Primary delayed cosmetic suture in the surgical treatment of acute purulent lactational mastitis (first experience)

Backgraund: after surgical treatment of purulent lactational mastitis, scars remain on the skin, which negatively affects the mood of young women, especially if the scar is rough and located in the "décolleté” zone. Aims: leveling the consequences of surgical treatment of abscessed lactational mastitis in the aesthetic aspect by using a primarily delayed (one day) cosmetic intradermal suture. Materials and methods: 1) study design: interventional, single-center, continuous, prospective, rondomized, controlled; 2) the object of research: patients with abscessing lactational mastitis; 3) the characteristics of the medical intervention: surgical opening, argon plasma sanitation of the breast abscess cavity, the imposition of a primary delayed double cosmetic suture, washing vacuum drainage; 4) duration of the study: more than five years; 5) primary study endpoint: removal of postoperative sutures 6) assessment methods: visual assessment of the aesthetic effect immediately and after six months. Results: the study involved 55 puerperas from 19 to 40 years old, with an average age of 26.4 years. All patients underwent surgical treatment according to the method described above, with a difference at the final stage. Thus, 16 patients received a primary delayed two-row cosmetic suture according to Zoltan (main group). The comparison group included the remaining 39 - they had a single-row interrupted suture. There were no suppurations of the seam in the groups. In the control group, three patients experienced skin eruption with threads during manual expression of milk, which required additional application of several interrupted sutures. All the drains were removed for 5-6 days, after which the patients were discharged. The stitches were removed on an outpatient basis for 11-12 days. Healing in both groups occurred by primary intention. Visual assessment of P / O scars in the main group looked subtle, threadlike. In the comparison group, the scars are more eroded, the places of the threads and the transverse traces along the course of the scar are clearly visible. Scars during wound healing by secondary intention do not look aesthetically pleasing - rough and wide. These patients were not included in the study. Conclusions: primary delayed double cosmetic suture according to Zoltan can be successfully used to close after surgical wounds of the mammary gland on the next day after argon plasma sanitation of the abscess cavity in combination with flow-washing vacuum drainage. In the aesthetic aspect, this technique gives the best cosmetic effect. In addition, it allows for high-quality sanitation of the purulent cavity, which is problematic, in our opinion, with minimally invasive methods of treatment.