Inguinal lymph node dissection and local anti-inflammatory drug treated rats talk local sterile applications investigating the effects of postoperative seroma formation

Accumulation of seroma is a common complication and is an important problem after lymphadenectomy for inguinal lymph node metastases caused by lower extremity malignancies. It may cause flap ischemia, necrosis, infection, and suture line dehiscence in 25% of patients who underwent lymphadenectomy. These complications cause a delay in wound healing, a delay in post-operative adjuvant therapy and a prolonged hospitalization time. So far, many techniques have been developed to prevent the accumulation of seroma. Supporting sutures for reducing the dead spaces, drainage systems, the use of medication in dissection area for forming sclerosis and adhesions, reducing the formation of the liquid with the use of anti-inflammatory agents, immobilization, pressure dressings were applied for this reason. However, either of these methods are not sufficient, do have side effects or higher costs. Currently, fast and effective treatment of the accumulation of seroma is a surgical problem. In this study, the effects of talc substance on seroma formation after inguinal lymph node dissection on rats were investigated. The effects of previously investigated antiinflammatory drugs and talc substance are compared. A total of 24 rats forming three groups are used for this study. The fatty tissue including the inguinal lymph nodes are excised. This area is irrigated by normal saline in group 1, by slurry talc in group 2 and by an antiinflammatory drug meloxicam in group 3 and the flaps are sutured afterwards. On the seventh postoperative day when the seroma formation is maximum, the effusion is aspirated, the volume is measured and biopsy samples are collected. On the third postoperative week when the wound healing is completed, the effusion is aspirated, the volume is measured and biopsy samples are collected again. The cytological samples are prepared with haematoxylin eosine and evaluted by checking the inflamation, infiltrative cell infiltration, cappillary and fibroblast-collagene fibrils. The samples are also evaluted by indirect immunohistochemical examination by avidin-biotin-peroxidase method using anti-IL 17 and anti-fibronectine antibodies. The volume of seroma aspirated from biggest to least was group 1, group 2 and group 3 respectively. In immunohistochemical staining IL-17 was used which shows the proliferation of T helper cells. Immonohistological examination showed that IL-17 has increased more in the talc group. In this group the production of fibronectin, fibrin and collagene have also increased. Histological comparison showed that the cellular activation is depressed in antiinflammatory drug group resulting with a decrease in seroma at the surgical field. Production of fibronectin, fibrin and collagene have also increased more in the talc group and this prevented collection of seroma in the disection field. There are articles about xithe effect of fibrin glue, tetracycline, corynebacterium parvum, 5-FU, synthetic steroids and antiimflamatory drugs on seroma formation but there is no experimental study on talc. The ideal method for preventing seroma should be simple, easily obtainable, with a low cost and effective. For this reason we recommend the use of talc more commonly in plastic surgery practice especially on lymph node dissection and flap disection areas.Keywords: inguinal lymph node dissection, seroma accumulation, talc