Triamcinolone reduces seroma re-accumulation in the extended latissimus dorsi donor site

doi:10.1016/j.bjps.2007.03.019

Journal of Plastic, Reconstructive & Aesthetic Surgery

Volume 61, Issue 6, June 2008, Pages 636-642

https://doi.org/10.1016/j.bjps.2007.03.019 Get rights and content

Summary

Background

The incidence of donor site seroma after autologous latissimus dorsi (ALD) breast reconstruction is in the order of 70%. In the majority of cases the seroma recurs following an initial aspiration. We designed a double-blind randomised controlled trial to test the hypothesis that an intracavity injection of the anti-inflammatory corticosteroid triamcinolone would inhibit seroma re-accumulation.

Methods

We recruited 52 ALD breast reconstructions in 49 patients, of whom 41 involved immediate reconstruction and 11 delayed reconstruction. Patients exhibiting seromas at their first postoperative visit were randomised to receive either intracavity triamcinolone 80 mg (Group A, n = 29) or saline (Group B, n = 23), following seroma aspiration. We recorded the incidence of wound complications, total time (days) and number/volume of subsequent aspirations to dryness.

Results

Triamcinolone significantly reduced the need for any further aspiration (A = 16/29, B = 22/23), total number of aspirations (A: median = 1, interquartile range = 0–1; B: median = 4, interquartile range = 2–5; P < 0.0001), total volume aspirated (A: median = 30 ml, interquartile range = 0–80; B: median = 325 ml, interquartile range = 199–550; P < 0.0001), and total time to dryness (A: median = 12 days, interquartile range 7–17; B: median = 37 days, interquartile range 20–49; P < 0.0001). The incidence of adjuvant chemotherapy (A = 16/29, B = 9/23) and radiotherapy (A = 16/29, B = 10/23) was similar, and there was no effect upon donor site complications (Group A = 4/29, Group B = 2/23, P = 0.725). The mean follow-up time for patients in the steroid group was 264 days compared to 254 days for those in the placebo group. Steroid injections were well tolerated, and there were no infective complications.

Conclusion

Following initial aspiration, intracavity injection of triamcinolone significantly reduced seroma re-accumulation after ALD breast reconstruction.

Section snippets

Study design

The study was designed with reference to the CONSORT statement for randomised controlled trials and the Declaration of Helsinki, and was approved by the local ethics research committee for North Glasgow University Hospitals NHS Trust.

The selection and timing of breast reconstruction was patient centred, after assessment and counselling with regard to body habitus, co-morbidity, and likelihood of radiotherapy. In this process the extended ALD reconstruction was considered equally with abdominal

Results

During the period of this study 85 autologous latissimus dorsi flaps (three combined with implants) were performed under one surgeon's care. The seroma rate of this cohort was found to be 66%. The study group analysed consisted of 56 donor sites in 52 patients (all patients with a seroma who consented to entry into the trial), with four donor sites in three patients subsequently excluded from participation after randomisation. One randomised to steroid injection was excluded due to partial,

Discussion

The extended autologous latissimus dorsi flap has become the workhorse of breast reconstruction in the Canniesburn Plastic Surgery Unit, and is gaining increasing acceptance in many units because of its ability to adequately restore volume and breast contour in many women, particularly in the context of immediate reconstruction after skin-sparing mastectomy. It has been favoured by our patient population, which overwhelmingly prefers autologous techniques, but can be wary of the longer recovery

Acknowledgements

The authors are indebted to Marion Stephenson for the control of blinding and documentation of the trial, Helen Christie, Marion McAneny, Georgie Lawless in the Plastic Surgery Outpatient department for aspiration and administration of injections and recording the seroma volumes.

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^☆: Paper presented at the summer meeting of British Association of Plastic Surgeons (BAPS) June 2005, Eton, UK and European Society of Plastic Reconstructive Aesthetic Surgeons (ESPRAS) September 2005, Vienna.

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Triamcinolone reduces seroma re-accumulation in the extended latissimus dorsi donor site☆

Summary

Background

Methods

Results

Conclusion

Section snippets

Study design

Results

Discussion

Acknowledgements

Clin Plast Surg

Br J Plast Surg

Eur J Surg Oncol

Am J Surg

Am J Surg

Breast reconstruction after radical mastectomy

Plast Reconstr Surg

Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients

Plast Reconstr Surg

Breast reconstruction with the extended latissimus dorsi flap

Plast Reconstr Surg

Sensitivity of breasts reconstructed with the autologous latissimus dorsi flap

Plast Reconstr Surg

To reduce your seroma rate

Plast Reconstr Surg

Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention

Ann Plast Surg

Latissimus dorsi donor-site quilting: less is more?

Plast Reconstr Surg