Local Triamcinolone Treatment Affects Inflammatory Response in Seroma Exudate of Abdominoplasty Patients: A Randomized Controlled Trial

Abstract

Background: 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. Methods: 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. Results: 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, p A1/C1 < 0.001, p B1/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). Conclusions: 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.

Effect of preoperative intravenous steroids on seroma formation after modified radical mastectomy

“…It was observed that local administration of 80mg of triamcinolone reduced postabdominoplasty formation of seroma markedly with the decrease in levels of IL-6 in seroma fluid. The suppression of inflammatory markers corresponded clinically with a reduction in seroma accumulation 22 . Likewise, the employment of injection triamcinolone in breast reconstruction surgery illustrated that 55% patients did not have formation of seroma.…”

Wound exudate reduction from retroperitoneum with facilitation of healing by triamcinolone injection: A case report

“…Topical administration of triamcinolone has been proposed as an effective treatment for seroma after latissimus dorsi flap harvesting and abdominoplasty. [7,8] Triamcinolone may prevent seroma from oozing into the dead space due to decreased vascular permeability and has an anti-inflammatory action that suppresses arachidonic acid synthesis, which plays a key role in the production of prostaglandins and leukotrienes. [10] In the case presented here, the exudate from the chronic granulation might have immersed the skin wound due to flap harvesting because of the absence of adhesion between the flap and peritoneum.…”

“…Local injection of triamcinolone has been reported to reduce pericardial fluid, ascites, and subcutaneous seroma formation after latissimus dorsi flap harvesting and abdominoplasty. [4][5][6][7][8] This report describes a case in which triamcinolone was injected locally, effectively decreasing exudate from the retroperitoneum that had been exposed for a prolonged period, thereby leading to wound closure.…”

“…Local injection of triamcinolone has been reported to reduce pericardial fluid, ascites, and subcutaneous seroma formation after latissimus dorsi flap harvesting and abdominoplasty. [4–8]…”

Management of Postoperative Seroma: Recommendations Based on a 12-Year Retrospective Study

“…Many clinical studies have tried to identify possible risk factors contributing to seroma formation, as well as strategies to minimize these risks. Preventive measures and surgical strategies have been proposed to reduce the incidence of seromas—especially after breast surgery, flap harvesting, abdominoplasty, and lymph node dissections—and include quilting and progressive tension sutures [ 1 ], sclerosing or adhesive substances, the application of triamcinolone or talc [ 2 ], as well as compression and immobilization [ 3 , 4 , 5 , 6 , 7 ]. Other studies have proposed comorbidities, such as increased BMI and hypertension, as possible risk factors in the development of seromas [ 8 , 9 ].…”