EFFECT OF FIBRINOGEN AND THROMBIN CONCENTRATIONS ON MASTECTOMY SEROMAPREVENTION

Seroma formation remains a significant clinical problem which increase s morbidity and hospital costs in patients undergoing mastectomy opera tions. This study evaluated the effect of varying the concentrations o f fibrinogen and thrombin in fibrin sealant on successfully preventing seroma formation in a rat model. After axillary dissection, control a nimals (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-VII I) had increasing concentrations of 0.5 ml of fibrinogen (25, 50, or 1 00 mg/ml) and 0.5 mi of thrombin (10 or 100 U/ml) applied. Seroma volu mes (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 mi, n = 15) using fibrinogen, 25 mg/ml, and thrombin, 10 m g/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 s tatistically significant difference in the mean seroma fluid volumes b etween the groups (P = 0.0021), while Scheffe's comparison showed a sp ecific 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 an d II), 3.5 +/- 2.4 ml, and all treated animals (Groups III-VIII), 1.7 +/- 2.1 ml, was highly significant by unpaired t test. (P < 0.0001). T hus, fibrin sealant was useful in reducing seroma formation in this ra t model with the highest concentration of fibrinogen and thrombin appe aring most effective. These data may be useful in guiding future clini cal trials in humans. (C) 1996 Academic Press, Inc.