Effects of Wound Irrigation with Topical Phenytoin Solution During Modified Radical Mastectomy on Postoperative Seroma Formation

Modified radical mastectomy (MRM), as a surgical treatment in breast cancer patients, may lead to important complications with significant morbidities including seroma formation. In this study, we used topical phenytoin to evaluate its impact on breast and axillary wound drainage and seroma formation after MRM. In a double-blinded randomized clinical trial, patients with breast cancer who were candidates for modified radical mastectomy (MRM) were enrolled. The patients were randomly assigned to two groups using a simple randomization method. Group A received topical phenytoin 1% solution for the irrigation of the mastectomy wound during the MRM procedure while group B (control group) underwent wound irrigation with normal saline solution. In addition to demographic data, postoperative variables including daily drainage of breast and axillary drains, drain removal days, and possible complications including seroma formation and their management were recorded. Except for daily drainage recorded on the fifth postoperative day, the drainage of both axillary and breast drains were significantly different between group A and B in the following days. Compared to group B, axillary drains could be removed significantly earlier in group A. In regard to the breast drains, they were removed earlier in group A with no statistically difference compared to group B, the difference was not statistically significant. Seroma was detected in 7(8.3%) patients, 3 patients in group A and 4 patients in group B, with no significant differences between the two groups. All the patients underwent repeated aspirations. Our findings showed that topical irrigation of the surgery site with phenytoin was effective in reducing axillary surgical wound drainage.