A
study at the University of Virginia Health Sciences Center reveals
that using fibrin sealant significantly reduces total fluid drainage
in patients undergoing modified radical
mastectomy
with axillary node
dissection .
This reduction in drainage may lead to an earlier removal of the
drainage tube . Fibrin sealant may also help
treat recurring seroma in patients who have had
lumpectomy followed by radiotherapy (see below).
Fibrin sealant is commonly used in cardiopulmonary bypasses
and spleen repair surgery. However, a recent study shows that fibrin
sealant may also be used to reduce the potential accumulation of
serous fluid (thin, watery liquid) after axillary node dissection
(removal of the armpit lymph nodes) in modified radical mastectomy
patients. In the twenty-one patient study, the cumulative fluid
drainage of patients with fibrin sealant used in surgery was reduced
by 57% compared to women who underwent the surgery without using
fibrin sealant.
The main ingredient of fibrin sealant is fibrinogen, a
protein from the blood that forms a clot when combined with
thrombin—another blood protein that clots blood.
Fibrin sealant is typically used during surgery to help
control bleeding (hemostatis). Fibrin sealant is also used as a
sealant for colostomy closure (closing a surgical opening created to
allow feces to pass through the abdominal wall; typically performed
on patients with colon cancer, or severe infection of the
colon).
Using fibrin sealant in modified radical mastectomy surgery
may reduce the recurrence of seromas (accumulations of clear fluid
in the wound) after breast surgeries. To remove blood and lymph node
fluid collected during the healing process, surgeons usually place a
plastic or rubber drainage tube in the breast or under the arm
before closing the skin with stitches or clips. Drainage tubes are
usually removed within two weeks, when the drainage is reduced to
less than 30 ccs (1 fluid oz) per day. By using fibrin sealant in
the study, doctors were able to remove patients’ drainage tubes an
average of three days earlier than normal, reducing the average
number of days a patient had to have the drainage tube in her breast
by 43%.
In addition to seroma and hematoma (blood trapped in the
wound), possible side effects of mastectomy include:
- wound infection
- temporary to permanent limitations of arm/shoulder movement
due to lymphedema (if lymph nodes are removed during the
operation)
- numbness in the upper-arm skin
Click here to learn more about
mastectomy and axillary node dissection
.
A
drainage tube is usually not used in lumpectomy (a surgical procedure to
remove a cancerous breast lump and a margin of surrounding tissue).
A seroma will usually fill the surgical cavity after the operation
and naturally remold the breast’s shape. Gradually, the seroma is
absorbed and the body replaces it with scar tissue. However, some
lumpectomy patients also experience recurrent seromas despite
aspiration (the removal of accumulated fluid by fine needle and
suction). Recurrent seromas may be related to radiation
therapy
received after lumpectomy.
Some patients may have to make frequent visits to their
surgeon or doctor to have fluid drained from their breasts after
lumpectomy. Though surgeons may use several methods of sclerosis
(hardening) to prevent the recurrence of seromas including the
injection of ethanol or the injection of an autologous fibrin clot
to fill the space in the breast, these treatments may be painful for
patients. Using fibrin sealant during the initial lumpectomy may be
a step toward preventing the complications of treating recurrent
seromas.
Breast cancer patients are encouraged to ask their cancer
treatment team about fibrin sealant prior to undergoing mastectomy
or lumpectomy.
References and additional
resources
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