Randomized clinical trial of prevention of seroma formation after mastectomy by local methylprednisolone injection

Qvamme, Gro M.; Axelsson, C. K.; Lanng, Charlotte; Mortensen, Marianne Foss; Wegeberg, Birgitte; Okholm, Mette; Arpi, Magnus; Szecsi, Pal B.

doi:10.1002/bjs.9874

Cited by 27 publications

(24 citation statements)

References 30 publications

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“…This observational study was a part of a double-blind randomized placebo-controlled intervention study described in detail previously [15, 16]. Briefly, the original study (EudraCT number 2009-016650-40) analyzed the effect on seroma formation after mastectomy of a single dose of 80 mg of steroids into the mastectomy cavity.…”

Section: Methodsmentioning

confidence: 99%

“…Local administration of the steroid triamcinolone into the wound cavity after autologous latissimus dorsi breast reconstruction has been shown to reduce seroma formation [13], whereas a single intravenous bolus of steroids (methylprednisolone) before mastectomy exerted no effect [14]. Steroid administration into the wound cavity on the first day after mastectomy with sentinel lymph node biopsy exerted a significant preventive effect against seroma formation during the next 30 days, while no effect was observed after mastectomy with axillary lymph node dissection [15].…”

Section: Introductionmentioning

confidence: 99%

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Bacterial colonization of seromas after breast cancer surgery with and without local steroid prophylaxis

et al. 2019

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Background Seroma formation is a frequent postoperative sequela after mastectomy for primary breast cancer. We investigated the role of bacterial colonization of seroma fluid with three different culture methods and the effect of intracavitary steroids. Methods The study group consisted of 212 patients scheduled for mastectomy from a previously performed double-blind randomized placebo-controlled intervention trial. The patients were allocated to a single dose of 80 mg of steroids (methylprednisolone) or saline, and the effect on seroma formation was investigated. From each aspiration, an equal volume of seroma fluid (10 mL) was distributed into one sterile transport tube (conventional method), one aerobic blood culture bottle and one anaerobic blood culture bottle. Results There was significant variation in the number of bacterial species detected in seroma samples among the three culture methods, ranging from 18 species with the conventional culture tubes to 40 species with aerobic blood culture bottles. Patients receiving prophylactic steroids had significantly more frequent colonization than those in the saline group. Nevertheless, the clinical surgical site infection rate of 7.0% was equal between the two groups. Conclusions In general, data analysis of the entire set of case material did not succeed in demonstrating a relationship between a specific bacterial species or a combination of species and seroma formation. However, in the few patients with growth of a pathogenic species, both the duration of seroma formation and volume of seroma fluid were more pronounced. Trial registration: Ethics Committee of Copenhagen (H-4-2009-137), (EudraCT number 2009-016650-40), the Danish Data Protection Agency (code J. no. F.750.75-2), and the Danish Health and Medicines Authority (sponsor protocol code number 23837). Start date November 2010.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bacterial colonization of seromas after breast cancer surgery with and without local steroid prophylaxis

et al. 2019

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“…Seroma formation and its subsequent complications still the main postoperative problems after mastectomy or modified radical mastectomy, proving that wound drainage is inadequate in combating seroma. 12,13 The most important clue aiming to decrease seroma formation seems to be the closure of the dead space. However, the techniques used to accomplish this goal are subject of much controversy and debate.…”

Section: Discussionmentioning

confidence: 99%

Is flap fixation an effective technique for reduction of postmastectomy seroma?

2019

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Background: Seroma formation after breast cancer surgery cannot be avoided, but it can possibly be decreased by closing of the dead space surgically. Prospective trials have established that flap fixation after mastectomy, and consequently dead space diminution, can be very valuable.Methods: A clinical trial done in Sohag University Hospital. All patients undergoing mastectomy or modified radical mastectomy for invasive breast cancer or ductal carcinoma in situ (DCIS) were eligible for inclusion and divided into two groups: The control group (C) From, patients had conventional wound closure; and flap fixation group (FF) where patients underwent wound closure using flap fixation.Results: We found that the mean blood loss was significantly higher among C group compared to only 41 ml among FF group. Regarding seroma formation, the total number of patients developed seroma showed non-significant difference between the two groups; while the number of seroma requiring aspiration was significantly higher among C group (48%) compared to FF group (20%). Regarding skin dimpling, it was mild and temporary in the minority of FF group cases, persisted in only 8% of cases after 6 months postoperative. Shoulder mobility was normal in the vast majority of cases in the early postoperative period (28% among C group and 40% among FF group); and all of these cases returned to normal shoulder mobility after 6 months of physiotherapy.Conclusions: This study demonstrates that reduction of the dead space after mastectomy using flap fixation reduces seroma formation and seroma aspirations without significant rise in the complications such as skin dimpling and shoulder mobility limitations.

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“…Seroma formation is most likely the result of the inflammatory response due to wound healing. Comparison of drain fluid to plasma ratios with known lymph to plasma values for biochemical parameters showed that this fluid is compositionally different from lymph, but is similar to inflammatory exudates [2]. In the seroma fluid several factors have been detected that support this assumption.…”

Section: Introductionmentioning

confidence: 89%

Efficacy of Single Pre Operative Dose of Glucocorticoid (125 mg of Solumedrol Intravenous) in terms of Seroma Formation in Patients Undergoing Mastectomy with Axillary Clearance for Breast Cancer: A Randomized Controlled Trial

Ishaq¹,

Nazia²,

Abida³

et al. 2020

Int J Surg Res Pract

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Randomized clinical trial of prevention of seroma formation after mastectomy by local methylprednisolone injection

Cited by 27 publications

References 30 publications

Bacterial colonization of seromas after breast cancer surgery with and without local steroid prophylaxis

Bacterial colonization of seromas after breast cancer surgery with and without local steroid prophylaxis

Is flap fixation an effective technique for reduction of postmastectomy seroma?

Efficacy of Single Pre Operative Dose of Glucocorticoid (125 mg of Solumedrol Intravenous) in terms of Seroma Formation in Patients Undergoing Mastectomy with Axillary Clearance for Breast Cancer: A Randomized Controlled Trial

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