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Use of a Novel Albumin-based Tissue Adhesive for Mitigation of Seroma in the Setting of a Porcine Dermal Implant
Craig Rowin, MD, Brian Freniere, BA, Ronald Ignotz, PhD, Elan Witkowski, MD, Raymond Dunn, MD.
UMass Memorial Medical Center, Worcester, MA, USA.
Background: Seroma formation is a well-recognized complication associated with a broad range of operative procedures including abdominal wall reconstruction and complex ventral hernia repair. Despite its ubiquity as a potential surgical complication, there remains a lack of definitive understanding of the etiology, natural history, and biochemistry of seroma. The aim of this study is to create seromas in a rat model in the setting of a commonly used porcine biologic mesh (PBM) and examining the ability of a novel albumin-based tissue adhesive to mitigate seroma formation.
Methods: Sprague-Dawley rats (12 per group, 6 groups) were assigned to either tissue adhesive application or control groups with or without implanted PBM. A 5 cm dorsal midline incision was made and the latissimus muscles were resected sharply bilaterally. In the experimental groups, PBM was sutured in the surgical bed and tissue adhesive applied. The groups were as follows: (1) no adhesive, no implant controls; (2) Adhesive A, no PBM; (3) Adhesive B, no PBM; (4) PBM, no adhesive; (5) PBM + Adhesive A; (6) PBM + Adhesive B. Postoperatively, rats were monitored for Seroma formation. At 28 days, rats were euthanized and seroma and implants were examined both grossly and histologically.
Results: Differential seroma incidence between groups was analyzed using Fisher’s Exact test. Of rats not receiving tissue adhesive or PBM (Group 1), 12/12 exhibited bursa cavities upon necropsy. For rats without PBM but receiving either Tissue Adhesive A or B (Groups 3 and 4), 4/12 rats in each group exhibited seroma bursae, a significant reduction of 66% (p<0.0001). Bursa size was also notably smaller than in rats without adhesive. When PBM was present (Group 2), 12/12 rats developed seromas without adhesive. With the addition of adhesive A or adhesive B (Groups 5 and 6), 11/12 and 12/12 rats exhibited seromas, respectively. Again, these seromas were substantially smaller than in the absence of tissue adhesive. Histologically, bursa presence was confirmed in all rats demonstrating gross seroma. In rats with PBM, a thin layer of connective tissue formed over the implant surface. In the presence of an adhesive, a statistically significantly thicker and more vascular layer of connective tissue was observed
Conclusions: This study confirms a reliable animal model of seroma formation. All rats that developed visible seromas had histologic evidence of a bursa. Albumin-based tissue adhesives decreased seroma incidence by 66% and seromas were smaller. Thus, adhesives proved effective at promoting adherence of two vascularized surfaces and reducing both the occurrence and size of seromas. Seroma incidence remained unchanged from controls with use of tissue adhesives in the presence of PBM but size was significantly reduced.
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