment for axillary bromhidrosis.However,residual malodor and skin necrosis typically occur following this treatment.Therefore,we improved this method to ensure fewer complications and better outcomes.Here,we have presented our programmed 6-step approach of improved liposuction-curettage.Methods The programmed 6-step approach of improved liposuction-curettage was used to remove the axillary apocrine glands.We used pointed and obtuse cannulas designed for liposuction-curettage.Results Patients treated using the programmed 6-step approach of improved liposuctioncurettage did not experience any serious complications or residual malodor.Conclusion The programmed 6-step approach of improved liposuction-curettage was more effective than traditional surgery with respect to the treatment of axillary bromhidrosis.

Injury to the axillary artery and brachial plexus caused by a closed floating shoulder injury: A case report

BACKGROUND A floating shoulder may be associated with catastrophic neurovascular injury and requires a multidisciplinary approach for its management. To maximize the like-lihood of good patient outcomes, this unique injury pattern should be recognized in patients as early as possible. This can be difficult to achieve, however, as there are currently few reports of floating shoulder in the literature, meaning that associated neurovascular injuries may be overlooked.CASE SUMMARY We present here a rare case of floating shoulder with axillary artery injury in a 34 -year-old woman. The patient complained of pain and numbness of her left upper limb after losing control of her motorcycle on a highway and falling from the vehicle 2 h ago. No blood pressure reading could be obtained from her left upper limb and no blood oxygen readings could be obtained from any of her left fingers. Computed tomography angiography and duplex ultrasonography revealed interruption of blood flow through the axillary artery, with distal flow being maintained through collateral arteries. The clinical diagnosis including fracture of the left proximal humerus, the left clavicle, and the left scapula, left axillary artery rupture, and left brachial plexus injury. We successfully performed open reduction and internal fixation of the fracture and vascular repair. The patient showed satisfactory recovery that was observed during 4 -mo follow-up.CONCLUSION Emergency surgery can be an effective therapeutic option for the closed floating shoulder with catastrophic axillary artery injury.

Bioinformatics Analysis on Regulating Axillary Branch Gene of Cucumber(Cucumis sativus L.)

The regulating axillary branch gene was cloned and named as CsCCD7.Using a series bioinformatic computer softwares,database and online programes,CsCCD7 nucleotide sequence and CsCCD7 amino acid sequence were analyzed and CsCCD7 function was predicted.The results showed that CsCCD7 cDNA full length sequence was 2 136 bp,and included a 1 665 bp ORF which encoded a 554 AA protein;there were 32 kinds of cis-acting regulating element in 2 136 bp cDNA sequence;CsCCD7 was an unstable protein(the unstable coefficient:40.77),including many phosphorylation sites related with CsCCD7 function;CsCCD7 had no transmembrane domain,and its subcellular localization was in chloroplast.CsCCD7 secondary structure contained four conformations including α-helix,β-sheet,β-turn and random coil.CsCCD7 protein had no signal peptide,so was non-secretory protein and hydrophilicity protein(grand average of hydropathicity:-0.401).Both CsCCD7 secondary and tertiary structure prediction results showed that it was classified as carotenoid oxygenase family.Phylogenetic tree drew by Geneious showed that CsCCD7 was more closely related to AtCCD7 than any other Arabidopsis CCD protein.

Ultrasound-Guided Infraclavicular Axillary Vein Cannulation

Background and Objective: Percutaneous central venous cannulation is a common invasive procedure. In comparison with an external landmark technique, the advantages of ultrasound-guided venous access include direct visualization of the anatomy and in vivo visualization of venous cannulation. Methods: We evaluated an ultrasound-guided technique for infraclavicular axillary vein cannulation, focusing on its ease of use, success rate and complications rate. One hundred and twenty patients who submitted to central venous catheter placement were punctured using our technique. The patients were positioned so that their ipsilateral upper limb was abducted at 90° to the longitudinal axis, which makes it possible to visualize the infraclavicular vessels due to the elevation of the clavicle, thereby improving accessibility. Results: Cannulation was successful in all patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 s (range 7 - 135 s). Both infraclavicular axillary veins were cannulated, and the vein was punctured successfully at the first attempt in 95% of the patients, without complications during the procedure. Conclusion: We propose an ultrasound-guided infraclavicular approach of the axillary vein, with a high success rate and no complications in the present cohort.

