Application of Subcutaneous Talc after Axillary Dissection in a Porcine Model Safely Reduces Drain Duration and Prevents Seromas

• Published in: Journal of the American College of Surgeons Vol. 214; no. 3; pp. 338 - 347
• Main Authors: Klima, David A., MD, Belyansky, Igor, MD, Tsirline, Victor B., MD, Lincourt, Amy E., PhD, Lipford, Edward H., MD, Getz, Stanley B., MD, Heniford, B. Todd, MD, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2012; Elsevier
• Subjects: Aerosols; Animals; Axilla; Biological and medical sciences; Drainage; General aspects; Lymph Node Excision; Medical sciences; Particle Size; Postoperative Complications - prevention & control; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Seroma - prevention & control; Surgery; Swine; Talc - administration & dosage; Time Factors; hematoxylin and eosin; large particle; SIRS; systemic inflammatory response syndrome; LND; small particle; IM; LP; H&E; intramuscular; lymph node dissection; SP; Talc; Seroma; Subcutaneous; Duration; Pig; Medicine; Prevention; Vertebrata; Mammalia; Treatment; Animal; Surgery; Models; Artiodactyla; Dissection; Ungulata; Axillary
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2011.11.004

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. Study Design 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.