The Use of Fibrin Sealant in the Prevention of Seromas

Abstract

Seroma formation is a difficult problem to treat and prevent. Its sequelae include wound infection, dehiscence, and skin-flap necrosis. The purpose of this study was to determine the effects of fibrin sealant on seroma formation and wound healing. Seromas were created in a rat model by harvesting the latissimus dorsi muscle. In group I (n = 20), only the latissimus dorsi muscle was harvested. In group II (n = 20), the latissimus dorsi muscle was harvested and fibrin sealant applied. Seromas were routinely aspirated. In group III (n = 20), the latissimus dorsi muscle was harvested, and once a seroma was evident clinically, it was aspirated and injected with fibrin sealant. Fibrin sealant was created by combining virally deactivated fibrinogen and thrombin (American Red Cross, Rockville, Md.). In group I, 90 percent of the animals formed seromas compared with only 20 percent in group II. The average total fluid aspirated in group I was 21 cc versus 6 cc in group II. Sixty percent of the animals in group I and 5 percent in group II required serial drainage for chronic seromas. Skin-flap necrosis occurred in 80 percent of the animals in group I, in 10 percent of group II, and in 40 percent of group III. Histologic evaluation confirmed that group II underwent better wound healing. At necropsy, group I animals with seromas had gross capsular formation; this was not readily apparent in the fibrin sealant groups. We conclude that (1) the harvesting of the rat latissimus dorsi muscle is a reliable model for creating seromas, (2) fibrin sealant effectively prevents seroma formation when applied intraoperatively, (3) wound healing in the seroma rat model is improved with intraoperative fibrin sealant application, (4) closed injection of fibrin sealant for existing seromas cannot be recommended at this time, (5) virally deactivated fibrin sealant retains its hemostatic and adhesive properties, and (6) current clinical trials of virally deactivated fibrin sealant may facilitate its use in the United States.

Comparison of the Clinical Outcome and Complications in Laparoscopic Hernia Repair of Inguinal Hernia With Mesh Fixation Using Fibrin Glue vs Tacker

“…This can be attributed to obliteration of dead space quickly achieved by fibrin glue. Fibrin glue has been used by plastic surgeons to prevent seromas in grafts [21]. Incidence of seroma in the present study was higher than other studies possibly because sensitive criteria (clinically as well as radiologically, i.e., by USG) were used.…”

Seroma Prevention by Using <i>Corynebacterium parvum</i> in a Rat Mastectomy Model

“…However, several factors are thought to be involved. In particular, lymphovascular interruption, lymphatic drainage into surgically created potential spaces, and mediators of inflammation are postulated as the most important [13,17]. Elimination of the dead space is important for seroma prevention.…”

“…Tetracycline was found to be ineffective [18,19] and painful [18] in experimental studies. Fibrin glue has been shown to be a highly effective agent [12,13,16]. However, these results have not been substantiated in clinical studies [20,21].…”

“…Delaying shoulder exercise [10] and compressive dressing after mastectomy [11] have also failed. Experimentally, fibrin glue as a sclerosing agent was found to be effective in reducing seroma formation [12,13].…”

Use of Fibrin Sealant in Hypospadias Surgical Repair Reduces the Frequency of Postoperative Complications

“…Recently, fibrin sealants have undergone a period of intensive development because of their use as hemostatic agents, principally for trauma surgery and visceral resection. Fibrin sealants increase the adherence levels and accelerate the healing process by inducing proliferation of local fibroblasts and substitution of connective tissue [8][9][10][11] .…”