| [Purpose]1. To evaluate the clinical effect of fibrin glue on lymphorrhea after axillary node dissection in breast cancer.2. To analyse the cost-benefit of fibrin glue in breast cancer surgery. [ Background ]Lymphorrhea or seroma is a common side effect after axillary lymphadectomy for breast cancer. In China, the most patients are operated by modified radical mastectomy (MRM), this procedure has proved a high incidence of lymphorrhea or seroma ranged between 15-53% in the literature.After axillary lymphadectomy in breast cancer, although postoperative lymphorrhea or seroma is not considered as major lift-threatening complications, its occurrence can lead to lymphedema, sepsis, necrosis and delayed wound-healing process. It also remains the main cause for prolonged hospital stay and frequent visits to the outpatient clinic, and finally, increase the postoperative medical cost.The number of lymph nodes, obesity of patients, neoadjuvant therapy and surgical procedure are associated with lymphorrhea, however, these predictingfactors can not be changed. Three postoperative factors are significantly implicated in the pathogenesis of lymphorrhea: hematic exudation, presence of space and lymphatic block. Prevention of lymphorrhea requires meticulous haemostasis, reduction of the surgical detachment spaces and improvement of lymph drainage.Despite the common use of postoperative drainage with vacuum drains, the risk persists. Many procedures have been proposed to decrease the incidence of lymphorrhea, such as the use of multiple drains, compressive dressing, shoulder immobilization, but the mean incidence of lymphorrhea is also about 35%. Is there a new possibility that could decrease the occurrence of lymphorrhea after surgical treatment of breast cancer? Fibrin glue, a biologic preparation containing fibrin glue, that can be to glue together the wound surfaces after dissection and to help to haemostasis may solve this problem."To join the separate" is a very old preoccupation of scientists. Since the beginning of the 20th century, fibrin glue has been used for its adhesive and haemostatic properties as well as to improve the wound-healing process. In 1909, Bergel documented the haemostatic effect of fibrin powder. That discovery was immediately followed by the work of Grey, who applied the fibrinogen derivative in liver and cerebral hemorrhage. In 1944, Cronkite et al. effectively combined fibrinogen and thrombin for clinical use in the fixation of skin grafts. At the beginning of 1970s, when the production of highly concentrated solutions of fibrinogen became possible, the fibrin' use as a haemostatic and adhesive agent became a reality. In 1972, using fibrinogen of high concentration, combined with factor XIII and aprotinin, Matras successfully repaired the traumatic nerve instead of suture.As improved purification and sterilization processes have ameliorated its biological tolerance and the resultant availability was very interest, fibrin glue is now increasingly used in several different surgical fields, such asmaxillofacial surgery, neurological surgery, plastic and reconstructive surgery, and thyroid surgery. In gastrointestinal tract surgery, fibrin glue has been used to secure digestive anastomoses to complete haemostasis or to treat injuries of the liver, spleen and pancreas. It has also been used successfully in the treatment of digestive postoperative fistulae.Fibrin glue contains two components: Component 1: fibrinogen, factor XIII and aprotinin; Component 2: thrombin and CaCl2. They mimics fibrin formation which represents both the last plasmatic stage of coagulation and the first step of the wound-healing process. Fibrin glue furthermore promotes fibroblast growth and accelerates fibroblastic duplication, which could explain the enhancement of the wound-healing process. It was logical to hope that application of fibrin glue after axillary lymph node dissection would reduce lymphorrhea, possibly through its positive effects on the wound-healing process and haemosta...
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