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Prevention of seroma formation after dissection of musculocutaneous flaps
M S Coons1, T A Folliguet, C Rodriguez
1Department of Surgery, Maimonides Medical Center, Brooklyn, New York 11219.
Abstract:
Dissection of musculocutaneous flaps is uniformly followed by the formation of seroma if drains are not used. Drains can be colonized and form deep tissue infection if left in place for a long time. In this study we investigated whether talc poudrage could prevent the formation of seroma following dissection of the latissimus dorsi muscle in a canine model. Twelve mongrel dogs were randomized into two groups. Group 1 (n = 6) underwent dissection of the left latissimus dorsi muscle which was rotated as a pedicle flap into the left chest through a second intercostal space thoracotomy. The wound was closed in layers without drains. Group 2 (n = 6) had the same procedure, but before closure of the wound, USP talc was applied to the tissues. All animals received cefazolin (500 mg) Q8h for 48 hours perioperatively. Animals were followed for 1-5 months. Wounds with fluctuation were aspirated as many times as necessary and the amount of fluid was recorded. All Group 1 animals developed seromas, in contrast, only one animal in group 2 had a seroma. There was a significant difference in the amount of fluid aspirated for each animal between the two groups (280 +/- 80 in group 1 vs 25 +/- 25 ml in group 2, P < 0.05). The total amount of fluid drained in group 1 was 1730 ml, whereas only 150 ml was aspirated in group 2. Group 1 animals required a total of 11 aspirations to control seromas, in contrast, only one aspiration was needed in group 2. No abscess was identified at postmortem in either group. Based on the results of this study we conclude that talc poudrage can be safely used to minimize seroma formation after dissection of musculocutaneous flaps.
Insights
Talc poudrage significantly reduced seroma formation after latissimus dorsi musculocutaneous flap dissection in a canine model. This method offers a safe alternative to drains, minimizing fluid accumulation and aspiration needs.
Area of Science:
- Surgical Oncology
- Plastic Surgery
- Experimental Surgery
Background:
- Seroma formation is a common complication following musculocutaneous flap dissection.
- Traditional surgical drains carry risks of colonization and deep tissue infection.
- Alternative methods to prevent seroma are needed to improve patient outcomes.
Purpose of the Study:
- To investigate the efficacy of talc poudrage in preventing seroma formation after latissimus dorsi musculocutaneous flap dissection.
- To compare the incidence and volume of seroma in dogs treated with and without talc poudrage.
Main Methods:
- A canine model was used with 12 dogs randomized into two groups.
- Group 1: Latissimus dorsi flap dissection, closure without drains.
- Group 2: Latissimus dorsi flap dissection with USP talc application before closure, without drains. Both groups received perioperative antibiotics.
Main Results:
- All Group 1 animals (n=6) developed seromas, with a mean aspirate volume of 280 ml.
- Only one animal in Group 2 (n=6) developed a seroma, with a mean aspirate volume of 25 ml.
- Significant difference in fluid aspirated (P < 0.05) and fewer aspirations required in the talc group.
Conclusions:
- Talc poudrage is a safe and effective method for minimizing seroma formation post-musculocutaneous flap dissection.
- Talc application significantly reduces the need for seroma aspiration compared to standard closure without drains.
- This technique presents a promising alternative to surgical drains in specific flap procedures.