Sıçanlarda Mastektomi ve Aksiller Diseksiyon Sonrası Seroma Gelişimi Üzerine Kriyoprezerve İnsan Amniyotik Membran ve Trombositten Zengin Plazmanın Etkileri

Abstract

Amaç: Seroma, mastektomi ve aksiller lenf nodu diseksiyonu sonrası en sık görülen komplikasyonlardan bir tanesidir. Yara iyileşmesinin eksüdatif ve inflamatuar fazının uzamasının bir sonucu olarak ortaya çıkar. Bu çalışmanın amacı, insan amniyotik membranı (human amniotic membrane, HAM) ve trombositten zengin plazma (platelet-rich plasma, PRP)’nın seroma oluşumu üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntemler: Toplam 24 adet sıçan kontrol, PRP ve HAM grubu olarak gruplara ayrıldı. Tüm sıçanlara radikal mastektomi ve aksiller lenf nodu diseksiyonu yapıldı. Diseksiyon bölgesine kontrol grubunda salin, ikinci grupta PRP ve üçüncü grupta ise HAM uygulandı. Tüm gruplar cerrahi alanın durumu, seroma hacmi ve histopatolojik değişiklikler açısından karşılaştırıldı. Bulgular: PRP grubunda seroma hacminde azalma görüldü, ancak HAM grubunda azalma gözlenmedi. Hem PRP hem de HAM grubunda lenfosit, eozinofil, histiyosit ve fibroblast seviyeleri kontrol grubuna göre anlamlı derecede daha düşük olduğu tespit edildi. PRP ve HAM gruplarının E-cadherin ve TGF-β1 immünreaktivitelerinin de kontrol grubuna göre daha yüksek olduğu tespit edildi. Sonuç: Bu çalışmada PRP ve kriyoprezerve HAM'ın doku iyileşmesini arttırdığı ve inflamatuar süreci azalttığı gözlendi. Ancak lokal PRP uygulanması seroma oluşumunu önemli ölçüde azaltsa da lokal HAM uygulamasının seroma oluşumunu azaltmadığı belirlendi. Bunun HAM'ın pürüzsüz yüzeyinin mekanik olarak dokuların yapışmasını engellemesinden kaynaklanabileceği düşünüldü. HAM'ın hazırlanmasında ve uygulanmasında yapılacak olan modifikasyon ile daha faydalı sonuçlar elde edilecektir.

Keywords

• Aksiller diseksiyon
• İnsan amniyotik membran
• Mastektomi
• Trombositten zengin plazma
• Seroma

The Effects of Cryopreserved Human Amniotic Membrane and Platelet-Rich Plasma on Seroma Development after Mastectomy and Axillary Dissection in Rats

Abstract

Aim: Seroma is one of the most common complications after mastectomy and axillary dissection. It occurs as a result of prolongation of the exudative-inflammatory phase of wound healing. The aim of this study is to evaluate the effects of human amniotic membrane (HAM) and platelet-rich plasma (PRP) on seroma formation. Material and Methods: A total of 24 rats were grouped as control, PRP, and HAM groups. All rats underwent radical mastectomy and axillary lymph node dissection. Saline in the control group, PRP in the second group, and HAM in the third group were applied to the dissection area. The groups were compared in terms of the condition of the surgical field, seroma volume, and histopathological changes. Results: Seroma volume decreased in the PRP group, but not in the HAM group. Lymphocyte, eosinophil, histiocyte, and fibroblast levels were significantly lower both in the PRP and HAM groups compared to the control group. E-cadherin and TGF-β1 immunoreactivities of PRP and HAM groups were higher than in the control group. Conclusion: In this study, it was observed that PRP and cryopreserved HAM increased tissue healing and decreased the inflammatory process. However, although local PRP application significantly reduced seroma formation, it was determined that HAM application did not reduce seroma formation. It was thought that this might be due to the fact that the smooth surface of HAM mechanically prevents the adhesion of the tissues. More beneficial results will be obtained with the modification to be made in the preparation and application of HAM.

Keywords

• Axillary dissection
• Human amniotic membrane
• Mastectomy
• Platelet-rich plasma
• Seroma

References

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49.
2. Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, et al. Pathophysiology of seroma in breast cancer. Breast Cancer. 2005;12(4):288-93.
3. McCaul J, Aslaam A, Spooner RJ, Louden I, Cavanagh T, Purushotham AD. Aetiology of seroma formation in patients undergoing surgery for breast cancer. Breast. 2000;9(3):144-8.
4. Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, et al. Evidence-based risk factors for seroma formation in breast surgery. Jpn J Clin Oncol. 2006;36(4):197-206.
5. Gubitosi A, Docimo G, Parmeggiani D, Pirozzi R, Vitiello C, Schettino P, et al. Acellular bovine pericardium dermal matrix in immediate breast reconstruction after Skin Sparing Mastectomy. Int J Surg. 2014;12(Suppl 1):S205-8.
6. Chow LW, Loo WT, Yuen KY, Cheng C. The study of cytokine dynamics at the operation site after mastectomy. Wound Repair Regen. 2003;11(5):326-30.
7. Watt-Boolsen S, Nielsen V, Jensen J, Bak S. Postmastectomy seroma. A study of the nature and origin of seroma after mastectomy. Dan Med Bull. 1989;36(5):487-9.
8. O'Neill AC, Randolph MA, Bujold KE, Kochevar IE, Redmond RW, Winograd JM. Preparation and integration of human amnion nerve conduits using a light-activated technique. Plast Reconstr Surg. 2009;124(2):428-37.

