SEROMA FORMATION FOLLOWING AXILLARY DISSECTION FOR BREAST-CANCER - RISK-FACTORS AND LACK OF INFLUENCE OF BOVINE THROMBIN

Background: Seromas of the axillary space following breast surgery can lead to significant morbidity and delay in the initiation of adjuvant therapy. A prospective, randomized study was undertaken to evaluate t he effect of bovine spray thrombin on seroma formation following eithe r modified radical mastectomy (MRM) or lumpectomy with axillary dissec tion (LAD). In addition, risk factors for seroma formation were analyz ed and identified. Methods: A total of 101 patients were randomized to receive either bovine thrombin (20,000 units) (treatment group) or no thrombin (control group) applied to their axilla following either MRM or LAD. Drains were left in place until the preceding 24-hour drainag e was <40 milliliters. The number of days the drains were in place and wound complications (including seroma formation) were recorded. Resul ts: Forty-nine (n = 49) patients were assigned to the treatment group and 52 (n = 52) to the control group. MRM was performed on 60 patients (59%) and LAD oN 41 (41%). Eighteen of the 49 patients (37%) in the t hrombin group developed a seroma in comparison to 21 of the 52 control patients (40%) (P = 0.71). Significant risk factors for seroma format ion included increased age, patient weight, initial 72-hour wound drai nage, and LAD. No statistically significant differences were observed between treatment and control groups with respect to time to drain rem oval, or the incidence of other wound complications. Conclusion: Altho ugh thrombin by itself appears to have no effect on subsequent seroma development following axillary dissection, the identification of predi ctive Variables will be helpful in designing future trials aimed at re ducing the incidence of this common complication of breast surgery. (C ) 1997 Wiley-Liss, Inc.