Effects of locally applied clinoptilolite (Froximun®) on seroma formation in a rat mastectomy and axillary lymph node dissection model

Year 2019, Volume: 33 Issue: 2, 139 - 147, 27.09.2019

Süleyman Özkan Aksoy , Cevdet Onur Tunk Ali İbrahim Sevinç Merih Güray Durak

Abstract

Objective:
Seroma formation is one of the most
frequent complications following breast cancer surgery. Although many
techniques and drugs have been investigated, no definitive data are available
concerning how to prevent this complication. The present study aims to
investigate impact of local clinoptilolite application on seroma formation in
an experimental mastectomy model created in rats.

Material
and Method: Two groups with seven rats in each were randomised.
Under general anesthesia, all rats underwent right mastectomy and axillary
dissection. Clinoptilolite was locally applied to surgical sites in the study
group, whereas no application was performed in the control group. Ten days
after the surgery, seroma formation was evaluated and tissue samples were
obtained from the surgical sites, for both biochemical and histopathological
examination

Results: There was
statistically significant decrease in seroma formation after clinoptilolite
application (p=0.002). In addition, granulation tissue formation was
significantly higher in the study group (p=0.006). No statistical difference
was found between groups in terms of biochemical parameters.

Conclusion: The reducing
effect of seroma formation by clinoptilolite application may be due to its
crystal cage structure. It collects seroma with its sero-absorbent features and
creates granuloma formation that reduces dead- space, therefore accelarating
wound healing.

Keywords

seroma, mastectomy, clinoptilolite, wound healing

RATLARDA MASTEKTOMİ VE AKSİLLER DİSSEKSİYON SONRASI KLİNOPTİLOLİT (FROKSİMUN®) KULLANIMININ SEROMA OLUŞUMUNA ETKİSİ

Abstract

Amaç: Seroma oluşumu, meme kanseri
cerrahisini takiben en sık görülen komplikasyonlardan biridir. Birçok teknik ve
ilaç araştırılmasına rağmen bu komplikasyonun nasıl önleneceğine dair kesin bir
veri bulunmamaktadır. Bu çalışmada, sıçanlarda oluşturulan deneysel mastektomi
modelinde, lokal klinoptilolit uygulamasının seroma formasyonu üzerindeki
etkisinin araştırılması amaçlanmıştır.Gereç ve Yöntem: Çalışmamızda,
sıçanlar çalışma grubu (n=7) ve kontrol grubu (n=7) olarak iki gruba randomize
edildi. Genel anestezi altında tüm sıçanlara sağ mastektomi ve aksiller
disseksiyon yapıldı. Çalışma grubuna lokal olarak klinoptilolit uygulanırken,
kontrol grubuna herhangi bir uygulama yapılmadı. Ameliyattan on gün sonra,
seroma formasyonu değerlendirildi ve hem biyokimyasal hem de histopatolojik
incelemeler için cerrahi alanlardan doku örnekleri alındı.

Bulgular: Klinoptilolit
uygulanan çalışma grubunda, kontrol grubuna göre seroma oluşumunda
istatistiksel olarak anlamlı azalma saptandı (p = 0,002). Ek olarak, çalışma
grubunda granülasyon dokusu oluşumu anlamlı olarak daha yüksekti (p = 0,006).
Biyokimyasal parametreler açısından gruplar arasında istatistiksel bir fark
bulunmadı.

Sonuç: Seroma oluşumunun klinoptilolit
uygulaması sonrası azalması, kristal kafes yapısına bağlı olabilir. Sero-emici
özellikleriyle seromayı toplar ve ölü boşluğu azaltan, dolayısıyla yara
iyileşmesini hızlandıran granülom yapılarını oluşturur.

