Intervention description {11a}
breast field block, shoulder abduction
SCAR
After completion of the mastectomy, a breast field block using bupivacaine or ropivacaine is installed all around underneath the fascia at the edges of the wound. Traditional wound closure consists of closure of subcutaneous tissues using absorbable multifilament 2/0 running suture, and skin closure using 4/0 monofilament resorbable running suture.The implemented intervention is the quilting suture technique (quilting). With quilting the subcutaneous tissue is sutured to the pectoralis muscle placing multiple rows of running sutures (absorbable, size 0). The suture starts at either end of the scar, running back and forth, creating rows of quilting stiches. The rows are placed transversely from the cranial to the caudal end of the wound with 2–3 cm between them, totalling some three to five rows for the cranial flap. The caudal flap is quilted with two to three rows in a caudal to cranial fashion. The redundant skin is trimmed away, resulting in a tight skin flap, sutured in a tension-free fashion consisting of a subcutaneous absorbable multifilament size 2/0 running suture followed by a 4/0 resorbable monofilament intracutaneous running suture. No wound drain is placed. Prophylactic antibiotics are not warranted, however, can be administered according to local protocol. Topical wound management consists of application of steri-strips. A tight fitting bra or bandage is recommended for the first postoperative days. Regular daily mobilization of the shoulder is stimulated, the first week with shoulder abduction limited to 90 degrees, thereafter without limitation.