Effect of Irrigation of Triamcinolone Versus Hypertonic Saline in Decreasing Seroma Post Abdominoplasty

Seroma Formation

Triamcinolone, hypertonic saline, Lipo-abdominoplasty, seroma, drain output

A total of 90 abdominoplasty patients were randomly assigned into three groups: Group A: Triamcinolone group, Group B: Hypertonic saline group, Group C: Control group Randomization: It was performed using the closed envelope technique. Technique: After performing a Lipo-abdominoplasty Group A (triamcinolone) irrigates 10 cm saline mixed with two 40 mg vials through the umbilicus into dead space; Group B (hypertonic saline) irrigates 20 cm of 10% solution similarly; Group C (control) receives no irrigation

A total of 90 patients were recruited in this study from November 2023 until July 2025. These patients presented to the outpatient clinic of the Plastic and Reconstructive Surgery Department, Kasr Al ainy Hospital with pendulous abdomen or manifestations of myofascial abdominal laxity and weakness or more commonly, a combination of both. In additions, almost all patients were complaining of localized stubborn fat deposits usually in the flank and epigastric areas that also needed to be addressed. Randomization: It was performed using . Opaque, sealed and sequentially numbered envelopes containing group assignments were prepared by an independent participant not enrolled in the study. Each envelope was opened only after a participant enrollment, ensuring allocation concealment and preventing selection bias. Pre-operative: Before admission, patients were consented on the study methodology and the randomization process. The initial consultation of our patients revolved around the expected procedural details, the preoperative preparatory steps and the post-operative recovery time and details. Afterwards, proper history and examination were conducted along with routine preoperative labs and abdominal ultrasound to detect hernial defects. Preoperative markings: In the standing position, after proper exposure of the trunk area, Markings of the liposuction area over the back were done. Followed by anterior markings which begins with identifying the anterior midline and marking both linae semilunaris while the patient contracts the rectus abdominis muscles. Next, the lateral ends of the expected abdominal scars are marked at the abdominal fold with the patient flexing the trunk 30 degrees. The midpoint of the proposed incision site is then marked in the midline at 6-8 cm under medium stretch, confirmed at 8-10 cm under maximum stretch. Measurements of 7 cm lateral to the midline at this site and 9 cm from the midline above the umbilicus are taken, ensuring these points coincide during closure for 2 cm abdominal flap medialization. This midpoint connects laterally to the 7 cm marking and then to the proposed incision ends. Using a pinch test, the proposed upper incision is marked in the midline above the umbilicus and connected to the lateral ends of the proposed lower incision. Finally, areas for liposuction in the anterior flanks and epigastrium are marked. Operative details: The patient is placed prone, sterilized, draped, and positioned in jack-knife for initial preparation, receiving one dose of a 3rd generation cephalosporin. Super wet solution (1 mg adrenaline, 1 mg tranexamic acid, and 10 cc of 2% lidocaine per 500 ml normal saline) is infiltrated via sacral and bra-line access incisions, followed by a 15-minute wait, then liposuction in marked areas using a straight Mercedes-shaped blunt-tipped 4 mm cannula until a desirable pinch is achieved. The patient is turned supine with trunk extension at the hips, re-sterilized, draped, and anterior access incisions made for infiltrating the same super wet solution into flanks and epigastrium, awaiting 15 minutes before liposuction to desirable pinch endpoint. The proposed incision site opens slantingly to preserve fat over anterior superior iliac spines, followed by uniform supra-fascial dissection to the umbilicus; the umbilicus is incised superficially, dissected to the anterior rectus sheath, circled to free its stalk, and a narrow epigastric tunnel elevated supra-fascial along medial rectus borders per Saldanha's technique without wider undermining. Plication of divarication occurs in two layers above and below the umbilicus with PDS 1-0 loop and proline 1-0 if indicated. The patient flexes to 45 degrees for flap excision, with two suction drains placed laterally; the neo-umbilicus is incised appropriately, umbilicus brought up, and closure performed in layers using 0 Vicryl for Scarpa's fascia, 2-0 Vicryl sub-dermally, and 3-0 Monocryl sub-cuticular. Drains are closed, then per group: Group A (triamcinolone) ; Group B (hypertonic saline) ; Group C (control). Doses were used according to best available evidence. The umbilicus secures with 4-0 Vicryl interrupted dermal and 4-0 Monocryl subcuticular skin sutures. A compression garment with underlying foam support are applied immediately Post-operative sequalae: The patient is transported to the ward in a semi-sitting position and maintained this way until discharge. Drains remain closed for 1 hour postoperatively, then fluid amount and color (categorized as dark red, serosanguineous, or serous) are measured and documented every 12 hours until removal, with patients instructed pre-discharge on consistent drainage collection and measurement, documenting every 12 hours themselves. Early ambulation with regular fluid intake prevents VTE, and chemoprophylaxis starts if indicated per the 2005 Caprini score. The first dressing occurs the next day to detect early liposuction complications, followed by discharge on antibiotics and analgesics. Lymphatic massage begins as early as postoperative day 3. In cases of seroma: Clinical seromas, diagnosed by palpable bulge or swelling, are addressed and aspirated using a wide bore cannula and 20 cc syringe. The amount of aspirated fluid is documented per session. And the sessions are repeated every 3 to 4 days according to the patient's condition till the seroma is resolved.

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