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A Prospective Randomized Trial of the Efficacy of Fibrin Glue and Triamcinolone Acetonide in Seroma Prevention After Latissimus Dorsi Breast Reconstruction
Alexandra M. Hart, M.D., Claire Duggal, M.D., Ximena Pinell-White, M.D., Albert Losken, M.D..
Emory University School of Medicine, Atlanta, GA, USA.

Purpose:
Donor site seroma is the most common complication following latissimus dorsi flap (LDF) breast reconstruction. Various agents have been sprayed into the donor site at the time of closure in an attempt to minimize seroma formation. The purpose of this study was to evaluate and compare the efficacy of different products at seroma prevention.
Methods:
This is a single-center, double-blinded, randomized, control trial of a consecutive series of breast cancer patients (n=76) receiving latissimus breast reconstruction by a single surgeon. Patients were randomized to receive 1) fibrin glue [TISSEEL® (Baxter Health Corporation)] (n= 23), 2) triamcinolone (n= 26), or 3) normal saline (control, n= 27) sprayed into the donor site prior to skin closure. Outcomes of interest include: seroma, aspiration history, daily drain output, and days to last drain removal. Comparisons were made between the three groups. Drain removal was standardized at <30 cc/day.
Results:
The 3 groups were evenly matched with no differences in risk, procedures, and complications. The overall seroma rate was 38% (n=29). There were no significant differences in outcomes (Table1).
Table 1. Comparison of Outcomes Among the Three Treatment Groups
Control
(n= 27)
Fibrin
(n=23)
Triamcinilone
(n=26)
p-value
Seromas (%)10 (34.5)8 (27.6)11 (37.9)0.854
Aspirations (No.)1.302.252.580.118
Days until last drain removed35.5239.5037.400.856
Drain output per day, mean (cc)95.693.584.60.895

Conclusion:
Fibrin and steroid spray into the latissimus donor site is no better that saline at minimizing donor site seroma.


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