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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2024 | Month : June | Volume : 18 | Issue : 6 | Page : PC06 - PC09 Full Version

Effect of Topical Application of Tranexamic Acid on Wound Drainage and Seroma Formation after Modified Radical Mastectomy: An Observational Study

Published: June 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/66035.19546

Grishma Reba Thomas, PS Rajesh

1. Junior Resident, Department of General Surgery, Government Medical College, Kottayam, Kerala, India. 2. Additional Professor, Department of General Surgery, Government Medical College, Kottayam, Kerala, India.

Correspondence Address :
Dr. Grishma Reba Thomas,
Junior Resident, Department of General Surgery, Government Medical College, Kottayam-686008, Kerala, India.
E-mail: grishmarebacathomas@gmail.com

Abstract

Introduction: Breast cancer is the most common malignancy detected in the female population in Kerala, India. Seroma formation after Modified Radical Mastectomy (MRM) may lead to a delay in recovery, a prolongation of hospital stay, and can also affect treatment by delaying adjuvant therapy and increasing the risk of infection. Topical Tranexamic Acid (TXA) reduces bleeding, wound drainage duration and seroma formation.

Aim: To find the effect of topical application of TXA on wound drainage and seroma formation after MRM.

Materials and Methods: The present prospective observational study was conducted in the Department of General Surgery, Government Medical College, Kottayam, Kerala, India, from February 2022 to January 2023. A total of 150 patients who underwent MRM were randomly selected to receive either TXA or a placebo before wound closure. Two groups were formed: Group-1 (interventional group) received 20 mL of diluted TXA (25 mg/mL), while Group-2 (placebo group) received normal saline. Each group consisted of 75 female patients. They were compared based on drain amount, number of days the drain was in place and seroma formation. Categorical parameters like the number of days the drain was kept, cumulative drain amount, and seroma occurrence were expressed as percentages. Statistical analysis was done with Chi-square test with a p-value <0.05.

Results: The median age of the patients was 50-60 years. On postoperative day 1, the drain amount in Group-1 was 37.3%, while in Group-2, it was 54.7%, with 1.3% of patients in Group-1 and 6.7% in Group-2 having more than 300 mL drained (p-value=0.001). By postoperative day 7, 21.3% of patients in Group-1 had drained less than 50 mL, compared to only 4% in Group-2 (p-value=0.02). The majority of patients in Group-1 had their drains removed in 5-10 days (97.3%), whereas in Group-2, drains were removed in 11-14 days (56%). Seroma formation occurred in 8% of patients in Group-1 and 5.3% in Group-2 (p-value=0.512).

Conclusion: All patients tolerated TXA without any side effects and it effective in lowering the volume and duration of wound drainage following MRM.

Keywords

Breast cancer, Cumulative drain, Drain, Intervention, Placebo

Introduction
Breast cancer is the most common malignancy detected in the female population in Kerala, India. In 2022, cancer incidence in India was 105.4 per one lakh people, while in Kerala it was 169 per one lakh people. The most commonly performed surgeries for carcinoma of the breast include MRM and breast conservation surgery (1). MRM allows local control with long-term survival advantages, but its disadvantages include lymphoedema, disfigurement, seroma formation, flap necrosis and emotional impact. Seroma is a collection of serous fluid that occurs after MRM in the dead space of the post-mastectomy skin flap, which can lead to delayed recovery, prolonged hospital stay, and may affect treatment by delaying adjuvant therapy and increasing the risk of infection (2). Topical TXA, an antifibrinolytic agent, helps control fluid accumulation in the dead space under the skin and axillary fossa (3). When TXA is applied topically, it results in low systemic concentration and high drug concentration at the site of application, thus, decreasing wound drainage and seroma formation (4),(5),(6),(7). The present study emphasised the effect of topical TXA on drain amount and seroma formation.
Material and Methods
The present prospective observational study was conducted in the Department of General Surgery, Government Medical College Kottayam, Kerala, India, from February 2022 to January 2023. After obtaining approval for the study from the Institutional Review Board (IRB No-8/22) and the ethical committee, patients admitted to the Department of General Surgery for MRM qualifying the inclusion and exclusion criteria were included in the study.

Sample size calculation: The sample size was calculated using the formula N=(Z)2*p*q/d2, where N is the sample size, p is the prevalence according to a previous study (6), q is 100-p, Z is the Type 1 error, d is the allowable clinical error, Z is 1.96 at 95% CI, p is 39%, q is 61%, and d is 20% of p=20/100*39. Therefore, the sample size was calculated to be 150.

