Seroma Volume Research Articles

A newer method of seroma reduction by fenestration of pseudo-sac during laparoscopic repair of direct inguinal hernia: A randomised, controlled pilot study.

Minimally invasive surgeries for inguinal hernia repair have been reduced post-operative morbidity. However, certain complications such as seroma formation are unavoidable. In this study, we introduce a newer technique of reducing seroma formation by fenestration of the pseudo-sac (thickened transversalis fascia) in patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia. A randomised, controlled pilot study was conducted from January 2019 to December 2020 for the patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia. Study participants were randomised into interventional group and control groups. Demographics, operative duration and complications including post-operative pain and seroma on days 1, 10 and 30 were analysed between both the groups. A total of 20 cases with 30 hernias were included in the study. Demographic data were comparable between the two groups. The intervention group showed a statistically significant decrease in the incidence of seroma formation on the post-operative day 10 (13.3% vs. 46.6%, P = 0.046). The mean volume of seroma on day 10 was also less compared to the non-fenestration group (2.5 vs. 6.58 ml, P = 0.048). After the 30th day, no patient had a presence of seroma. There were no statistically significant differences in terms of mean operative duration, post-operative pain and other complications. Fenestration of pseudo-sac in laparoscopic hernia repair for uncomplicated direct inguinal hernia is a simple and effective technique. It has reduced the incidence and volume of seroma formation without any increased risk of infection, acute or chronic pain and recurrence.

Methylprednisolone for Prevention of Seroma Formation after Mastectomy

Background: Breast cancer is the most common cause of death in middle aged women. Seroma formation is claimed to be a very common problem after axillary dissection in patients with breast cancer. Aim: To conduct this study to see if injecting methyl prednisolone can improve the post-operative outcomes of modified radical mastectomy in terms of seroma formation Methods: This Study design is a randomized control trial, done at Surgical Department, Khyber Teaching Hospital, Peshawar from October 12th 2019 till April 12th 2020. Randomization was done through lottery method. Sample size was 38 in each group. All the data was analyzed in SPSS (version 22). Mean + SD was calculated for continuous var-iables like age, BMI and volume of seroma. Frequency and percentages were calculated for categorical variables like stage of breast cancer, whether neoadjuvant chemotherapy was received andefficacy. Efficacy in both groups was compared using chi square test keeping p value of <0.05 as significant. Result: Mean age in Group A was 38±12.72 years whereas in Group B was 40±11.83 years. Efficacy of both the groups was analyzed as Group A ( Methyl prednisolone) was effective in 76% patients in preventing seroma for-mation. Normal Saline injection in Group B was effective in preventing seroma formation in 53% patients. Methylprednisolone being statistically significant in prevention of seroma formation with a p value of 0.03. Conclusion: Our study concludes that local methyl prednisolone is more effective than normal saline injection in preventing seroma formation after modified radical mastectomy for carcinoma breast. Clinical Implications: This study will not only add to the national and international literature that is available on the topic but would also help us in modifying in treatment guidelines if proven efficacious in order to improve patient management. Keywords: Breast Cancer, Methylprednicolone, modified radical mastectomy, seroma, normal saline

43 (PB-043) Poster - Use of Arista™ AH Absorbable Hemostat in breast surgery – analysis of seroma volumes and duration of drainage

Background: Novel hemostatic agents such as Arista™ AH have been widely adopted in surgical procedures as the application is easy and direct to the bleeding site. Microporous polysaccharide hemospheres are a powder hemostat made from purified plant starch.

