Summary
Background
Seroma formation is still a common problem in breast surgery. Seroma formation is associated with morbidity and financial loss. Fibrin glue was used in several studies for solution, but the results were controversial. On the other hand surgical meshes are promising to prevent the seroma formation.
Methods
A total of 48 female Sprague-Dawley rats were randomly assigned to four groups. Each underwent radical mastectomy, axillary lymph node dissection, and disruption of the dermal lymphatic vessels. Group 1 is the control group (n = 12). In group 2 (n = 12), 1 × 1 cm polyglactin 910 mesh (Vicryl, Ethicon Johnson&Johson USA) is placed over the chest wall under the skin flaps prior to closure. The animals in group 3 received 0.5 mL fibrin glue (Baxter Healthcare Ltd. United Kingdom) topically throughout the wound before the closure (n = 12). The animals in group 4 (n = 12) received 0.5 mL fibrin glue topically throughout the wound, and 1 × 1 cm polyglactin 910 mesh is placed under the skin flaps prior to the closure. Full thickness tissue samples from both the chest wall and the skin were harvested. The harvested tissue samples were evaluated by a single pathologist in a blind fashion.
Results
The mean seroma volume of the control group was 1.536 mL whereas the mean seroma volume of the groups 2, 3, and 4 were 1.189, 0.438, and 0.556 respectively. Mean seroma volume was significantly lower, adhesion index and foreign body reaction were higher in group 4.
Conclusion
Although various studies show controversial results to prevent the seroma formation. This experimental study is an evidence that fibrin glue and polyglican mesh reduce seroma with increasing inflammatory reaction.
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References
Aitken DR, Minton JP. Complications associated with mastectomy. Surg Clin North Am. 1983;63(6):1331–52.
Stehbens WE. Postmastectomy serous drainage and seroma: probable pathogenesis and prevention. ANZ J Surg. 2003;73(11):877–80.
Woodworth PA, McBoyle MF, Helmer SD, Beamer RL. Seroma formation after breast cancer surgery: incidence and predicting factors. Am Surg. 2000;66(5):444–50; discussion 450–1.
Hayes JA, Bryan RM. Wound healing following mastectomy. Aust N Z J Surg. 1984;54(1):25–7.
Budd DC, Cochran RC, Sturtz DL, Fouty WJ, Jr. Surgical morbidity after mastectomy operations. Am J Surg. 1978;135(2):218–20.
Sakkary MA. The value of mastectomy flap fixation in reducing fluid drainage and seroma formation in breast cancer patients. World J Surg Oncol. 2012;10:8.
Gong Y, Xu J, Shao J, Cheng H, Wu X, Zhao D, Xiong B. Prevention of seroma formation after mastectomy and axillary dissection by lymph vessel ligation and dead space closure: a randomized trial. Am J Surg. 2010;200(3):352–6.
Whitfield PC, Rainsbury RM. Suction versus siphon drainage after axillary surgery for breast cancer: a prospective randomized trial. Br J Surg. 1994;81(4):547.
Britton BJ, Gilmore OJ, Lumley JS, Castleden WM. A comparison between disposable and non-disposable suction drainage units: a report of a controlled trial. Br J Surg. 1979;66(4):279–80.
Cameron AE, Ebbs SR, Wylie F, Baum M. Suction drainage of the axilla: a prospective randomized trial. Br J Surg. 1988;75(12):1211.
O’Hea BJ, Ho MN, Petrek JA. External compression dressing versus standard dressing after axillary lymphadenectomy. Am J Surg. 1999;177(6):450–3.
Lindsey WH, Masterson TM, Spotnitz WD, Wilhelm MC, Morgan RF. Seroma prevention using fibrin glue in a ratmastectomy model. Arch Surg. 1990;125:305–7.
Moore MM, Nguyen DH, Spotnitz WD. Fibrin sealant reduces serous drainage and allows for earlier drain removal after axillary dissection: a randomized prospective trial. Am Surg. 1997;63:97–102.
Moore M, Burak WE, Nelson E, et al. Fibrin sealant reduces the duration and amount of fluid drainage after axillary dissection: a randomized prospective clinical trial. J Am Coll Surg. 2001;192:591–9.
Rousou JA, Engleman RM, Breyer RH. Fibrin glue: an effective homeostatic agent for nonsuturable intraoperative bleeding. Ann Thorac Surg. 1984;38:409.
Rosch R, Junge K, Schachtrupp A, Klinge U, Klosterhalfen B, Schumpelick V. Mesh implants in hernia repair. Inflammatory cell response in a rat model. Eur Surg Res. 2003;35:161–6.
