Clinical therapeutic evaluation of vacuum sealing drainage and precise ultrasound-guided debridement in the treatment of non-lactational mastitis

Abstract

The aim of the present study was to compare the efficacy of vacuum sealing drainage (VSD) and precise ultrasound-guided debridement in the treatment of non-lactational mastitis and to determine the optimal surgical treatment. A set of 60 cases diagnosed with non-lactational mastitis who had received surgical treatment at the Department of Thoracic and Breast Surgery of Xiamen Hospital of Traditional Chinese Medicine (Xiamen, China) between July 2017 and June 2019 were included. According to the surgical method, 30 patients were assigned to the VSD group and 30 patients were assigned to the precise ultrasound-guided debridement group. The clinicopathological data of the two groups were compared. The overall rates of recurrence and new incidence were 6.8 and 8.5%, respectively. The mean total disease course was 5.3 months and all of the patients were cured after treatment. Except for the hospitalization time and postoperative pain scores, the clinicopathological data between the two groups were similar. The hospitalization time in the VSD group was significantly longer than that in the precise ultrasound-guided debridement group. Pain scores on the first and third days after the operation in the precise ultrasound-guided debridement group were significantly higher than those in the VSD group (P=0.008 and 0.001, respectively). In conclusion, the efficacies of VSD and precise ultrasound-guided debridement for the treatment of non-lactational mastitis were generally both satisfactory without significant differences. Of note, the former is suitable for patients with inverted nipples and obvious skin ulcerations, while the latter is mainly suitable for patients with abscesses, small surgical incisions and those who require short hospital stays.

Keywords: granulomatous lobular mastitis; mammary duct ectasia; non-lactational mastitis; periduct mastitis; precise ultrasound-guided debridement; surgery; vacuum sealing drainage.

Figure 1

Representative images of VSD (all images were obtained from the same patients whose age was 33 years). (A) The lesion invaded each quadrant of the breast preoperatively. (B) Color ultrasound examination revealing abscesses and sinus tracts. (C) The medical sponge was cut to fit the size and shape of the wound. (D) After debridement, the medical sponges were placed to fill the cavity. (E) The wound was sealed with semi-permeable membrane and sucking disc was connected to a negative pressure device. (F) After VSD, the cavity diminished and the granulation tissue was fresh. (G) The wound was sutured and drainage tubes were placed. VSD, vacuum sealing drainage.

Figure 2

Representative images of precise ultrasound-guided debridement (the images were obtained from 4 patients whose ages ranged from 26 to 35 years). (A) The lesion was marked on the skin prior to the operation. (B) During the operation, a probe was used to explore the purulent cavity and the necrotic tissue was scraped off with a spatula. (C) Color ultrasound located the lesion intraoperatively. (D) Various spatulas. (E) Vaseline gauzes were placed for drainage. (F) The wound was covered with triangular gauze. (G) Elastic bandages were applied under pressure to bandage the breast.