Prevent Seroma Formation Research Articles

Method prevention of seroma formation after breast surgery

Method prevention of seroma formation after breast surgery

Reducing seroma formation with fibrin glue in an animal mastectomy model

Mastectomy is a frequently performed surgical procedure which has some important complications that may prolong hospital stay. Seroma formation after mastectomies and axillary dissection has an incidence of 5.8-53%. A new technique for preventing seroma formation was studied in an animal mastectomy model. Radical mastectomy was performed in guinea pigs. A control group of 20 animals had no further procedure post-mastectomy other than drying the wound with sterile gauze. In the other group fibrin glue was topically applied to prevent seroma formation to the operative field. Ten days after the operation, necropsy was performed and fluid collections were drained with an 18-gauge needle. The results were statistically analysed with a Two-sample rank-sum test. A significant difference existed between Groups I and II (P < 0.00005). It is concluded that fibrin glue can be used to prevent seroma formation after mastectomies.

Effect of Fibrinogen and Thrombin Concentrations on Mastectomy Seroma Prevention

Seroma formation remains a significant clinical problem which increases morbidity and hospital costs in patients undergoing mastectomy operations. This study evaluated the effect of varying the concentrations of fibrinogen and thrombin in fibrin sealant on successfully preventing seroma formation in a rat model. After axillary dissection, control animals (Groups I and II) had 1 ml of either normal saline or thrombin (100 U/ml) applied to the axilla while treated animals (Groups III–VIII) had increasing concentrations of 0.5 ml of fibrinogen (25, 50, or 100 mg/ml) and 0.5 ml of thrombin (10 or 100 U/ml) applied. Seroma volumes (means ± standard deviation) were measured on Postoperative Day 5. They were largest in Group I (3.1 ± 1.9 ml,n= 13) and Group II (3.9 ± 2.7 ml,n= 15) and then decreased from a high in Group III (2.5 ± 2.4 ml,n= 15) using fibrinogen, 25 mg/ml, and thrombin, 10 mg/ml, to a low in Group VIII (0.8 ± 1.0 ml,n= 15) using fibrinogen, 100 mg/ml, and thrombin, 100 U/ml. Analysis of variance revealed a statistically significant difference in the mean seroma fluid volumes between the groups (P= 0.0021), while Scheffe's comparison showed a specific significant difference (P= 0.028) between the thrombin control (Group II) and the highest concentration fibrin sealant (Group VIII). The difference in seroma volumes for all control animals (Groups I and II), 3.5 ± 2.4 ml, and all treated animals (Groups III–VIII), 1.7 ± 2.1 ml, was highly significant by unpairedttest. (P< 0.0001). Thus, fibrin sealant was useful in reducing seroma formation in this rat model with the highest concentration of fibrinogen and thrombin appearing most effective. These data may be useful in guiding future clinical trials in humans.

Comparison of topical fibrin glue, fibrinogen, and thrombin in preventing seroma formation in a rat model

Fibrin glue has been shown to decrease seroma formation in animal models. To further delineate this mechanism, the efficacy of fibrin glue was compared to topical fibrinogen and thrombin in preventing postoperative seromas. A model consistently producing seromas was developed by bilateral neck dissection, lymphadenectomy, and submandibular sialoadenectomy in the Sprague-Dawley rat. Groups of 20 rats underwent this procedure and were blindly treated with either fibrin glue, fibrinogen, thrombin, or saline control. Necropsy on postoperative day 5 revealed a statistically significant (chi-squared) decrease in seroma incidence using fibrin glue (0%) and fibrinogen (15%), while thrombin (95%) and saline (100%) were ineffective in preventing seromas. The use of fibrin glue and fibrinogen in this role merits further investigation.

The Use of Closed Suction Drainage After Lumpectomy and Axillary Node Dissection for Breast Cancer A Prospective Randomized Trial

Closed suction drainage has been used to prevent seroma formation after lumpectomy and axillary node dissection for breast cancer. To study the efficacy of closed suction drains, the authors conducted a prospective randomized study from 1987 to 1990 of 227 axillary dissections. One hundred eight were randomized to a drain group (DG) and 119 to a no drain group (NDG). Drains were removed on the first postoperative day just before patient discharge. Postoperatively, all palpable axillary collections were aspirated on each follow-up visit. The volume aspirated, the number of aspirations, the time to seroma resolution, and all complications were recorded. The mean number of aspirations in the DG was significantly lower than the NDG (2.2 +/- 2.2 versus 3.3 +/- 2.1; p less than or equal to 0.002). Mean volume aspirated in the DG (146.3 +/- 181.1 mL) was less than the NDG (266.1 +/- 247.6 mL; p less than or equal to 0.003), and the time to seroma resolution was decreased in the DG as compared with the NDG (11.5 +/- 10 days versus 18 +/- 10.1 days; p less than or equal to 0.0002). Closed suction drainage after lumpectomy and axillary node dissection is advantageous in decreasing the incidence and degree of seroma formation and need not delay early hospital discharge.