Tanaka Kiyomi, Oura Shoji, Yasuda Koji, Makimoto Shinichiro
Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
Case Rep Oncol. 2021 Mar 2;14(1):290-295. doi: 10.1159/000513491. eCollection 2021 Jan-Apr.
A 57-year-old woman underwent salvage nipple-preserving mastectomy with immediate breast reconstruction using extended latissimus dorsi muscle flap for her in-breast recurrence. The patient had been well with a presumed encapsulated seroma in her back for 8 years and 3 months but suddenly developed a protrusion of the persistent seroma. The patient requested us to improve the cosmetic deterioration of the visible large protrusion. In the operation, the operative target was converted from the newly protruded portion to the whole persistent seroma due to the leakage of presumed contaminated fluid. The posterior wall of the long-lasting seroma sticked rigidly to the ribs, forcing us not to resect the whole capsule but to resect the anterior and lateral walls with scraping the posterior wall with a curet. Pathological study showed a dense fibrous capsule, amorphous eosinophilic material, cholesterin crystals, and massive histiocyte infiltration. Postoperative course was uneventful, but wound healing was not observed over 3 weeks after operation. Minocycline 100 mg diluted in 20 mL saline was injected into the seroma cavity after full aspiration of the seroma fluid, causing immediate irritable sensation around the seroma cavity and complete disappearance of the seroma cavity in 3 weeks after the minocycline injection. Pathogenesis of this extremely rare complication remains uncertain, but long-lasting seroma formation should be avoided not to cause this type of late-phase complication. Minocycline injection into the seroma cavity is a feasible method to accelerate the wound healing.
一名57岁女性因乳房内复发接受了保留乳头的挽救性乳房切除术，并立即使用背阔肌延长肌皮瓣进行乳房重建。患者背部有一个推测为包裹性血清肿，情况良好达8年零3个月，但血清肿突然出现突出。患者要求我们改善可见的大突出导致的外观恶化。手术中，由于推测有污染液体渗漏，手术目标从新突出部分转变为整个持续存在的血清肿。长期存在的血清肿后壁与肋骨紧密粘连，迫使我们不能切除整个包膜，而是用刮匙刮除后壁的同时切除前壁和侧壁。病理研究显示有致密的纤维包膜、无定形嗜酸性物质、胆固醇晶体和大量组织细胞浸润。术后过程顺利，但术后3周以上伤口未愈合。在将血清肿液完全抽吸后，将100毫克米诺环素用20毫升生理盐水稀释后注入血清肿腔，注射米诺环素后血清肿腔周围立即出现刺激感，3周后血清肿腔完全消失。这种极其罕见并发症的发病机制仍不确定，但应避免长期形成血清肿以防止这类晚期并发症。向血清肿腔内注射米诺环素是加速伤口愈合的一种可行方法。