9. Fairbairn NG, Ng-Glazier J, Meppelink AM, Randolph MA, Winograd JM, Redmond RW. Improving outcomes in immediate and delayed nerve grafting of peripheral nerve gaps using light-activated sealing of neurorrhaphy sites with human amnion wraps. Plast Reconstr Surg. 2016;137(3):887-95.
10. Zhao YZ, Jiang X, Xiao J, Lin Q, Yu WZ, Tian FR, et al. Using NGF heparin-poloxamer thermosensitive hydrogels to enhance the nerve regeneration for spinal cord injury. Acta Biomater. 2016;29:71-80.
11. Mamede AC, Carvalho MJ, Abrantes AM, Laranjo M, Maia CJ, Botelho MF. Amniotic membrane: from structure and functions to clinical applications. Cell Tissue Res. 2012;349(2):447-58.
12. Aydin O, Karaca G, Pehlivanli F, Altunkaya C, Uzun H, Özden H, et al. Platelet-rich plasma may offer a new hope in suppressed wound healing when compared to mesenchymal stem cells. J Clin Med. 2018;7(6):143.
13. Choi MS, Kim HK, Kim WS, Bae TH, Kim MK. A comparison of triamcinolone acetonide and fibrin glue for seroma prevention in a rat mastectomy model. Ann Plast Surg. 2012;69(2):209-12.
14. Calisir A, Ece I, Yormaz S, Colak B, Kirazli H, Sahin M. The effects of platelet-rich plasma to decrease the risk of seroma formation after mastectomy and axillary dissection. J Surg Res. 2020;256:156-62.
15. Karaköse O, Pülat H, Özçelik KÇ, Zihni İ, Bozkurt KK, Şenol S, et al. Effects of different applications on postoperative seroma formation and wound healing following mastectomy and axillary dissection in rats. Galician Med J. 2021;28(1):E202115.
16. Harada RN, Pressler VM, McNamara J. Fibrin glue reduces seroma formation in the rat after mastectomy. Surg Gynecol Obstet. 1992;175(5):450-4.
17. Anjani J, Amit O, Kuber S, Achal G. Factors affecting seroma formation after modified radical mastectomy in patients of carcinoma breast: A prospective study. IJSS J Surg. 2016;2(1):1-5.
18. Gonzalez EA, Saltzstein EC, Riedner CS, Nelson BK. Seroma formation following breast cancer surgery. Breast J. 2003;9(5):385-8.
19. McCarthy C, Lennox P, Germann E, Clugston P. use of abdominal quilting sutures for seroma prevention in TRAM flap reconstruction: a prospective, controlled trial. Ann Plast Surg. 2005;54(4):361-4.
20. Aksoy SÖ, Tunk CO, Sevinç Aİ, Güray Durak M. Effects of locally applied clinoptilolite (Froximun®) on seroma formation in a rat mastectomy and axillary lymph node dissection model. DEU Tıp Derg. 2019;33(2):139-47.
21. Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg. 2004;62(4):489-96.
22. Liu Z, Zhu X, Zhu T, Tang R. Evaluation of a biocomposite mesh modified with decellularized human amniotic membrane for intraperitoneal onlay mesh repair. ACS Omega 2020;5(7):3550-62.
23. Parolini O, Soncini M, Evangelista M, Schmidt D. Amniotic membrane and amniotic fluid-derived cells: potential tools for regenerative medicine? 2009;4(2):275-91.
24. Iranpour S, Mahdavi-Shahri N, Miri R, Hasanzadeh H, Bidkhori HR, Naderi-Meshkin H, et al. Supportive properties of basement membrane layer of human amniotic membrane enable development of tissue engineering applications. Cell Tissue Bank. 2018;19(3):357-71.
25. Mazzocca AD, McCarthy MB, Intravia J, Beitzel K, Apostolakos J, Cote MP, et al. An in vitro evaluation of the anti-inflammatory effects of platelet-rich plasma, ketorolac, and methylprednisolone. Arthroscopy. 2013;29(4):675-83.
26. Chai J, Ge J, Zou J. Effect of autologous platelet-rich plasma gel on skin flap survival. Med Sci Monit. 2019;25:1611-20.
27. Kuwahara M, Hatoko M, Tada H, Tanaka A. E-cadherin expression in wound healing of mouse skin. J Cutan Pathol. 2001;28(4):191-9.
28. Choi JA, Jin HJ, Jung S, Yang E, Choi JS, Chung SH, et al. Effects of amniotic membrane suspension in human corneal wound healing in vitro. Mol Vis. 2009;15:2230-8.
29. Spartalis E, Tsilimigras DI, Charalampoudis P, Karachaliou GS, Moris D, Athanasiou A, et al. The “Yin and Yang” of platelet-rich plasma in breast reconstruction after mastectomy or lumpectomy for breast cancer. Anticancer Res. 2017;37(12):6557-62.
30. Kang NH, Hwang KA, Kim SU, Kim YB, Hyun SH, Jeung EB, et al. Potential antitumor therapeutic strategies of human amniotic membrane and amniotic fluid-derived stem cells. Cancer Gene Ther. 2012;19(8):517-22.
31. Kelekci S, Uygur D, Yilmaz B, Sut N, Yesildaglar N. Comparison of human amniotic membrane and hyaluronate/carboxymethylcellulose membrane for prevention of adhesion formation in rats. Arch Gynecol Obstet. 2007;276(4):355-9.