title: Application of subcutaneous talc after axillary dissection in a porcine model safely reduces drain duration and prevents seromas.
abstract: BACKGROUND
  Talc, the most common pleurodesis agent, has recently been shown to prevent seromas and decrease drain duration when placed subcutaneously after large subcutaneous dissection accompanying open ventral hernia repair. We hypothesized that talc would decrease drain duration and prevent seromas after axillary dissection without local or systemic side effects.
  
  
  METHODS
  Six pigs underwent full, bilateral axillary dissection (n 12 dissections). Three animals each had aerosolized small particle (SP) talc and large particle (LP) talc sprayed unilaterally (TALC) before closure, with the contralateral axillary dissection serving as the control (NOTALC). Functional status, wound complications, and drain duration were recorded. Local neurovascular structures and systemic organs were harvested at 28 days, processed with hematoxylin and eosin, and examined under normal and polarized light microscopy by blinded physicians.
  
  
  RESULTS
  All pigs were back to baseline functional status by 72 hours. Two seromas (33%) were noted in the NOTALC dissections vs 0 in the TALC group (0%). Drain duration was significantly decreased in TALC vs NOTALC dissections (8.3 ± 2.7 vs 12.0 ± 3.2 days, p = 0.03), as was total drain volume (222.5 ± 127.1 mL vs 334.2 ± 137.9 mL, p = 0.02). Gross and histologic evaluation revealed neurovascular structures to be intact. Minimal splenic deposition of talc within macrophages without evidence of injury was identified in all specimens, with fewer deposits in the large particle talc group. Serum laboratory examination at time of harvest revealed all animals to have normal values.
  
  
  CONCLUSIONS
  Direct application of talc throughout the wound after axillary dissection in pigs decreased drain duration and drain volume and prevented seroma formation. Gross, histologic, and serum laboratory evaluation demonstrated no talc-related local or systemic complications. Aerosolized talc is an effective and safe pretreatment to prevent seromas and hasten drain removal after axillary dissection.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC 28204, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Klima
authors.forename: Igor
authors.initials: I
authors.lastname: Belyansky
authors.forename: Victor B
authors.initials: VB
authors.lastname: Tsirline
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.forename: Edward H
authors.initials: EH
authors.lastname: Lipford
authors.forename: Stanley B
authors.initials: SB
authors.lastname: Getz
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000336:Aerosols; D000818:Animals; D001365:Axilla; D004322:Drainage; D008197:Lymph Node Excision; D010316:Particle Size; D011183:Postoperative Complications / Q000517:prevention & control; D049291:Seroma / Q000517:prevention & control*; D013552:Swine; D013627:Talc / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D000336:Aerosols; D013627:Talc