Development of Experimental Animal Model and Methodology for Evaluation of a Seroma Prevention Approach

Abstract

Background: seroma is a frequent complication after routine procedures such as mastectomy or latissimus dorsi flap harvesting. Despite multiple attempts to find preventive and curative solutions, seroma remains a major surgical complication.No method of prevention is completely satisfactory at the present time.Objective: we aim to present an experimental animal model of seroma production after latissimus dorsi muscle and axillary nodes harvest and follow-up protocol to evaluate the efficacy and tolerability of seroma prevention methods.Methods: we performed a harvest of the right latissimus dorsi muscle and axillary lymph nodes, in 50 Wistar rats divided in 5 groups (n = 10 rats per group). In group I no seroma prevention was performed. Seroma prevention groups were the following: in group II Quilting Sutures (QS), group III Fibrin Glue (FG) application, group IV VENASEAL ® application and group V NEXPOWDER ® application. Follow-up included standard photographs, in vivo fluorescence imaging of flap perfusion, microCT-scan, seroma puncture and histological flap analysis at POD7, 30 and 90.Results: we developed a reliable surgical animal model of latissimus dorsi harvest to create seroma as observed in clinical practice. At POD7 the use of QS, FG and VENASEAL ® showed a significant decrease in seroma volume compared with control group (respectively p=0.0016, p=0.0005 and p<0.0001) in both microCT-scan and puncture measurements. At POD30 there was no difference between groups. POD7 flap vascularization was significantly lower in control group compared to QS (p<0.0001), FG (p< 0.0001), VENASEAL ® (p<0.0001) and non-operated (p=0.0289) groups as illustrated by fluorescence imaging. Histological analysis showed significant inflammation in the prevention methods and specifically when a TA was used. Conclusion:Our animal model and monitoring methodology allow for assessing methods of prevention of seroma as well as the potential associated complications. It may be used as a basic protocol for further studies of innovative tissue adhesives.