Surgical Glue versus Tetracycline in prevention and management of post mastectomy seroma

Abstract

Breast cancer has remained the second leading cause of cancer death among women worldwide over the past three decades and contributes significantly to cancer surgical load . Seroma is most common problem occurring after mastectomy. Seroma incidence varied from 10% to over 85%. Most surgeons view it is as necessary evil rather than complication . Seroma formation prevention has become most important goal, due to lack of effective treatment. In all methods, the main preventive strategy is to reduce lymphatic leakage and obliterate dead space, including use of some sclerosing agents, such as fibrin glue or fibrin sealant which have been found to be effective for seroma prevention and Tetracycline (TCN) which is antibiotic that proved to have potent sclerosing agent by enhancing fibroblast collagen synthesis. The aim of this study is to compare the effect of Tetracycline injection versus Surgical glue in prevention and management of post operative seroma formation after breast carcinoma Surgery . Various sclerosants have also been used to prevent and manage seroma. The most commonly reported sclerosant in the literature is Tetracycline and similar to fibrin glue, some reports found them useful whereas others did not . Fibrin glue is a two-component material consisting of fibrinogen and thrombin. In the presence of small amounts of calcium and factor XIII, the thrombin converts fibrinogen into insoluble fibrin, the final stable form of the agent. Fibrin sealant now has over a century of development and use. The use of fibrin glue may reduce lymphatic drainage by reducing the number of transections of small vessels and lymphatics during axillary lymph node removal . Tetracycline (TCN) is antibiotic that proved to have potent sclerosing agent and use of it has been advocated to decrease serous drainage and the formation of seromas after modified radical mastectomy. Our study study was done on 45 patients who underwent modified radical mastectomy divided into ( 15 patients treated with surgical glue ,15 patients treated with Tetracycline (TCN) and 15 patients were as a control group ) . We found that 10 patients (66.7%) of Tetracycline (TCN) group gave satisfactory net results and 5 patients (33.3%) were not satisfactory and form seroma .But there were 9 patients (60%) of surgical glue group gave satisfactory net results and 6 patients (40%) were not satisfactory and form seroma .In control group 8 patients (53.3%) did not form seroma and 7 patients (46.7%) form seroma .