Stereotactic Breast Radiotherapy Delivered via External Beam Daily Online Adaptive Replanning

<h3>Purpose/Objective(s)</h3> Linear accelerator based accelerated partial breast irradiation (APBI) in early-stage breast cancer necessitates a reduction in non-target breast tissue to decrease long term toxicity and adverse cosmetic outcome. In particular, lumpectomy cavity seromas may decrease in size and deform in shape during short course APBI. We present the first recorded treatments of stereotactic partial breast radiotherapy utilizing linear accelerator based kv-CBCT online daily adaptive replanning. <h3>Materials/Methods</h3> Two patients (left sided, right sided) with early-stage breast cancer underwent SBRT to a dose of 600 cGy x 5=3000cGy in non-consecutive fractions. The CTV consisted of the seroma cavity+ 5-10mm with a PTV margin of 3mm. Both were planned in a treatment management system with 10 IMRT fields with a laterally localized hemi spherical field distribution. Plans were optimized using the Ethos Intelligent Optimization Engine with primary planning objectives for the V3000cGy_CTV and V3000cGy_PTV of >= 99% and 95% respectively. Additionally, organ at risk (OAR) evaluation parameters for the heart, ipsilateral and contralateral lung, ipsilateral and contralateral breast, and skin were planned and verified daily. <h3>Results</h3> The table describes metrics of each delivered plan. The means of each adaptively replanned and delivered fraction (±1 SD) demonstrated reduced target volumes and improved metrics to the heart, lungs, and ipsilateral breast compared to the reference plan from the simulation dataset. Conformity and gradient indices were similar between reference and adaptive plans. <h3>Conclusion</h3> Daily adaptive replanning for stereotactic body breast APBI allowed for reduced PTV margins and real time plan modification for changing seroma volumes and variable breast setups with excellent DVH parameters.

Raised Blood Pressure as a Risk Factor of Post-Operative Seroma Formation in Patients of Modified Radical Mastectomy

Despite seroma is rarely potentially lethal and is typically harmless, it can cause considerable sequelae such as flap necrosis, wound dehiscence, predisposes to infection. The objective of the study was to determine the association of raised blood pressure as a risk factor of development of seroma after MRM in breast cancer patients. Material Methods: In this case control study, all women of age 30 to 70 years with MRM done for carcinoma of the breast of stage T2 and lymph nodes N2 were enrolled and followed for 3 days after MRM surgery for seroma formation. Out of total 122 patients, 64 patients were cases and 58 controls. Patients with disease upto N2 had level 2 clearances with upfront surgery. Age, history of essential hypertension, compression bandage applied, serum albumin level, seroma formation and volume of seroma on 3rd post-operative day was documented. Results: Mean age of the patients was 51.2 + 9.5 years and 53.5 + 10.8 years in case and control, respectively. Majority of the patients were of the age group 40 to 50 year’s age group. 56.3% (n=36) cases and 43.8% (n= 28) controls had history of essential hypertension. Seroma formation was seen in cases 51% (n=31) as compare to controls 13% (n= 8) with odd ratio OR 1.48. Drainage volume among two groups was analyzed as in case group, the drainage volume was 148.1 + 76.4 ml (range 50 to 290) while in control group the drainage volume was 130 + 56.9 ml (60 to 250) and was statistically significant with p-value &lt;0.001. Conclusion: Although the pathogenesis of seroma remains controversial, hypertension is the most consistent significant risk factor for seroma formation subsequent to modified radical mastectomy for carcinoma breast. Good pre, peri and post-operative blood pressure control can reduce the risk of seroma formation and the associated morbidity. Keywords: MRM, Seroma, nodal clearance, breast cancer,

Effect of Topical Tranexamic Acid on Seroma Formation in a Rat Mastectomy Model.

