Kulber D A, Bacilious N, Peters E D, Gayle L B, Hoffman L
Division of Plastic Surgery, Department of Surgery, New York Hospital-Cornell Medical Center, New York, N.Y., USA.
Plast Reconstr Surg. 1997 Mar;99(3):842-9; discussion 850-1. doi: 10.1097/00006534-199703000-00034.
Seroma formation is a difficult problem to treat and prevent. Its sequelae include wound infection, dehiscence, and skin-flap necrosis. The purpose of this study was to determine the effects of fibrin sealant on seroma formation and wound healing. Seromas were created in a rat model by harvesting the latissimus dorsi muscle. In group I (n = 20), only the latissimus dorsi muscle was harvested. In group II (n = 20), the latissimus dorsi muscle was harvested and fibrin sealant applied. Seromas were routinely aspirated. In group III (n = 20), the latissimus dorsi muscle was harvested, and once a seroma was evident clinically, it was aspirated and injected with fibrin sealant. Fibrin sealant was created by combining virally deactivated fibrinogen and thrombin (American Red Cross, Rockville, Md.). In group I, 90 percent of the animals formed seromas compared with only 20 percent in group II. The average total fluid aspirated in group I was 21 cc versus 6 cc in group II. Sixty percent of the animals in group I and 5 percent in group II required serial drainage for chronic seromas. Skin-flap necrosis occurred in 80 percent of the animals in group I, in 10 percent of group II, and in 40 percent of group III. Histologic evaluation confirmed that group II underwent better wound healing. At necropsy, group I animals with seromas had gross capsular formation; this was not readily apparent in the fibrin sealant groups. We conclude that (1) the harvesting of the rat latissimus dorsi muscle is a reliable model for creating seromas, (2) fibrin sealant effectively prevents seroma formation when applied intraoperatively, (3) wound healing in the seroma rat model is improved with intraoperative fibrin sealant application, (4) closed injection of fibrin sealant for existing seromas cannot be recommended at this time, (5) virally deactivated fibrin sealant retains its hemostatic and adhesive properties, and (6) current clinical trials of virally deactivated fibrin sealant may facilitate its use in the United States.
血清肿的形成是一个难以治疗和预防的问题。其后遗症包括伤口感染、裂开和皮瓣坏死。本研究的目的是确定纤维蛋白密封剂对血清肿形成和伤口愈合的影响。通过切取大鼠背阔肌在大鼠模型中制造血清肿。在第一组（n = 20）中，仅切取背阔肌。在第二组（n = 20）中，切取背阔肌并应用纤维蛋白密封剂。血清肿常规抽吸。在第三组（n = 20）中，切取背阔肌，一旦临床上出现明显的血清肿，将其抽吸并注射纤维蛋白密封剂。纤维蛋白密封剂通过将病毒灭活的纤维蛋白原和凝血酶（美国红十字会，马里兰州罗克维尔）混合制成。在第一组中，90%的动物形成了血清肿，而第二组中只有20%。第一组平均吸出的总液体量为21毫升，而第二组为6毫升。第一组60%的动物和第二组5%的动物因慢性血清肿需要连续引流。第一组80%的动物、第二组10%的动物和第三组40%的动物发生了皮瓣坏死。组织学评估证实第二组伤口愈合情况更好。尸检时，有血清肿的第一组动物有明显的包膜形成；这在纤维蛋白密封剂组中不明显。我们得出结论：（1）切取大鼠背阔肌是制造血清肿的可靠模型；（2）术中应用纤维蛋白密封剂可有效预防血清肿形成；（3）在血清肿大鼠模型中，术中应用纤维蛋白密封剂可改善伤口愈合；（4）目前不建议对现有的血清肿进行纤维蛋白密封剂的封闭注射；（5）病毒灭活的纤维蛋白密封剂保留其止血和黏附特性；（6）目前关于病毒灭活纤维蛋白密封剂的临床试验可能会促进其在美国的使用。
