Talc serodisis

University Department of Surgery, Hollywood Private Hospital, Nedlands, Western Australia

Talc is a known stimulator of fibrosis in biological systems. We present four cases in which instillation of talc in to serous cavities have produced obliteration of these cavities. No side-effects were noted.

Talc is a sheet silicate with a large negatively-charged surface area. The role of such a surface in promoting fibrosis by activating fibroblasts directly or via macrophages has been speculated upon. Its use in pleurodesis is widespread, and more recently, cases of lymphocoele have been treated with talc.

Teiche et al (1992) reported a case of pelvic lymphocoele occurring after radical prostatectomy.¹ Talc was introduced into this lymphocoele and a nephrostomy tube used to drain the collection. Resolution occurred within 2 weeks. Vrouenraets et al (1998) reported four patients with lymphocoeles occurring after skin flaps.² All were treated successfully with talc instillation. An Argon per thousand beam laser was used to coagulate the cavity prior to installation.

A 75-year-old man underwent a femoropopliteal bypass graft for proximal occlusive disease in his left lower limb. Following surgery he developed a persistent collection and discharge in association with his popliteal wound. The collection persisted with conservative treatment for 3 weeks post-operatively. The patient was taken back to theatre and the wound re-opened. Talc aerosol (Sclerosol per thousand , Bryan Corporation) was used to generously coat the cavity. Within one week, drainage had almost ceased and following a 2-week review there was no further drainage. There was no recurrence of a leak or complications at follow up 12 months later.

A 71-year-old lady developed a right drain lymphocoele following right external iliac endarterectomy surgery. This persisted with repeated needle aspirations for 3 months postoperatively. Talc instillation was performed with insertion of a drain for 3 days post-operatively. Within one week the cavity was not evident and there was no evidence of drainage from the wound at 2 weeks. Follow up at 3 months revealed a well-healed wound.

A 79-year-old man underwent bilateral hernia repair. Following surgery he developed large serous collections. Repeated aspiration and elastic compression dressings were ineffective. Initially, a small incision was made in each wound to allow drainage. Drainage persisted until 6 weeks post-operatively, when it was decided to employ talc instillation. Both wounds were reopened and talc instilled. Closure was with interrupted prolene as in the other cases. A drain was employed in each wound and elastic dressings applied. No drainage was evident at 2 weeks. The wounds healed well with no complications or leakage at review 6 months later.

An 85-year-old man underwent right femoropopliteal bypass surgery. This surgery was complicated by an anastomotic leak distally which required surgical correction. There was, however, persistent serous drainage from this popliteal wound. This persisted for one month following his initial surgery. Talc instillation was performed with resolution of drainage within 10 days. At follow up, one month, later there was no sign of leakage and the wound had healed well.

Talc instillation provided an effective means of dealing with post-operative lymphocoeles. Drainage of the wound was necessary when the collection had not drained spontaneously. There were no complications and all five procedures were successful. Talc instillation, therefore, should be considered for persistent lymphocoeles, where initial conservative treatment fails. Obviously, talc may have potential side-effects such as excessive fibrosis or the potential to provide a nidus for infections. These risks need to be weighed against its potential benefit in obliterating serosal cavities.

1. Teiche PE, Pauer W, Schmid. Use of talcum in sclerotherapy of pelvic lymphoceles. Tech Urol 1999; 5: 52-3
2. Vrouenraets BC, Thompson JF, McCarthy WH. Treatment of large, persistent lymphocoeles using argon bean coagulator and talc. Aust N Z J Surg 1998; 68:743-4

Copyright date: 15th October 2000
Correspondence: Dr D Holthouse, 39 Doney Street, Alfred Cove, Western Australia, 6154 Australia
E-mail: bassman1@iinet.com.au

THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH

THE FOURTH POST-GRADUATE COURSE IN GENERAL SURGERY FOR FRCS PARTS B AND C, MRCS
(PART II), MS AND DNB EXAMINATIONS IN INDIA

Mrs Maureen Lowrie
Education Department
The Royal College of Surgeons of Edinburgh
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Talc serodesis - report of four cases

THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH