Effect of Tissue Adhesives on Seroma Incidence After Abdominoplasty: A Systematic Review and Meta-Analysis

Nasr, Marwan; Jabbour, Samer; Mhawej, Rachad; El-Khoury, Joseph S.; Sleilati, Fadi

doi:10.1093/asj/sjv276

Cited by 26 publications

(12 citation statements)

References 48 publications

(102 reference statements)

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“…The structure of the distribution of patients according to the hernia classification is presented in Table 1. A significant risk factor is the presence of overweight [17,18], in our sample the majority (78 % of the main and 74 % of the control group) patients were obese. The average body mass index (BMI) in the main group was 31.2 kg/m 2 , in the control group 32.5 kg/m 2 .…”

Section: Methodsmentioning

confidence: 54%

Use of Platelets Rich Plasma as a Factor of the Reduction of the Risk of Early Postoperative Complications in Patients With Postoperative Ventral Hernias

Atanasov

2019

EUREKA: Health Sciences

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Non-tensioned allohernioplasty with a polypropylene mesh implant has several disadvantages associated with the local occurrence of non-specific long-lasting inflammatory reactions in response to a foreign body. Excessive exudation in the implantation zone leads to the formation of seromas, requiring puncture aspiration, which significantly increases the treatment time. In the long-term, chronic prolonged inflammatory process leads to the formation of coarse connective tissue, which explains the development of biomechanical complications. Growth factors, introduced by platelet rich plasma (PRP), stimulate the release of regenerative cytokines, reduce local inflammatory manifestations in the integration of homoplastic grafts and reduce the incidence of postoperative complications. Aim: through the use of plasma enriched with platelets reduce the severity of early postoperative complications in patients with postoperative ventral hernias. Materials and methods. A clinical study was performed in the surgical department of the center for reconstructive and restorative medicine (university clinic) of the Odessa National Medical University (ONMedU) in the period from 2013 to 2019: 84 patients were operated because of postoperative ventral hernia. The average age of patients was 60.1±7.6 years. The size of hernial defects was on average 8.2 cm. The average BMI was 31.8 kg/m2. According to indications, patients underwent a standard surgical extent of intervention: hernia repair, allohernioplasty of the anterior abdominal wall with a lightweight (80 g/m2) polypropylene implant. After the plastics of the main group, a prosthesis implantation zone was infiltrated with activated autologous PRP, which was prepared by double centrifugation, in a volume of 14–38 ml. There was a control group in which PRP infiltration was not performed. The cavity above the mesh implant was actively drained by Redon for 2–4 days. An ultrasound examination was performed and, if necessary, fine needle aspiration of serous fluid over the mesh was done. Results. The evaluation of the postoperative period (up to 28 days) in patients of both groups. In none of the cases were manifestations of allergic, pyrogenic, local inflammatory or infectious complications. According to the quantitative assessment of early postoperative complications as well as the assessment of the degree of pain syndrome subjectively, according to VAS, the postoperative period in the main and control study groups was almost identical. The need for puncture aspirations and the total volume of discharge was significantly less in the main study group. The dependence of the severity of the effect of the proposed technology on such factors as the size of the hernial defect, the nature of plastics, and body mass index was noted. The greatest efficacy was demonstrated in the group of patients undergoing plastic surgery with the placement of a mesh implant in direct contact with subcutaneous fatty tissue for large-sized hernias (W2+) in the presence of concomitant obesity. Conclusions: the risk of development and the severity of fluid accumulations in the area of allohernioplasty can be predicted taking into account such risk factors as the size of the hernial defect, the nature of plastics, the presence of concomitant pathology, overweight. The technique of soft tissue infiltration in contact with a polypropylene prosthesis is safe, without significantly increasing the risk of local or systemic complications. The proposed method significantly reduces the risk of development and the severity of fluid accumulations in the area of implantation of the prosthesis. The effectiveness of technology is significantly higher compared to groups of patients with a high risk of seromas formation.