Seroma is the most common complication after mastectomy and reconstruction surgery. Therefore, this study aimed to determine whether the topical application of tranexamic acid would be useful to reduce seromas in a rat mastectomy model. Forty-eight Sprague-Dawley rats were divided into four groups. After mastectomy and axillary lymph node dissection, 0.4mL of normal saline was administered to group A in the dead space. In group B, 0.4mL of a triamcinolone mixed solution was administered. In group C, 0.4mL of a tranexamic acid (10mg/kg) mixed solution was administered. In group D, 0.4mL of a tranexamic acid (50mg/kg) mixed solution was administered. Gross examination, assessment with micro-computed tomography (CT), quantitative analysis via aspiration, and histopathologic assessment were implemented 7 and 14 days postoperatively. No other complications such as wound infection and skin necrosis were observed. At postoperative week 1, groups B and C showed significantly lower seroma volume values on micro-CT (P < 0.001 and P < 0.05, respectively) and seroma volume values at aspiration (P < 0.01 and P < 0.001, respectively) than group A. According to histopathologic analysis, inflammation was observed more frequently in groups A and D than in the other groups, and angiogenesis was more active in groups B and C than in the other groups. Topical application of tranexamic acid was as effective as topical application of triamcinolone to prevent seroma formation. The stability of tranexamic acid was confirmed when the high dose of tranexamic acid was used. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Frequency of Seroma Formation after Modified Radical Mastectomy in Patients who receive Neo-adjuvant Chemotherapy

Background: Breast cancer is among the commonest of causes of the death caused due to cancer in the females throughout the world. Objective: To determine the frequency of Seroma formation in patients undergoing Modified Radical Mastectomy after neoadjuvant therapy. Methodology: Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Surgery, Chandka Medical College Hospital, Larkana from November 2019 to January 2022. A total of 217 diagnosed cases of breast carcinoma patients who underwent a modified radical mastectomy after initially receiving neoadjuvant chemotherapy were selected for this study. Pre-designed proforma was used to collect information related to different variables. Results: The average age of the women was 47.29±8.38 years. The frequency of seroma formation in patients undergoing modified radical mastectomy with neo-adjuvant therapy was found in 41.94% (91/217). The average seroma Volume and number of resected lymph nodes were 56.64±5.64 ml and 7.59±1.08. Conclusion: Prediction of seroma formation following Modified Radical Mastectomy with neo-adjuvant therapy remains challenging. We identified no potential risk factors other than the pathological status of the tumor which was associated with an increased frequency of seroma formation.

Evaluation of Complications of Short-term and Long-term Drainage Following Mastectomy with Removal of Axillary Lymph Nodes: A Randomized Clinical Trial.

Breast cancer is one of the most common cancers in Iran and round the globe. Seroma formation is the most common primary complication after mastectomy (partial/radical). Nowadays, drainage is used as a routine method to reduce seroma formation after mastectomy, although there is no consensus about the appropriate time to perform drainage after this surgery. This study evaluated the effects of short-term and long-term drainage after mastectomy along with removal of axillary lymph nodes. This randomized clinical trial was performed on 88 women who underwent mastectomy with ALND in hospitals in Yazd (were randomly divided into two groups). Suction drains were inserted for all patients at completion of surgery. The data collection tool was a researcher-made form based on variables. In the first group, the drain was removed 24 hours after surgery and the patients were discharged, but the second group was discharged with the drain in place after 24 hours and the drain was removed 5 days after surgery. Data were analyzed with SPSS18 using T-Test, Chi square, and Mann-Whitney U test. The results showed that 28 (31.8%) participants had formed seroma, of whom 22 (50%) were in the 1-day drainage group and 6 (13.6%) were in the 5-day drainage group. There was a statistically significant correlation among seroma frequency, mean aspiration volume, mean number of aspirations, mean seroma volume in sonography one week after surgery, and mean seroma volume in sonography between the two groups three weeks after surgery (P<0.05). Based on the results, it can be concluded that long-term drainage reduces the risk of seroma formation after mastectomy with removal of axillary lymph nodes compared to short-term drainage. Complementary study be performed by considering other underlying factors such as comorbidities to obtain the best drain removal time in breast cancer patients.

Do Abdominal Binders Prevent Seroma Formation and Recurrent Diastasis Following Abdominoplasty?

