Application of Subcutaneous Talc in Hernia Repair and Wide Subcutaneous Dissection Dramatically Reduces Seroma formation and Postoperative Wound Complications

Abstract

Wound complications after large ventral hernia repairs when combined with wide subcutaneous dissection (OVHR/WSD) are common (33 to 66%). We evaluate a novel technique of applying talc to wound subcutaneous tissues to decrease wound complications. We accessed our prospectively collected surgical outcomes database for OVHR/WSD procedures performed. Patients were divided into those that did and did not receive subcutaneous talc (TALC vs NOTALC). Demographics intraoperative and outcomes data were collected and analyzed. The study included 180 patients (n = 74 TALC, n = 106 NOTALC). Demographics were all similar, but hernias were larger in the TALC group. TALC patients had their drains removed earlier (14.6 vs 25.6 days; P < 0.001) with dramatic reduction in postoperative seromas requiring intervention (20.8 to 2.7%; P < 0.001) and cellulitis (39.0 to 20.6%; P = 0.007). Short-term follow-up demonstrates significantly higher recurrence rates in the NOTALC group with each recurrence related to infection. The use of talc in the subcutaneous space of OVHR/WSD results in significantly earlier removal of subcutaneous drains, fewer wound complications, and a decrease in early hernia recurrence. Use of talc in the subcutaneous space at the time of wound closure is an excellent technique to decrease wound complications in large subcutaneous dissections.

Quality of Life Following Component Separation Versus Standard Open Ventral Hernia Repair for Large Hernias

“…In a previously reported study, we demonstrated significantly earlier removal of drains, fewer seromas, an 8-fold decrease in seroma interventions, and significantly fewer wound infections following the use of aerosolized talc in the subcutaneous space. 45 Indeed, institution of this protocol improved the outcomes of the CS group that we are now reporting. An additional option to reduce CS woundrelated complications may include endoscopic CS, which has been shown to decrease these complications while still facilitating significant advancement of the rectus muscles.…”

“…The need for seroma intervention was 14% in these patients, which is similar to other reports of 14% to 21%. 44,45 But whereas these other reports included only the operative or radiological interventions for seromas, the data in this study included bedside aspirations as well. The reduction in seroma-related problems is attributed to our use of talc applied to the subcutaneous tissues of CS patients just prior to closing, which began in January of 2009.…”

Refractory Donor-Site Seroma Following DIEP Breast Reconstruction

“…18 In contrast, available literature supports the use of talc both prophylactically and in the treatment of seroma. 20,22 Butler 23 examined the use of fibrin sealant in patients who developed refractory seroma after autologous breast reconstruction (latissimus dorsi muscle and TRAM flaps). Here, seroma was considered refractory if it persisted more than 6 weeks postoperatively with serial aspiration and/or drain insertion.…”

“…18 In contrast, available literature supports the use of talc both prophylactically and in the treatment of seroma. 20,22…”

Onlay ventral hernia repairs using porcine non-cross-linked dermal biologic mesh

“…The most common morbidity we encountered was seroma formation, likely as a host response to the biologic mesh since our incidence was higher than reports in the literature for synthetic mesh onlay (23 %) and in comparison with our own historical data (7.1 %, unpublished data) [ 27 ]. This experience has led us to consider the use of aerosolized talc in the space beneath the subcutaneous flaps given recent evidence showing a significant reduction in seroma formation, length of indwelling drains, and cellulitis with the use of talc [ 28 ]. However, it is important to realize that a seroma in a patient with a biologic mesh is completely different than a seroma in a patient with a synthetic mesh.…”