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


CONCLUSIONS
Following initial aspiration, intracavity injection of triamcinolone significantly reduced seroma re-accumulation after ALD breast reconstruction.
Taghizadeh
Rieka
R
Canniesburn Plastic Surgery Unit, Glasgow, UK. rieka78taghizadeh@yahoo.com
Shoaib
Taimur
T
Hart
Andrew M
AM
Weiler-Mithoff
Eva M
EM
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D055502:Secondary Prevention; D049291:Seroma / Q000209:etiology / Q000517:prevention & control*; D013396:Suction; D013524:Surgical Flaps; D020858:Tissue and Organ Harvesting / Q000009:adverse effects; D014221:Triamcinolone / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D014221:Triamcinolone