For decades, the postoperative wearing of abdominal binders has been suggested to reduce dead space and prevent mobilization of the musculoaponeurotic layer in an attempt to decrease the risk of seroma formation and recurrent diastasis. This study sought to evaluate whether the postoperative wearing of an abdominal binder provides any additional contribution to the reduction of either seroma formation or recurrent diastasis recti when abdominoplasty is performed with quilting sutures. Thirty-four women undergoing abdominoplasty were randomized into 2 groups: the binder group (n = 16) wore abdominal binders during the postoperative period, whereas the control group (n = 18) did not. Ultrasound examination was performed on postoperative days 7 and 14 to assess seroma formation and at 6 months postoperatively to assess recurrence of diastasis recti. A t test for independent samples was applied to compare means between 2 numeric variables. Generalized estimation equation models were used to evaluate seroma volume at different time points for the 2 groups. No significant differences in seroma volume were found between groups on postoperative days 7 (P = 0.830) and 14 (P = 0.882). Seven cases of subclinical recurrent diastasis were observed by ultrasound examination in the supraumbilical (4 cases) and infraumbilical regions (3 cases), but without significant differences (P = 1.000) between the 2 groups. Recurrent diastasis was not detected during physical examinations. The postoperative wearing of abdominal binders was not effective in preventing either seroma formation or recurrent diastasis following abdominoplasty with quilting sutures.

Does the Use of BioZorb® Result in Smaller Breast Seroma Volume?

To evaluate the impact of BioZorb®, a 3D-bioabsorbable marker, on the tumor-bed boost volume and dosimetric parameters in adaptive boost planning for breast cancer. Records were reviewed for 51 breast-cancer patients who underwent breast-conserving surgery and adjuvant whole-breast irradiation between January 2017 and October 2018. Changes in lumpectomy boost volume (LBV), doses to organs at risk, toxicity and cosmesis were compared between patients with and without BioZorb® Chi-square test and paired and independent t-tests were used for comparisons of variables. Median follow-up was 35.5 months. Mean LBV on initial CT (LBV1; 32.2 vs. 33.8 cc, p=0.74) and on boost computed tomography (CT) (LBV2; 25.3 vs. 24.8 cc, p=0.87) were similar with and without BioZorb® The mean decrease from LBV1 to LBV2 was 9.0 cc and 6.8 cc with and without BioZorb®, respectively (p=0.42). LBV1 was significantly positively correlated with a 20% reduction in LBV (p=0.02). Mean heart and lung doses on adaptive boost planning CT were slightly lower compared to initial planning CT in both groups. Acute breast pain was reported in 18/51 patients, 9 of whom had BioZorb® (p=0.24). Grade-2 pain was reported in 5/51 patients, 3 of whom had BioZorb® (p=0.11). Excellent or good cosmesis was reported in 36/41 patients. Fair cosmesis was reported in 5/41 patients, of whom 2 had BioZorb® (p=0.64). BioZorb® placement does not impact the tumor-bed boost volume nor the variation of seroma volume within the period of treatment. More data and longer follow-up are needed to identify a measurable clinical impact of BioZorb® placement.

Sıçanlarda Mastektomi ve Aksiller Diseksiyon Sonrası Seroma Gelişimi Üzerine Kriyoprezerve İnsan Amniyotik Membran ve Trombositten Zengin Plazmanın Etkileri

Aim: Seroma is one of the most common complications after mastectomy and axillary dissection. It occurs as a result of prolongation of the exudative-inflammatory phase of wound healing. The aim of this study is to evaluate the effects of human amniotic membrane (HAM) and platelet-rich plasma (PRP) on seroma formation. Material and Methods: A total of 24 rats were grouped as control, PRP, and HAM groups. All rats underwent radical mastectomy and axillary lymph node dissection. Saline in the control group, PRP in the second group, and HAM in the third group were applied to the dissection area. The groups were compared in terms of the condition of the surgical field, seroma volume, and histopathological changes. Results: Seroma volume decreased in the PRP group, but not in the HAM group. Lymphocyte, eosinophil, histiocyte, and fibroblast levels were significantly lower both in the PRP and HAM groups compared to the control group. E-cadherin and TGF-β1 immunoreactivities of PRP and HAM groups were higher than in the control group. Conclusion: In this study, it was observed that PRP and cryopreserved HAM increased tissue healing and decreased the inflammatory process. However, although local PRP application significantly reduced seroma formation, it was determined that HAM application did not reduce seroma formation. It was thought that this might be due to the fact that the smooth surface of HAM mechanically prevents the adhesion of the tissues. More beneficial results will be obtained with the modification to be made in the preparation and application of HAM.