Laschke MW, Haufel JM, Thorlacius H, Menger MD. New experimental approach to study host tissue response to surgical mesh materials in vivo. J Biomed Mater Res A. 2005;74:696–704.
Klinge U, Klosterhalfen B, Birkenhauer V, Junge K, Conze J, Schumpelick V. Impact of polymer pore size on the interface scar formation in a rat model. J Surg Res. 2002;103:208–14.
Agrawal A, Ayantunde AA, Cheung KL. Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg. 2006;76(12):1088–95.
Ruggiero R, Procaccini E, Piazza P, Docimo G, Iovino F, Antoniol G, Irlandese E, Gili S, Lo Schiavo F. Effectiveness of fibrin glue in conjunction with collagen patches to reduce seroma formation after axillary lymphadenectomy for breast cancer. Am J Surg. 2008;196(2):170–4.
Ulusoy AN, Polat C, Alvur M, Kandemir B, Bulut F. Effect of fibrin glue on lymphatic drainage and on drain removal time after modified radical mastectomy: a prospective randomized study. Breast J. 2003;9(5):393–6.
Shultz I, Barholm M, Grondal S. Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: a prospective randomized study. Ann Surg Oncol. 1997;4:293–97.
Barwell J, Campbell L, Watkins RM, et al. How long should suction drains stay in after breast surgery with axillary dissection? Ann R Coll Surg Engl. 1997;79:435–37.
Laschke MW, Häufel JM, Scheuer C, Menger MD. Angiogenic and inflammatory host response to surgical meshes of different mesh architecture and polymer composition. J Biomed Mater Res B Appl Biomater. 2009;91(2):497–507.
Harada RN, Pressler VM, McNamara J. Fibrin glue reduces seroma in the rat after mastectomy. Surg Gynecol Obstet. 1992;175:450–4.
Kulber DA, Bacilious N, Peters ED, et al. The use of fibrin sealant in the prevention of seromas. Plast Reconstr Surg. 1997;99:842–9.
Weinrach JC, Cronin ED, Smith BK, et al. Preventing seroma in the latissimus dorsi flap donor site with fibrin sealant. Ann Plast Surg. 2004;53:12–6.
Akhtar S, Spyrou GE, le Fourie R. Our early experience in the use of tissue glue to reduce the incidence of seroma formation from the latissimus dorsi flap donor site. Plast Reconstr Surg. 2005;116:347–8.
Gilly FN, François Y, Sayag-Beaujard AC, Glehen O, Brachet A, Vignal J. Prevention of lymphorrhea by means of fibrin glue after axillary lymphadenectomy in breast cancer: prospective randomized trial. Eur Surg Res. 1998;30(6):439–43.
Burak WE, Jr., Goodman PS, Young DC, Farrar WB. Seroma formation following axillary dissection for breast cancer: risk factors and lack of influence of bovine thrombin. J Surg Oncol. 1997;64(1):27–31.
Klinge U, Schumpelick V, Klosterhalfen B. Functional assessment and tissue response of short- and long-term absorbable surgical meshes. Biomaterials. 2001;22(11):1415–24.
Montes JH, Bigolin AV, Baú R, Nicola R, Grossi JV, Loureiro CJ, Cavazzola LT. Analysis of adhesions resulted from mesh fixation with fibrin sealant and suture: experimental intraperitoneal model. Rev Col Bras Cir. 2012;39(6):509–14.
Chung TL, Holton LH, 3rd, Goldberg NH, Silverman RP. Seroma prevention using Mytilus edulis protein in a rat mastectomy model. Breast J. 2006;12(5):442–5.
Sitzmann JV, Dufresne C, Zuidema GD. The use of sclerotherapy for treatment of postmastectomy wound seromas. Surgery. 1983;93:345–7.
Shamley DR, Barker K, Simonite V, Beardshaw A. Delayed versus immediate exercises following surgery for breast cancer: asystematic review. Breast Cancer Res Treat. 2005;90:263–71.
Carcoforo P, Soliani G, Maestroni U, et al. Octreotide in the treatment of lymphorrhea after axillary node dissection: a prospective randomized controlled trial. J. Am. Coll. Surg. 2003;196:365–9.
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Yeniay, L., Ünalp, Ö., Uğuz, A. et al. Can polyglactin mesh be used for prevention of seroma after mastectomy: an experimental study. Eur Surg 46, 268–272 (2014). https://doi.org/10.1007/s10353-014-0281-9
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DOI: https://doi.org/10.1007/s10353-014-0281-9