<i>In Vitro</i>Propagation of Mature Carob Trees (<i>Ceratonia siliqua</i>L.) from the Axillary Buds

The influence of tree age and the effect of growth regulators on the micropropagation of the carob (Ceratonia siliqua L.) from the axillary buds of mature trees have been described. Significant differences (P < 0.005) in results are obtained in the stages of initiation, multiplication, and rooting according to their response to the various concentrations of different growth regulators examined, namely BA, IBA, AG3. The use of 0.5 mg/l BA and 0.2 mg/l IBA was the most favorable for shoots neoformation. The leafy shoots are propagated in MS medium with BA at a concentration of 1.5 mg/l. The addition of gibberellic acid at 0.2 mg/l in the culture medium allows a good elongation and development of the shoots of the carob. The effect of the age of the plant material used has shown that explants taken from mature carob trees have a low capacity for bud sprouting and shoot proliferation compared to those taken from juvenile trees. Rooting has been successful when the plant material used is taken from young trees on an MS medium containing 2 mg/IBA, with an average number of 3 to 4, roots 1 to 2 cm long, then for the adult material, no rooting was observed. Based on these tests, it appears that micropropagation of the carob from the axillary buds is feasible, but additional work must be done to root this recalcitrant material.

Determination of Metastatic Axillary Lymph Node in Breast Cancer: Differentiation with Dynamic MRI Examination by Signal Intensity-Time Curves

Purpose: We aimed to evaluate the role of dynamic magnetic resonance imaging (MRI) in the detection of axillary lymph node metastasis based on the signal intensity-time curves. Materials and Methods: The data of 120 patients (benign patients, n = 91;malignant patients, n = 29) who underwent dynamic breast MRI were reviewed. The lymph nodes with the strongest criteria for malignancy (morphological-dynamic properties) were included in the analysis. Signal intensity-time curves were plotted by the software. Results: Of 29 patients with breast cancer, axillary lymph nodes were involved in 21 and not involved in the remaining 8. There was no significant difference between benign and malignant cases in terms of the distributions of Type Ia, Type Ib and Type IV curves (p = 0.12), whereas a significant difference was found between benign and malignant cases in terms of the distributions of Type II and III curves (p Conclusion: On dynamic MRI studies, benign and metastatic lymph nodes display different signal intensity-time curves.

A Double-Blinded Prospective Randomised Controlled Trial to Assess the Efficacy of Glubran-2 in Reducing Seroma Formation after a Mastectomy with or without Axillary Dissection

Background and Purpose: Seroma formation is a common complication following a mastectomy and axillary surgery. Decreasing the dead space is believed to decrease seroma formation. The aim of this study is to compare the incidence of seroma formation with the use of Glubran-2 versus normal saline during the wound closure in participants undergoing mastectomy with or without axillary dissection. Methods: This multicentre, prospective, double-blinded, randomised controlled trial, enrolled women 18 years of age or older with breast cancer, who were underwent total or partial mastectomy, with or without axillary dissection. Participants were randomised to Glubran-2 or Saline arm. The primary outcome was the volume and duration of wound seroma. Secondary outcome was post-operative wound infection. Results: A total of 76 women were randomised and there was no loss to follow-up or mortality. The total seroma volume was higher in the Glubran-2 arm. The duration of seroma was higher in the mastectomy and axillary dissection group in the Glubran-2 arm (P = 0.69). Elderly and participants with higher BMI had a higher volume of seroma. Post-operative infection rate was higher in the Glubran-2 arm (13.2% vs. 5.6%;P = 0.26). There was no statistically significant difference between the groups. Conclusion: Our study did not show any benefit with the use of Glubran-2 in mastectomy and axillary surgery in reducing the risk of seroma formation. In elderly and obese participants the use of Glubran-2 showed an increase in seroma formation and post-operative wound infection.