Role of Autologous Fibrin Glue (AFG) to Reduce Drainage Volume After Modified Radical Mastectomy for Breast Cancer

Background: Seroma is arguably the most significant complication that can happen after mastectomy. Although seroma is not a life-threatening complication, this condition can lead to severe morbidities. This situation can cause prolonged hospital stays and delayed adjuvant therapy. In this regard, autologous fibrin glue is a hemostatic agent that can accelerate fibrin formation, stop vascular oozing, and decrease dead space. Therefore, this research was performed to evaluate autologous fibrin glue function in lowering seroma volume after mastectomy and shortening the length of hospital stay.Methods: This randomized control trial research was designed to compare the effect of autologous fibrin glue to a control group that did not receive autologous fibrin glue. Seroma volume was calculated every 24 hours. The drains were then removed after the production of seroma less than 30 mL/24 hours.Results: We recruited 20 patients for each of the two groups who met the inclusion criteria. Age, histopathology type, breast cancer stage, number of lymph nodes, and tumor size did not significantly differ. However, patients in the fibrin glue group had significantly lower cumulative drain production. The median seroma volume in the treatment group was 9.30 mL, while the median in the control group was 20.90 mL (p &lt; 0.05).Conclusions: Autologous fibrin glue significantly decreased seroma formation and length of hospital stay.

Patient Characteristics and Clinical Factors Affecting Seroma Volume

Partial breast irradiation (PBI) has increased in utilization recently, with the postoperative seroma and clips used to guide target volumes. The ideal post-surgical timing to perform computed tomography (CT)-based treatment planning for this technique is unclear. Prior studies have examined change in volume over time from surgery, however, the effect of patient characteristics on seroma volume has not been previously reported. We sought to investigate patient and clinical factors that may contribute to larger post-surgical seromas, and therefore would predict for larger PBI volumes.212 consecutive women with invasive or in situ breast cancer underwent planning CT after breast-conserving surgery at a single institution with four radiation centers during the year 2020. 215 total lumpectomy cavities were contoured per institutional standard. Contoured volume was computed using the treatment planning system. Generalized estimating equation methods were used to analyze the combined data, using treatment center as the cluster effect. Univariate and multivariate analyses (MVA) were performed to evaluate the associations between the seroma volume and patient and clinical factors.Distribution among sites were 61 patients (28.4%), 24 patients (11.2%), 57 patients (26.5%), and 73 patients (34.0%). Patient characteristics included median age 61.0 years (range, 30-85) and median BMI 30.1 kg/m² (17.3-53.9). 94% of patients did not receive neoadjuvant hormone therapy, 47.9% did not have hypertension, 93.5% of patients did not have coronary artery disease, 34.4% were treated in prone position, mean interval from surgery to CT simulation was 58.0 days ± 49.1, and mean seroma volume was 43.3 cm3 ± 46.1. Longer interval from surgery was significantly associated with smaller seroma volume, P = 0.0360. Age, BMI, hypertension, position, coronary artery disease, and use of neoadjuvant hormone therapy remained significant on MVA (P < 0.05 for all), and thus were independently associated with seroma volume. Increased age, BMI, and prone position vs. supine were associated with larger mean seroma volume; absence of hypertension, absence of coronary artery disease, and absence of neoadjuvant hormone therapy were associated with decreased seroma volume. Surgical re-excision, oncoplastic reduction, prior breast surgery, receipt of chemotherapy, race, diabetes, smoking status, and presence of clips were not significantly associated.Increased age, higher BMI, hypertension, coronary artery disease, and prone position were associated with larger seroma volume, and longer interval from surgery to simulation was associated with smaller seroma volume. Especially relevant for patients planned to receive PBI, these data may be used to select patients for which longer time to simulation may result in smaller seroma volumes and therefore smaller PBI target volumes. Larger datasets and prospective evaluation would be ideal to confirm these hypotheses.

