An Evaluation of Safety and Patient Outcomes for Hand Surgery following Prior Breast Cancer Treatment: Establishing New Recommendations in Lymphedema

• Published in: Plastic and reconstructive surgery (1963) Vol. 145; no. 2; p. 459
• Main Authors: Paton, Madeline, Kovar, Alexandra, Iorio, Matthew L
• Format: Journal Article
• Language: English
• Published: United States 01.02.2020
• Subjects: Breast Neoplasms - complications; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Carpal Tunnel Syndrome - etiology; Carpal Tunnel Syndrome - surgery; Elective Surgical Procedures - statistics & numerical data; Female; Hand - surgery; Humans; Lymph Node Excision - adverse effects; Lymph Node Excision - methods; Lymphedema - complications; Lymphedema - surgery; Mastectomy - adverse effects; Mastectomy - methods; Patient Safety; Postoperative Complications - etiology; Retrospective Studies; Second-Look Surgery - statistics & numerical data; Sentinel Lymph Node Biopsy - adverse effects; Sentinel Lymph Node Biopsy - methods; Surgical Wound Infection - etiology; Tourniquets; Treatment Outcome
• ISSN: 1529-4242
• DOI: 10.1097/PRS.0000000000006438

Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient. The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection. One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema. Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.