Effect of topical application of tranexamic acid on reduction of wound drainage and seroma formation after mastectomy

Objectives
Formation of a seroma most frequently occurs after mastectomy and axillary surgery. Prolonged drainage is troublesome as it increases the risk for infection and can significantly delay adjuvant therapy. Topical tranexamic acid as an antifibrinolytic agent may control fluid accumulation in the dead space under the skin flaps and in the axillary fossa after mastectomy. The aim of this study was to investigate whether moistening a wound surface with tranexamic acid reduces bleeding and fibrinolysis and therefore reduces the total wound drainage after mastectomy and also the incidence of hematoma or seroma formation.
Patients and methods
We conducted a prospective cohort study on 115 patients with breast cancer who underwent modified radical mastectomy. Topical tranexamic acid was used to moisten the area in some patients to assess its effect on total wound drainage and seroma formation in follow-up period of 1 month.
Results
The amount of wound drainage was significantly lower in the study group as compared with the control group (798.06±107.3 vs. 1067.1±188.6 ml; <0.005). The duration of drainage was also lower in the study group as compared with the control group (9.85±1.66 vs. 11.67±1.9 days; <0.005). Eight (12.3%) patients in the study group had seroma formation after removal of drains as compared with six (12%) patients in the control group. Three (4.6%) patients of the study group had wound infection compared with one (2%) patient in control group; wound was managed by local drainage and antibiotics.
Conclusion
Tranexamic acid was tolerated without any adverse effects in all patients, and is valuable in reducing the amount and duration of wound drainage after mastectomy without having any effect on the rate of seroma formation.