Effects of Different Applications on Postoperative Seroma Formation and Wound Healing Following Mastectomy and Axillary Dissection in Rats

The most frequent postoperative complication after breast surgery is seroma formation. Seroma occurs due to lymphatic and vascular fluid leakage into the dead space created by surgical dissection.&#x0D; The objective of the research was to evaluate the effects of local fibrin glue, tetracycline, talc applications, and flap fixation technique on reducing seroma formation after mastectomy and axillary dissection. In addition, we aimed to determine the level of efficacy for these applications, as well as to identify the most appropriate method to be used in operations with high risk of seroma formation.&#x0D; Materials and Methods. This experimental study was conducted using a total of 60 female Wistar albino rats. They were allocated into six groups and each comprised ten rats. Unilateral mastectomy and axillary dissection were performed on all the rats. Local applications of fibrin glue, tetracycline, talc, and alcoholic iodine were performed in four separate groups. Flap fixation technique was applied in one group and those rats that did not receive any intervention constituted the control group. On the 10th postoperative day, seroma was aspirated under anesthesia, and the amount of seroma fluid was recorded. Seroma fluid was analyzed for interleukin 1-β, vascular endothelial growth factor, and C-reactive protein levels. Tissue samples were obtained from the skin overlaying the dissection area, the axilla, and the thoracic wall. Wound healing was evaluated with histopathological examination.&#x0D; Results. Seroma volume was lower and the wound healing scores were the highest in the flap fixation group and the tetracycline group as compared to the control group. However, the alcoholic iodine group and the talc group had a greater amount of seroma (p &lt; 0.05). There was no difference between the fibrin glue group and the control group.&#x0D; Conclusions. In our mastectomy model, local application of alcoholic iodine and talc substances caused more wound site problems and postoperative seroma formation. While fibrin glue did not cause wound site problems, it did increase seroma formation. These three substances were determined to be inefficacious in postoperative seroma formation. Local tetracycline application and flap fixation technique were found to reduce postoperative seroma and benefit wound healing.

A randomised controlled study on the effects of hernial sac stump fenestration on ultrasound seroma prevention in laparoscopic Type III inguinal hernia repair.

Background:The incidence of ultrasound seromas has significantly increased after large hernial sac surgery. Several methods are available for preventing ultrasound seromas, but the clinical results are poor. It has also been demonstrated that hernial sac stump fenestration during laparoscopic incisional hernia repair surgery can significantly decrease the incidence of ultrasound seromas.Materials and Methods:Ninety patients aged 18–75 years who were treated in our hospital for primary Type III indirect inguinal hernia from March 2017 to March 2018 were randomised to a preventive fenestration group and a control group. All patients underwent transabdominal preperitoneal repair. The number of ultrasound seromas in the inguinal regions and ultrasound seroma volume on day 6 and months 1 and 3 after surgery in the two groups were compared. The secondary outcomes included length of surgery, urinary retention, acute pain, chronic pain, length of hospitalisation, recurrence rate and other complications.Results:There were no significant differences in demographic characteristics. Ultrasound seroma incidence and ultrasound seroma volume on day 6 and months 1 and 3 after surgery were significantly lower in the preventive fenestration group than that in the control group. There were no significant differences in the length of hospitalisation or incidence of acute pain or urinary retention between the two groups.Conclusions:Hernial sac stump fenestration after hernial sac transection in inguinal hernia repair surgery is a simple method that can effectively reduce post-operative ultrasound seromas.

