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Introduction: After axillary lymph node dissection for the treat of malignancies, patients are cautioned to avoid procedures on the ipsilateral upper extremity to avoid the risks of infections, wound healing complications, and lymphedema. Thus patients often forego surgeries for hand ailments, though there is little data in the literature and no consensus in the recommendations for these patients. The purpose of this study is to evaluate if patients who have had axillary lymph node dissection have an increased incidence of postoperative complications.

Methods: A review of all patients presenting to our hand clinic for two senior surgeons over a 13-year period was performed (1998-2011). Patients with the diagnosis of breast cancer or melanoma or a history of prior axillary lymph node dissection were selected. Operative and clinic notes were reviewed. Patients who were treated without surgical intervention and those who had elective hand surgery in the contralateral upper extremity were excluded.

Results: 147 patients were identified. 52 patients were treated surgically for various hand conditions. Of this group, 20 patients (19 females with breast cancer, 1 male with melanoma) had axillary lymph node dissection on the ipsilateral extremity. Procedures included 7 carpal tunnel releases, 6 trigger finger releases, 4 soft tissue lesion excisions, and 1 each of Dupuytren’s release, CMC arthroplasty, scar revision, flexor tendon repair, and foreign object removal. 2 patients had concomitant procedures. The average age at the time of lymph node dissection was 55.1 years (37.5-73.6); age at the time of hand surgery was 64.5 years (41.6-83.5). The interval between the two surgeries was 8.2 years (7 days-37.3 years). 4 of these patients had pre-existing lymphedema. Post-operatively there was no exacerbation of existing lymphedema and no new cases of lymphedema. 4 patients (25%) had periincisional erythema, requiring oral antibiotics for presumed superficial infection. 2 patients had issues with incisional pain and scarring, each resolved after corticosteroid treatment. No patients required a return to the operating room.

Conclusion: With breast cancer alone diagnosed at a rate of more than 200,000 per year in the United States, there are likely many such patients with a history of lymph node dissection. We have shown, in our limited number of patients, that routine minor hand surgery does not result in lymphedema and did not increase existing lymphedema in patients who had a previous ipsilateral axillary lymph node dissection. This study suggests surgery may be pursued safely.