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Section: Methodsmentioning

confidence: 54%

Use of Platelets Rich Plasma as a Factor of the Reduction of the Risk of Early Postoperative Complications in Patients With Postoperative Ventral Hernias

Atanasov

2019

EUREKA: Health Sciences

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“…In a meta-analysis covering 15 studies with > 1,800 patients, only the abdominoplasty with preservation of Scarpa’s fascia or placement of progressive tension sutures was associated with a significantly reduced incidence of seroma compared with standard abdominoplasty. Abdominoplasty with the application of fibrin glue was similar to standard abdominoplasty regarding seroma development [ 15 ][ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Chronic Encapsulated Seroma Persisting for Three Years after Abdominoplasty and a Successful Surgical Solution

Goldman¹,

Wollina²,

França³

et al. 2018

Open Access Maced J Med Sci

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Abdominoplasty is listed among five most common esthetic surgical procedures in the Western World. Despite all efforts, abdominoplasty bears a high risk of complications. We observed a 39-year-old-woman with previous classical abdominoplasty performed elsewhere three years ago. Clinical examination demonstrated a swollen and tense abdominal mass. Laboratory findings were normal. Clinical examination was completed by abdominal ultrasonography which demonstrated both, a significant fluid volume in this area and a dense fibrous “capsule”. The diagnosis was a late or chronic encapsulated seroma with a thick pseudocapsule or “bursa”. We performed a revision abdominoplasty with a standard supra-fascial dissection. Surgical resection of infra-umbilical flap containing skin, subcutaneous tissue and capsulectomy were performed under general anaesthesia. A new umbilicus was created attaching small skin flaps in the muscular fascia. No drains were used. We observed no seroma formation. Follow up after six and ten months was unremarkable. The fibrous pseudocapsule of chronic seroma results in different degrees of deformities, abdominal scar deviation and asymmetry. Surgical capsulectomy combined with revision abdominoplasty with preservation of Scarpa’s fascia and placement of progressive tension sutures resulted in being effective and leads an esthetic outcome without seroma recurrence.

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“… 1 , 2 An earlier meta-analysis of tissue adhesives (surprisingly) found no significant reduction in seroma rates. 4 Is it time for plastic surgeons to adopt quilting sutures and preserve the Scarpa fascia?…”

Section: Sirmentioning

confidence: 99%

“…In support of their meta-analysis, Seretis et al 2 comment, “The methodology overcomes the insufficient study power of several RCTs [randomized controlled trials] to measure more than one endpoint due to small sample sizes and obviates the methodological flaws of retrospective studies or case series.” In truth, no amount of statistical rigor can compensate for flaws in the constituent studies. 5 Nasr et al 4 acknowledge the heterogeneity of data and risk of bias. Despite limiting their analysis to randomized trials, these investigators found inadequate study quality.…”

Section: Sirmentioning

confidence: 99%

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Quilting Sutures, Scarpa Fascia Preservation, and Meta-Analyses of Seroma Rates after Abdominoplasty

Swanson

2017

Plastic and Reconstructive Surgery - Global Open

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Effect of Tissue Adhesives on Seroma Incidence After Abdominoplasty: A Systematic Review and Meta-Analysis

Abstract: 2 Therapeutic.

Cited by 26 publications

References 48 publications

Use of Platelets Rich Plasma as a Factor of the Reduction of the Risk of Early Postoperative Complications in Patients With Postoperative Ventral Hernias

Use of Platelets Rich Plasma as a Factor of the Reduction of the Risk of Early Postoperative Complications in Patients With Postoperative Ventral Hernias

Chronic Encapsulated Seroma Persisting for Three Years after Abdominoplasty and a Successful Surgical Solution

Quilting Sutures, Scarpa Fascia Preservation, and Meta-Analyses of Seroma Rates after Abdominoplasty

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