SEROMA PREVENTION IN A RAT MASTECTOMY MODEL - USE OF A LIGHT-ACTIVATED FIBRIN SEALANT

Seroma formation following mastectomy and axillary dissection remains a common and significant problem contributing to patient morbidity and health-care costs. Previous data have suggested that fibrin sealant ( FS), a biological adhesive, is capable of controlling lymphatic leakag e and assisting with skin graft adhesion. In this study, the use of an experimental, light-activated FS under development by CryoLife (CFS) was evaluated in a rat mastectomy model in order to reduce seroma form ation. CFS is a premixed form of FS, containing an inactivator that is reversed in the presence of light, causing sealant to form. In this m odel, rats underwent mastectomy and extensive dissection of the axilla ry lymphovasculature. Next, I ml of saline or FS was applied to the op erative site and the wound was closed. Three groups of animals were ev aluated 5 days postoperatively by measuring the volume (in milliliters ) of seroma able to be aspirated from the surgical site. The saline co ntrol group (N = 20) had a seroma volume (mean +/- standard deviation [SD]) of 4.2 +/- 2.9 ml, while a form of CFS containing human fibrinog en (80 to 100 mg per milliliter) and human thrombin (20 U per millilit er) (N = 20) had a significantly smaller seroma volume of 1.1 +/- 1.6 ml (p < 0.001 analysis of variance). University of Virginia (UVA) FS, containing human fibrinogen (20 mg per milliliter) and bovine thrombin (500 U per milliliter) (N = 20), had a seroma volume of 2.0 +/- 1.6 m l (p < 0.01, compared to control; p > 0.2, compared to CFS). Thus, thi s farm of CFS significantly reduced seroma formation compared to salin e control and also appeared to result in a smaller fluid accumulation than with UVA FS, although this trend was not statistically significan t. These data suggest that the use of CFS may help to reduce seroma fo rmation in humans.