From the Center for Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg; and the Department of Clinical Cancer Prevention and the McCombs Institute for the Early Detection and Treatment of Cancer, University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2021 Feb 1;147(2):345-354. doi: 10.1097/PRS.0000000000007523.
As the leading complication of abdominoplasty, seroma formation might represent an inflammatory process in response to surgical trauma. This prospective randomized trial investigated whether local administration of the antiinflammatory agent triamcinolone could prevent seroma accumulation.
Weekly and cumulative seroma volumes were compared between the study groups A, B, and C over a 4-week follow-up (group A, with drain, without triamcinolone; group B, without drain, without triamcinolone; group C, without drain, with triamcinolone). Aspirated seroma samples were analyzed by enzyme-linked immunosorbent assay for selective inflammatory mediators.
Triamcinolone significantly reduced cumulative seroma volume (n = 60; mA 845 ± SDA 578 ml, mC 236 ± SDC 381 ml, p = 0.001). The most accentuated suppressive effect of triamcinolone was observed shortly after the treatment (week 1) (mA1 616 ± SDA1 457 ml, mB1 153 ± SDB1 161 ml, mC1 22 ± SDC1 44 ml, pA1/C1 < 0.001, pB1/C1 = 0.014). Local triamcinolone administration resulted in a differential concentration of interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9 (week 1) in seroma exudate as measured by enzyme-linked immunosorbent assay (mIL-6A1 1239 ± SDA1 59 pg/ml, mIL-6C1 848 ± SDC1 80 pg/ml, p < 0.001; mMMP-9A1 2343 ± SDA1 484 pg/ml, mMMP-9C1 376 ± SDC1 120 pg/ml, p = 0.001).
Local administration of 80 mg of triamcinolone reduced postabdominoplasty seroma accumulation significantly. Under triamcinolone treatment, suppressed levels of IL-6 and MMP-9 in seroma fluid were observed. Notably, inflammatory marker suppression correlated clinically with a decrease in seroma accumulation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
血清肿是腹部整形术的主要并发症，可能代表一种对手术创伤的炎症反应。本前瞻性随机试验研究了局部应用抗炎药曲安奈德是否能预防血清肿积聚。
在 4 周的随访期间，比较了研究组 A、B 和 C 中每周和累计血清肿体积（组 A，带引流管，无曲安奈德；组 B，不带引流管，无曲安奈德；组 C，不带引流管，用曲安奈德）。通过酶联免疫吸附试验分析抽吸的血清肿样本中的选择性炎症介质。
曲安奈德显著减少了累积的血清肿体积（n = 60；mA 845 ± SDA 578 ml，mC 236 ± SDC 381 ml，p = 0.001）。曲安奈德的抑制作用在治疗后不久最为明显（第 1 周）（mA1 616 ± SDA1 457 ml，mB1 153 ± SDB1 161 ml，mC1 22 ± SDC1 44 ml，pA1/C1 < 0.001，pB1/C1 = 0.014）。通过酶联免疫吸附试验测量，局部曲安奈德给药导致了白细胞介素-6（IL-6）和基质金属蛋白酶-9（MMP-9）在血清肿渗出物中的浓度差异（第 1 周）（mIL-6A1 1239 ± SDA1 59 pg/ml，mIL-6C1 848 ± SDC1 80 pg/ml，p < 0.001；mMMP-9A1 2343 ± SDA1 484 pg/ml，mMMP-9C1 376 ± SDC1 120 pg/ml，p = 0.001）。
局部应用 80 mg 曲安奈德可显著减少腹部整形术后血清肿的积聚。在曲安奈德治疗下，血清肿液中观察到 IL-6 和 MMP-9 的抑制水平。值得注意的是，炎症标志物的抑制与血清肿积聚的减少具有临床相关性。
临床问题/证据水平：治疗，II 级。