Keywords

seroma, mastektomi, klinoptilolit, yara iyileşmesi

References

• Woodworth PA, McBoyle MF, Helmer SD, Beamer RL. Seroma formation after breast cancer surgery: incidence and predictive factors. Am Surg 2000; 66: 444 – 450.
• McCaul JA, Aslaam A, Spooner RJ, Louden I, Cavanagh T, Purushotham AD. Aetiology of seroma formation in patients undergoing surgery for breast cancer. Breast 2000; 9: 144 – 148.
• Kuroi K, Shimozuma K, Taguchi T, Imai H, Yamashiro H, Ohsumi S, et al. Pathophysiology of seroma in breast cancer. Breast Cancer 2005; 12: 288 – 293.
• Pogson CJ, Adwani A, Ebbs SR. Seroma following breast cancer surgery. Eur J Surg Oncol 2003; 29: 711 – 717.
• Stehbens WE. Postmastectomy serous drainage and seroma: probable pathogenesis and prevention. ANZ J Surg 2003; 73: 877-880.
• Tekin E, Koçdor MA, Saydam S, Bora S, Harmancıoğlu Ö. Seroma prevention by using Cornybacterium parvum in a rat mastectomy model. Eur Surg Res 2001; 33: 245 – 248.
• Egeli T, Sevinç Aİ, Bora S, Yakut MC, Cevizci T, Canda T, Şişman AR. Microporous pollysaccharide hemospheres and seroma formation after mastectomy and axillary dissection in rats. Balkan Med J 2012; 29: 179 – 183.
• Sersale R. Natural zeolites: processing, present and possible applications. Studies in Surface Science and Catalysis 1985; 24: 503 – 512.
• Kraljevi´c Paveli´c, S.; Simovi´c Medica, J.; Gumbarevi´c, D.; Filoševi´c, A.; Pržulj, N.; Paveli´c, K. Critical Review on Zeolite Clinoptilolite Safety and Medical Applications in vivo. Front Pharmacol 2018; 9, 1350.
• Ivkovic S, Deutsch U, Silberbach A, Walraph E, Mannel M. Dietary supplemantation with the tribomechanically activated zeolite clinoptilolite in immunodeficiency: effects on the immune system. Adv Ther 2004; 21: 135 – 147.
• Harada RN, Pressler VM, McNamara JJ. Fibrin glue reduces seroma formation in the rat after mastectomy. Surg Gynecol Obstet 1992; 175: 450 – 454.
• Watt-Boolsen S, Nielsen VB, Jensen J, Bak S. Postmastectomy seroma. A study of the nature and origin of seroma after mastectomy. Dan Med Bull 1989; 36: 487 – 489.
• Wang JY, Goodman NC, Amiss LR Jr, Nguyen DH, Rodeheaver GT, Moore MM, et al. Seroma prevention in a rat mastectomy model: use of a light- activated fibrin sealant. Ann Plast Surg 1996; 37: 400 – 405.
• Coveney EC, O'Dwyer PJ, Geraghty JG, O'Higgins NJ. Effect of closing dead space on seroma formation after mastectomy-a prospective randomized clinical trial. Eur J Surg Oncol 1993; 19: 143–146.
• McCarthy C, Lennox P, Germann E, Clugstone P. Use of abdominal quilting sutures for seroma prevention in TRAM flap reconstruction: a prospective, controlled trial. Ann Plast Surg 2005; 54: 361 – 364.
• Chilson TR, Chan FD, Lonser RR, Wu TM, Aitken DR. Seroma prevention after modified radical mastectomy. Am Surg 1992; 58: 750 – 754.
• Shultz I, Barholm M, Gröndal S. Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: a prospective randomized study. Ann Surg Oncol 1997; 4: 293 – 297.
• Dawson I, Stam L, Heslinga JM, Kalsbeeg HL. Effect of shoulder immobilization on wound seroma and shoulder dysfunction following modified radical mastectomy: a randomized prospective clinical trial. Br J Surg 1989; 76: 311 – 312.
• O’Hea BJ, Ho MN, Petrek JA. External compression dressing versus standard dressing after axillary lymphadenectomy. Am J Surg 1999; 177: 450 – 453.
• Burak WE Jr, Goodman PS, Young DC, Farrar WB. Seroma formation following axillary dissection for breast cancer: risk factors and lack of influence of bovine thrombin. J Surg Oncol 1997; 64: 27 – 31.
• Oertli D, Laffer U, Haberthuer E, Kreuter D, Harder F. Perioperative and postoperative tranexamic acid reduces the local wound complication rate after surgery for breast. Br J Surg 1994; 81: 856 – 859.
• Rice DC, Morris SM, Sarr MG, Farnell MB, van Heerden JA, Grant CS, et al. Intraoperative topical tetracycline sclerotherapy following mastectomy, a prospective randomized trial. J Surg Oncol 2000; 73: 224 – 227.
• Yapışlar H, Taşkın E, Özdaş S, Akın D, Sönmez E. Counteraction of apoptotic and ınflammatory effects of adriamycin in the liver cell culture by clinopitolite. Biol Trace Elem Res 2016; 170: 373 – 381.
• Gardner A, Pass HA, Prance S. Techniques in the prevention and management of breast seroma: An evaluation of current practice. The Women’s Oncology Review 2005; 5: 135 – 143.
• Janis JE, Khansa L, Khansa I. Strategies for postoperative seroma prevention: a systematic review. Plast Reconstr Surg 2016; 138: 240 – 252.
• Mastinu A, Kumar A, Maccarinelli G, Bonini S, Premoli M, Aria F. Zeolite Clinoptilolite: Therapeutic virtues of an ancient mineral. Molecules 2019; 24, 1517.
• Jurkic L. M, Cepanec I, Paveli ´c S (2013). Biological and therapeutic effects of ortho-silicic acid and some ortho-silicic acid-releasing compounds: new perspectives for therapy. Nutr Metab 2013; 10, 1–12. doi: 10.1186/ 1743-7075-10-2
• Ozogul F, Šimat V, Gokdogan S. Effect of Natural Zeolite (Clinoptilolite) on in vitro Biogenic Amine Production by Gram Positive and Gram Negative Pathogens. Front Microbiol 2018; 9: 2585. doi.org/10.3389/fmicb.2018.02585
• Bayır, A, Eryılmaz, M, Demirbilek, M. Comparison of the topical haemostatic efficacy of nano-micro particles of clinoptilolite and kaolin in a rat model of haemorrhagic injury. Eur J Trauma Emerg Surg 2016; 42: 77 – 86. doi:10.1007/s00068-015-0506.
• Y. Li, H. Li, L. Xiao, L. Zhou, J. Shentu, X. Zhang, J. Fan. Hemostatic efficiency and wound healing properties of natural zeolite granules in a lethal rabbit model of complex groin injury. Materials 2012; 5: 2586 – 2596.
• Ağalar C, Sevinç Aİ, Aysal A, Egeli T, Aksoy ÖS, Koçdor MA. Porcine Dermal Collagen Prevents Seroma Formation After Mastectomy and Axillary Dissection in Rats. Eur J Breast Health 2017; 13: 200 – 205. doi: 10.5152/ejbh.2017.3616.
• Bakır H, Uysal E, Kurt AH, Kirdak T. Analysis of the Effect of Locally Applied Bovine Collagen Sponge and Adipose-Derived Mesenchymal Stem Cells on Seroma Development in Rats Undergone Mastectomy and Axillary Dissection. J Invest Surg 2017; 30: 252 – 59. doi.org/10.1080/08941939.2016.1236856