Does Fibrin Sealant Reduce Seroma after Immediate Breast Reconstruction Utilizing a Latissimus Dorsi Myocutaneous Flap?

Gyu, Han; Kang, Sang Gue; Shin, Ho Seong; Kang, Moon Seok; Nam, Seung Min

doi:10.5999/aps.2012.39.5.504

Cited by 24 publications

(26 citation statements)

References 16 publications

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“…For example, Cha et al who applied it in immediate breast reconstruction utilizing a latissimus dorsi myocutaneous flap. 10 Burak et al whose results using only bovine thrombin failed to get significant outcome, similar results obtained by Cipolla et al in their study over 159 patients. 18, 30 Vaxman et al reported that with the use the fibrin glue the total drain output increased.…”

Section: The Statistical Analysis Of Received Pre-and Postoperative Dsupporting

confidence: 74%

“…Its role in seroma prevention has been studied with varying results in mastectomy and thyroidectomy patients. [9][10] Human fibrin glue (HFG) is formed of two components contained in separate vials; the first component is a freeze-dried concentrate of clotting proteins, mainly fibrinogen, Factor XIII and fibronectin (the sealant) and the second substance is freeze dried thrombin (the catalyst). The first component is reconstituted with an aprotinin solution that inhibits tissue fibrinolysis.…”

Section: Introductionmentioning

confidence: 99%

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Role of fibrin glue in seroma reduction after modified radical mastectomy

Fawzy¹,

Gaber²,

Farid³

2017

Int Surg J

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INTRODUCTIONBreast cancer is the second leading cause of cancer death among women. The surgical treatment is the best choice for those patients. 1 Since the first mastectomy which was carried out by Halsted in 1882, surgeons have faced several problems such as skin flaps necrosis, wound breakdown, seroma, infection, nerve injuries, lymphedema, phantom breast syndrome and hematoma. Seroma, which is a subcutaneous collection of serous fluid, is a common problem in breast surgery where it develops under the skin flaps during mastectomy or in the axillary dead space after axillary dissection. It usually resolves within a few weeks, so many surgeons view this problem as an unavoidable nuisance rather than a serious complication. 3Seroma formation is the most frequent postoperative complication after breast cancer surgery. Incidence of seroma formation after breast surgery varies between 2.5% and 51%. Although seroma is not life threatening, it can lead to significant morbidity (e.g. flap necrosis, wound dehiscence, predisposes to sepsis, prolonged recovery period, multiple physician visits) and it may delay adjuvant therapy.1 The pathogenesis of seroma has not been fully elucidated. It has been hypothesized that seromas form as an exudate from an acute inflammatory ABSTRACT Background: Seroma is one of the most common morbidity occurring post modified radical mastectomy (MRM). It can delay post-operative initiation of adjuvant therapy. This study was designed to determine the role of fibrin glue spray in reduction of seroma volume and duration after breast surgeries. Methods: A prospective, randomized, controlled study over forty female patients who underwent (MRM) was done. The study cohort was randomized into control group where only conventional drain placement was used and experimental group where double dose of fibrin glue has been sprayed to the axillary and mammary beds plus conventional drain placement. Data regarding the amount of drained fluid in the first post-operative day, hospital stay, length of drain placement, amount and duration of post-operative seroma, number of excised lymph nodes (L. Ns) and pathological results were recorded. Results: No difference in mean age, number of excised L. Ns and rate of post-operative infection between both groups was detected. There was significant reduction in hospital stay time favouring fibrin glue group (p=0.006). Fibrin glue group had a significant reduction in the length of drain placement (p=0.001). The amount of postoperative serous fluid was reduced and the incidence of occurrence of post-operative seroma was (7/20) 35% in control group compared to (1/20) 5% in fibrin glue group giving significant reduction in incidence and amount. Conclusions: Use of fibrin glue sealant during MRM resulted in noticeable and significant decrease of post-operative rate of seroma formation, its amount and the length of drain placement.

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Section: The Statistical Analysis Of Received Pre-and Postoperative Dsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Role of fibrin glue in seroma reduction after modified radical mastectomy

Fawzy¹,

Gaber²,

Farid³

2017

Int Surg J

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“…In the present study, we did not observe a statistically significant difference in the drain removal time, so we inferred that FS did not reduce the drainage amount, as the adhesive sealant blocked the lymphatic channel in both the early and the late phase. This might be attributed to the re-opening of the lymphatic system after surgery, irrespective of the use of FS [12,18].…”

Section: Discussionmentioning

confidence: 99%

“…First, we think that the area of the back donor site is too large to be covered with only 4 mL of FS; further, it is difficult to predict which part will have reactive fluids or bleeding when applying FS. Second, since reactive fluid formation occurs frequently in the back area and leads to a drainage amount of tens of milliliters a day, it is difficult for FS to have a distinct adhesive effect [18]. Third, as the constant movement of the patient's shoulder and flank area generates a shearing effect between the skin and the underlying musculature, it is difficult to have the same effect as that of an FS application to a small area such as an internal organ or a vessel that has minimal movement.…”

Section: Discussionmentioning

confidence: 99%

Will a Fibrin Sealant be Effective as a Seroma Reductant and a Hemostatic Agent in Breast Reconstruction Using a Latissimus Dorsi Flap?

Lee

Kang

Tak

2017

Arch Aesthetic Plast Surg

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BackgroundThe latissimus dorsi (LD) flap is widely used in breast cancer reconstruction, but donor-site morbidity is one of the major limitations of this surgery. Donor-site seroma is the most common complication. To prevent seroma formation, we consider the use of a fibrin sealant (FS) because of its hemostatic and sealing effects. In this study, we investigate the effect of a FS on seroma prevention and as a hemostatic agent at the LD donor site. Methods A retrospective study was conducted from 2011 to 2015. Herein, we analyzed the preoperative status, changes in the hemoglobin (Hb) level according to the postoperative day, postoperative drain amount, and the drain removal time. Results The decline in the Hb level was not statistically significantly less in the FS group than in the control group. Further, the difference in the drain amount between the 2 groups was not statistically significant either. The seroma rate and the drain removal time between the 2 groups also did not show any statistically significant difference. Conclusions The FS does not have hemostatic effect and the drain amount reduction in the early phase of recovery and does not prevent seroma. Therefore, an empirical use of the FS alone is no longer recommended to prevent seroma. In contrast, the quilting suture has been reported to be effective in seroma prevention. Therefore, it is necessary to study the effects of a combination of quilting sutures and the FS on seroma and the other risk factors of this surgical complication.

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“…When drainage was less than 20 mL for a 24-hour period, the drainage tubes were removed. 13,14 Outcome of the measures was the volume of drainage output, the length of time that the drain remained in the site, hospitalization period, and evaluation of dead space using ultrasonography. In addition, any complications, including recurred seroma, wound dehiscence, infections, and delayed wound healing, were studied.…”

Section: Methodsmentioning

confidence: 99%