Inclusion criteria: Patients with histopathologically proven carcinoma of the breast undergoing MRM in the age group of 18-80 years were included in the study.

Exclusion criteria: Patients who require immediate reconstruction, who were pregnant or breastfeeding, patients with known thromboembolic disease, patients on anticoagulants, myocardial infarction, transient ischaemic attack/ stroke within the last year were excluded from the study. Patients with history of seizure disorder and neoadjuvant chemoradiation were also excluded from the study.

Study Procedure

Patients were divided into two groups, Group-1 and Group-2 using a single-blinding method, where the patient was unaware of whether they were placed in an experimental or control group by drawing lots.

Group-1 (Intervention arm): TXA was diluted to a volume sufficient to maintain a fairly large wound surface. Two 10 mL syringes containing 25 mg/mL TXA were topically instilled to ensure a sufficiently high concentration. Twenty milliliters moistens about 1500 cm2. It was prepared by diluting one ampoule of TXA in 15 mL of normal saline, so the prepared solution contains 20 mL of 25 mg/mL TXA. In all patients, a continuous vacuum suction drain with an 800 mL capacity reservoir was used. A suction drain was placed in the surgical bed, and occlusive dressings were placed over the surgical wounds. Drains were placed in surgical wounds during the operation, and the amount of blood on the drain was measured in mL (6).

Group-2 (Placebo arm): Two 10 mL syringes containing 10 mL NS were applied topically to the mastectomy cavity for 15 minutes before wound closure. Parameters measured were:

1. Drain production in the first 24 hours (since bleeding may contribute to drainage in the first 24 hours, it is recorded separately).
2. Drain production up to drain removal-cumulative volume (time frame: three weeks).
3. In patients with seroma, aspiration was done, and the volume was measured.
4. Number of days the drain was kept.

The drain was subsequently removed when wound drainage was less than 50 mL/24 hours for three consecutive days. Local postoperative complications (necrosis of the breast skin flap, seroma, haematoma, and infection of the surgical wound) were also observed for all patients, wherein the only complication that occurred among the study population was seroma. All patients were followed-up until the drain was removed.

Statistical Analysis

The data obtained were entered into an Microsoft Excel sheet and analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0 with a Chi-square test.
Results
The median age of the patients was 50-60 years. There was no significant difference in the age group between both groups (Table/Fig 1). On postoperative day 1, the drain amount in Group-1 was 37.3%, while in Group-2, it was 54.7%, with 1.3% of patients in Group-1 and 6.7% in Group-2 having more than 300 mL drained (p-value=0.001). By postoperative day 7, 21.3% of patients in Group-1 had drained less than 50 mL, compared to only 4% in Group-2 (p-value=0.02). The majority of patients in Group-1 had their drains removed in 5-10 days (97.3%), whereas in Group-2, drains were removed in 11-14 days (56%). Seroma formation occurred in 8% of patients in Group-1 and 5.3% in Group-2 (p-value=0.512). The amount of wound drainage was significantly lower in the study group compared with the control group in each volume range (p-value <0.005) (Table/Fig 2). Six (8%) patients in the study group had seroma formation after the removal of drains compared with 4 (5.3%) patients in the control group (Table/Fig 3).

Single aspiration was used to treat each patient with seroma development in the study group and the control groups. The amount of seroma in the intervention group was in the range of 150-200 mL for about 50% of patients and in the control group in the range of 200-250 mL for about 75% of patients (Table/Fig 4). Considering the total number of days the drain was kept, it was 5-10 days (97.3%) in Group-1, whereas Group-2 had their drain removed in 11-14 days (56%) (Table/Fig 5).
Discussion
Breast cancer is the most common cancer in women and the second leading cause of cancer-related death in women worldwide (7). Perioperative bleeding has always been an important determinant in the care of surgical patients. One of the main effects of surgery is the increased activity of local fibrinolytic factors and enhanced coagulability. Haemostasis is achieved with catecholamine-mediated platelet function, along with an increase in the level of coagulation factors and decreased function of coagulation inhibitors (8).

The TXA is a synthetic antifibrinolytic drug (9). It has been extensively used in different disciplines of surgery for reducing perioperative blood loss, the need for blood transfusions, and haematoma formation. Still, the route of administration of TXA and its effective dose need to be standardised (10). In-vitro, a minimum concentration of 5-10 μg/mL is needed to inhibit fibrinolysis (11),(12).