Effect of autologous fibrin glue on seroma reduction after modified radical mastectomy for breast cancer: A randomized controlled trial

IntroductionBreast cancer stands out as the second most common cancer in the world with incidence 35.1% of all malignancies among females in Egypt. Fluid build-up after breast surgery is still the most annoying complication which leads to worse outcome. We aimed to evaluate whether autologous fibrin glue might lessen the formation of seroma following modified radical mastectomy. MethodsThis was a randomized controlled trial designed to configure the effect of autologous fibrin glue given in the study group using the drain in comparison to a control group who received the drain only; seroma volume was calculated every 24 h. For all of the cases. The drains were removed when the daily drainage was less than 30 ml for 3 consecutive days. ResultsWe recruited 30 patients to each of the two groups. Age, pathology, breast cancer stage, number of lymph nodes and tumour size did not differ significantly between groups. A comparison of the median days to drain removal showed 8 days reduction in median days to drain removal compared in the intervention group (7 days) than the control (15 days). The patients in the fibrin glue group had a significantly lower cumulative drain output volume (mean ± SD of 505,6 ± 209,3 ml) than those in the control group (1674.1 ± 1 373,8 ml). ConclusionsAutologous fibrin glue significantly decrease seroma formation post-modified radical mastectomy.

Effectiveness of Cyanoacrylate in Reducing Seroma Formation in Breast Cancer Patients Post-Axillary Dissection: A Randomized Controlled Trial.

Background/PurposeSeroma is a common complication after axillary dissection in women with node-positive breast cancer. We aim to determine the effect of Cyanoacrylate on reducing seroma formation in patients undergoing axillary dissection. This a randomized clinical trial.MethodsThis is a single-center, randomized, single-blinded, and two-arm parallel study. Women with node-positive breast cancer eligible for axillary dissection were enrolled. Patients with a Body Mass Index (BMI) greater than 35 kg/m2, those who underwent immediate breast reconstruction, and/or received neoadjuvant chemotherapy were excluded. Patients were randomized in a 1:1 ratio, and were stratified according to their age, BMI, tumor size, and operation type. The primary endpoint was the total seroma volume (the total drained volume and the total aspirated volume after drain removal). Data presented as mean and range when applicable.Results111 patients were randomized (Cyanoacrylate 57; control 54). 105 patients were analyzed. Sixty-nine patients underwent breast conserving surgery, and 36 underwent modified radical mastectomy. There was no difference in the total seroma volume between the Cyanoacrylate vs. control arms (1,304 (60–4,950) vs. 1,446 (100–5,223) ml, p=0.458). Wound infection, flap necrosis, number of manual aspirates, and hematoma formation were not statistically different between the two groups. Time to drain removal was shorter in the Cyanoacrylate arm (11.04(3–23) vs. 13.84(3–37) days, p=0.015). The use of Cyanoacrylate was not cost effective ($586.93 (550–748) vs. $29.63 (0–198), p<0.001). Higher seroma volume was correlated with modified radical mastectomy, older age, and BMI more than 30 kg/m2.ConclusionCyanoacrylate did not reduce seroma formation and its use was not cost effective.Clinical Trial Registrationclinicaltrials.gov, identifier NCT02141373.

Local Triamcinolone Treatment Affects Inflammatory Response in Seroma Exudate of Abdominoplasty Patients: A Randomized Controlled Trial.

As the leading complication of abdominoplasty, seroma formation might represent an inflammatory process in response to surgical trauma. This prospective randomized trial investigated whether local administration of the antiinflammatory agent triamcinolone could prevent seroma accumulation. Weekly and cumulative seroma volumes were compared between the study groups A, B, and C over a 4-week follow-up (group A, with drain, without triamcinolone; group B, without drain, without triamcinolone; group C, without drain, with triamcinolone). Aspirated seroma samples were analyzed by enzyme-linked immunosorbent assay for selective inflammatory mediators. Triamcinolone significantly reduced cumulative seroma volume (n = 60; mA 845 ± SDA 578 ml, mC 236 ± SDC 381 ml, p = 0.001). The most accentuated suppressive effect of triamcinolone was observed shortly after the treatment (week 1) (mA1 616 ± SDA1 457 ml, mB1 153 ± SDB1 161 ml, mC1 22 ± SDC1 44 ml, pA1/C1 < 0.001, pB1/C1 = 0.014). Local triamcinolone administration resulted in a differential concentration of interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9 (week 1) in seroma exudate as measured by enzyme-linked immunosorbent assay (mIL-6A1 1239 ± SDA1 59 pg/ml, mIL-6C1 848 ± SDC1 80 pg/ml, p < 0.001; mMMP-9A1 2343 ± SDA1 484 pg/ml, mMMP-9C1 376 ± SDC1 120 pg/ml, p = 0.001). Local administration of 80 mg of triamcinolone reduced postabdominoplasty seroma accumulation significantly. Under triamcinolone treatment, suppressed levels of IL-6 and MMP-9 in seroma fluid were observed. Notably, inflammatory marker suppression correlated clinically with a decrease in seroma accumulation. Therapeutic, II.

