Marquez Jocellie E, Kapadia Kailash, Ghosh Kanad, Silvestri Brittni, Singh Gurtej, Huston Tara L
From the Division of Plastic Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY.
Division of Plastic and Reconstructive Surgery, Rutgers University-New Jersey Medical School, Newark, NJ.
Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S41-S43. doi: 10.1097/SAP.0000000000002327.
Fibrin sealant is a controversial method for reducing seroma formation. It is comprised of human proclotting factors, fibrinogen and thrombin. Fibrin sealants have been extensively studied for their efficacy in reducing the rates of seroma by sealing the dead space; however, in most studies, the sealants are used with surgical drains. According to the U.S. Food and Drug Administration, fibrin sealant carries the risk of life-threatening thromboembolic complications, gas emboli, and transmission of infectious agents. Despite these concerns, many plastic surgeons use such products in ambulatory surgeries even though its effect on seroma formation has yet to be elucidated. The aim of our study is to determine the efficacy of fibrin sealants in seroma prevention in reduction mammoplasty with and without surgical drains.
A retrospective chart review was performed of all bilateral reduction mammaplasty by a single-surgeon from 2014 to 2018. Patients had at least 90 days postoperative follow-up. Exclusion criteria consisted of patients younger than 18 years, had prior breast surgery, or had an incidental cancer diagnosis in breast reduction tissue specimen.
On analysis, 159 patients met inclusion criteria and were categorized into group 1, with fibrin sealant (n = 101) and group 2, no fibrin sealant (n = 58). There were no statistical differences in patient demographics. There was no significant difference in the incidence of seroma between group 1 and group 2 (21% vs 19%, P = 0.782). Group 1 incidence of seroma was further analyzed by sealant type: Tisseal, Floseal, and Evicel (12% vs 27% vs 23%, P = 0.436). In group 1, the use of sealant alone was more likely to result in seroma formation when compared with the combination of sealant and surgical drains (25% vs 8%, P = 0.069).
There is no difference in rate of seroma formation with the use of fibrin sealants in reduction mammaplasty. The use of fibrin sealants without surgical drains may increase the rate of seromas. Plastic surgeons could consider weighing the risk versus benefits in using fibrin sealants with or without drains in ambulatory surgeries.
纤维蛋白封闭剂是一种用于减少血清肿形成的存在争议的方法。它由人凝血前体因子、纤维蛋白原和凝血酶组成。纤维蛋白封闭剂通过封闭死腔来降低血清肿发生率的功效已得到广泛研究；然而，在大多数研究中，封闭剂与外科引流管一起使用。根据美国食品药品监督管理局的说法，纤维蛋白封闭剂存在危及生命的血栓栓塞并发症、气体栓塞和传染原传播的风险。尽管存在这些担忧，但许多整形外科医生在门诊手术中仍使用此类产品，尽管其对血清肿形成的影响尚未阐明。我们研究的目的是确定纤维蛋白封闭剂在有或无外科引流管的缩乳术中预防血清肿的功效。
对一位外科医生在2014年至2018年期间进行的所有双侧缩乳术进行回顾性病历审查。患者术后至少随访90天。排除标准包括年龄小于18岁、既往有乳房手术史或在缩乳组织标本中偶然诊断出癌症的患者。
经分析，159例患者符合纳入标准，分为第1组，使用纤维蛋白封闭剂（n = 101）和第2组，未使用纤维蛋白封闭剂（n = 58）。患者人口统计学特征无统计学差异。第1组和第2组血清肿发生率无显著差异（21%对19%，P = 0.782）。第1组血清肿发生率按封闭剂类型进一步分析：Tisseal、Floseal和Evicel（12%对27%对23%，P = 0.436）。在第1组中，与封闭剂和外科引流管联合使用相比，单独使用封闭剂更易导致血清肿形成（25%对8%，P = 0.069）。
在缩乳术中使用纤维蛋白封闭剂时血清肿形成率无差异。不使用外科引流管而使用纤维蛋白封闭剂可能会增加血清肿发生率。整形外科医生在门诊手术中使用或不使用引流管的情况下使用纤维蛋白封闭剂时可考虑权衡风险与益处。