The safety profile and efficacy of topical administration of TXA were still unclear in the literature (9),(10). Systemic administration of TXA was associated with reduced mean drain output volume in patients who underwent MRM (13). The concentration of TXA needed for topical action is not well understood. Patients undergoing cardiac and Orthopaedic surgery have been studied for the administration of a bolus containing 1-3 grams of TXA diluted in 100 milliliters of saline (concentration 10-30 mg/mL) (5),(14),(15). In contrast, epistaxis has been treated with sponges moistened with undiluted TXA for intravenous use (100 mg/mL) (16). The concentration used in this study is 25 mg/mL, which is still sufficiently diluted to generate a volume that is adequate to moisten a sizable surface area. There is no much research that has been published where the application method was similar to the moistening used in the present study.

The use of drains after reduction mammoplasty has little scientific evidence, but is nevertheless common (17). At the time of the study, the departmental routine was to use drains until fluid production was below 50 mL per 24 hours for three consecutive days. The present study suggests that topical TXA reduces drain fluid production after MRM to below this cut-off value in almost all patients and may obviate the need for a prolonged drain.

None of the patients in both groups had either flap necrosis or haematoma. In the present study, 8% of patients in which TXA was instilled had seroma formation compared to 5.3% in Group-2. One probable explanation is that the patient received a single dose of TXA, which decreased drain output in the early postoperative phase.

However, when the drug’s impact was discontinued, seroma production increased, and by then, the drains had been removed (17). Similar significant results were obtained in the studies conducted by Ausen K et al., who demonstrated the beneficial effects of topical TXA in reducing the mean drain output in MRM patients (p-value=0.026, p-value=0.038) (6). Once topical TXA was administered at a dose of 25 mg/dL, another randomised controlled trial by Eldesouky MS et al., discovered that it was beneficial in decreasing the amount of drain output. These also had significant results, with a p-value of <0.005 (798.06±107.3 mL vs 1067.1±188.6 mL) (3). Conversely, a trial carried out by Emara W et al., found a statistically negligible difference. His research shows that when TXA was supplied intravenously, the mean blood loss was 640±25 mL, however, when it was applied topically, the mean blood loss was 625±35 mL (p-value >0.05) (18).

The overall reduction in drain fluid production after the administration of topical TXA here accords with previously published studies (19),(20),(21),(22). Wherein it was performed in patients undergoing total knee arthroplasty, hip and knee replacement, and the outcome of all of them was measured in terms of the range of blood transfusion required. It was a cost-effective modality, thereby reducing bleeding, the need for further blood transfusions, and preventing reoperation due to haemorrhage.

In the present study, the authors were able to identify that topical TXA was effective in decreasing drain production, thereby producing a positive impact on patient outcomes, and the postoperative period was uneventful in the majority.

Limitation(s)

Findings cannot be generalised as the study was conducted in a single centre.
Conclusion
Bleeding during MRM is inevitable, and blood transfusion is often required when there is excessive blood loss. Due to this reason, surgeons and anaesthetists have always employed a wide variety of techniques to reduce blood loss. TXA is useful in decreasing the quantity and amount of wound drainage following MRM without affecting the rate of seroma formation. It was tolerated by all patients without any side-effects.
Reference
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Czajka ML, Pfeifer C. Breast cancer surgery. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
2.
Sampathraju S. Rodrigues, seroma formation after mastectomy: Pathogenesis and prevention. India J Surg Oncol. 2010;1(4):328-33.   [CrossRef]  [PubMed]
3.
Eldesouky MS, Ashour HS, Shahin MA. Effect of topical application of tranexamic acid on reduction of wound drainage and seroma formation after mastectomy. Egypt J Surg. 2019;38(4):772-75.
4.
Wong J, Abrishami A, El Beheiry H, Mahomed NN, Roderick Davey J, Gandhi R, et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: A randomized, controlled trial: A randomized, controlled trial. J Bone Joint Surg Am [Internet]. 2010;92(15):2503-13. Available from: https://dx.doi.org/10.2106/JBJS.I.01518.   [CrossRef]  [PubMed]
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Bonis D, Cavaliere M, Alessandrini F, Lapenna F, Santarelli E, Moscato F. Topical use of tranexamic acid in coronary artery bypass operations: A double-blind, prospective, randomized, placebo-controlled study. J Thorac Cardiovasc Surg. 2000;119(3):575-80.   [CrossRef]  [PubMed]
6.
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DOI and Others
DOI: 10.7860/JCDR/2024/66035.19546

Date of Submission: Jun 15, 2023
Date of Peer Review: Sep 13, 2023
Date of Acceptance: Mar 28, 2024
Date of Publishing: Jun 01, 2024

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 16, 2023
• Manual Googling: Sep 25, 2023
• iThenticate Software: Mar 27, 2024 (24%)

ETYMOLOGY: Author Origin

EMENDATIONS: 8
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