Role of Autologous Fibrine Glue to Decrease Seroma Volume On 14th Post Operative Day in Carcinoma Mamae Patients that Underwent Simple Mastectomy

&#x0D; &#x0D; &#x0D; Background: Seroma is the most significant complication that occurred after mastectomy, happen in 25% until 60% cases. Seroma are not life threatening complications, but can lead to serious morbidity, prolonged hospital stay and delay adjuvant therapy. Autologous Fibrin Glue is a hemostatic agent that can accelerate fibrin thread formation, stop vascular oozing and decrease dead space. This research was performed to evaluate Autologous Fibrin Glue function in lowering seroma volume at 14th days after simple mastectomy.&#x0D; Methods: This research is a clinical trial to compare average seroma volume between advance stage locally breast carcinoma patients group which are given Autologous Fibrin Glue on the surface of surgical wound, 14 days after simple mastectomy (trial group) and control group (without special treatment) with ultrasonography.&#x0D; Result: From 42 patients who met the inclusion criteria, divided into 2 groups, 21 patients were given Autologous Fibrin Glue on the surgical wound surface in a simple mastectomy procedure, 21 patients as a control group. The number of seromas in the treatment group was measured using ultrasound on the 14th day, fewer meaningfully than the control group, the median seroma volume in the treatment group was 9,30 mL and median seroma volume in the control group was 20.90 mL. The P value in the variable number of seroma is smaller than 0.05 (P. &lt; 0.05) which means significant, the number of seromas measured using ultrasonography (USG) on the 14th day, fewer meaningfully in the treatment group.&#x0D; Conclusion: Subjects that was given Autologous Fibrin Glue on the surface of surgical wound after simple mastectomy has a lower volume of seroma compared to control group.&#x0D; &#x0D; &#x0D;

Effect of Collagen-Enhanced Fibrin Sealant on Seroma Formation in a Rat Mastectomy Model

Background: Seromas are caused by leakage of lymphovascular fluid into postoperative dead space. This is the most common complication after reconstructive breast surgery. The purpose of this study is to demonstrate the utility of seroma-preventing substances by using a collagen-enhanced fibrin sealant on a rat mastectomy model.Methods: Thirty-six Sprague-Dawley rats were divided into three groups. After mastectomy and axillary lymph node dissection, normal saline was applied to the dead spaces in group 1 (control). In group 2, a collagen-enhanced fibrin sealant was applied, and in group 3, triamcinolone acetate solution was applied. Afterwards, the amount of seroma was measured by three-dimensional micro-computed tomography (3D micro-CT) volumetry analysis and manual aspiration after 7 and 14 days, respectively.Results: The volume of seroma were significantly reduced in groups 2 and 3 compared to group 1 in both 3D micro-CT volumetry analysis and manual aspiration on postoperative day 7 (P&lt;0.001). In addition, the results observed in day 14 also showed a decrease in the amount of seroma analyzed by CT in groups 2 and 3 compared to group 1 (P&lt;0.05). In histopathologic examination inflammation was observed more frequently in group 1 and angiogenesis was more active in group 2.Conclusion: The use of a collagen-enhanced fibrin sealant (Collaseal) is as effective as triamcinolone control injected in a rat mastectomy model.