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.
- The Virginia Health Sciences Center’s January 1997 medical report, "Fibrin sealant reduces
serous drainage and allows for earlier removal after axillary
dissection: a randomized prospective trial" is available online at
http://www.ncbi.nlm.nih.gov/
htbin-post/Entrez/query?uid=8985079&form=6&db=m&Dopt=b. - Information from the Food and Drug Administration about a newly approved fibrin sealant (May 1, 1998) is available online at http://www.fda.gov/bbs/topics/ANSWERS/ANS00865.asp
- The May 1, 1998 WorldMedical press release about the FDA approved fibrin sealant is available at http://www.worldmedical.com/pr-abstracts/fibrin_sealant.asp.
