The Use of Fibrin Sealant (Tisseel) in Abdominoplasty

The Use of Fibrin Sealant (Tisseel) in Abdominoplasty

Norma Cruz-Korchin, MD and Leo Korchin, DDS, MS

INTRODUCTION: Seroma formation is a common postoperative complication in the field of plastic and reconstructive surgery, resulting in significant patient morbidity and expense. The incidence of seromas is particularly high in abdominoplasty where it is reported to occur in 10% to 57% of the patients (1-2). The higher incidence rates are reported in obese patients, in men, and when liposuction is performed in addition to the surgery. Since fibrin sealants have been reported to decrease the incidence of seromas and hematomas in various types of surgery (3-6), extending its use to plastic surgery procedures known to have these problems, is reasonable.

METHOD: In an effort to reduce the incidence of seromas in abdominoplasty we evaluated the use of a commercial fibrin sealant (Tisseel, Baxter Corporation, Deerfield, IL) in a clinical study. Ninety-one patients underwent abdominoplasty performed by one surgeon, and the potential benefit of using a fibrin sealant was analyzed. Patients were randomized prior to surgery into one of two groups: in group I (n=43) the sealant was not used, and in group II (n=48) the aerosolized sealant was used (Figure 1).

Preparation of the sealant involves heating the sealer protein and fibrinolysis inhibitor for 10 minutes and then mixing them to form a sealer protein solution. Diluted thrombin and calcium chloride are then combined to form a thrombin solution. The two components, consisting of a protein sealant and thrombin solution, are then each placed in separate syringes in a dual injection system. The dual syringe is connected to a pressurized nitrogen gas tank which aerosolizes the sealant into a fine mist. For our study the fibrin sealant was made with 5 IU/ml of thrombin by diluting the standard preparation with normal saline. Dilution of the thrombin delays the initiation of polymerization of the product for 1-3 minutes, allowing time for proper setting of the flap to the recipient bed.

In all cases standard abdominoplasties were performed. In group II, after completing the central fascia plication, resection of the lower redundant part of the abdominal flap and positioning the umbilicus, the sealant spray was applied while an assistant held each side of the abdominal flap with retractors. The flap was brought down and previously placed sutures at Scarpa’s fascia were tied. Compression was applied for five minutes by the surgeon and assistant over the abdominal flap. Final skin closure was completed at the end of the compression period. Small ¼ inch Penrose drains were left at each end of the skin closure.

RESULTS: The results of the study demonstrated that the groups were not significantly different in mean age (39 vs. 40), body mass index (26 vs. 26), and amount of tissue removed (990 grams vs. 928 grams). Prolonged drainage and seromas, however, were significantly reduced by use of the fibrin sealant.

Group I (Control) / Group II (Tisseel) / p
Drainage > 3 days / 30% / 5% / p<0.05
Seroma/Hematoma / 19% / 4% / p<0.05

CONCLUSION: In this study the fibrin sealant (Tisseel) was found to be effective in preventing prolonged drainage and serosanguinous fluid collections after abdominoplasty. We believe that fibrin sealant will gain increased acceptance and wider use among plastic surgeons as its benefits become known.

Figure 1. Tisseel spray apparatus.

REFERENCES

1. Chaouat M, Levan P, Lalanne B, et al. Abdominal dermolipectomies: Early postoperative complications and long-term unfavorable results. Plast Reconstr Surg 106:1614-1618, 2000.

2. Van Uchelen JH, Werker PMN, Kon M. Complications of abdominoplasty in 86 patients. Plast Reconstr Surg 107:1869-1873.

3. Fezza JP, Cartwright M, Mack W, Flaharty P. The use of aerosolized fibrin glue in face-lift surgery. Plast Reconstr Surg 110:658-664, 2002.

4. Grossman JA, Capraro PA, Burneikis, V. Minimizing complications in the use of fibrin sealant in aesthetic facial procedures. Aesthetic Surgery 21: 32-39, 2001.

5. Sierra DH. Fibrin sealant adhesive systems: a review of their chemistry, material properties and clinical applications. J Biomater Appl 7:309-352, 1993.

6. Schlag G, Redl H. Fibrin sealant: efficacy, quality, and safety. En: Waclawiczek HW (ed). Progress in Fibrin Sealing. Springer-Verlag, Nueva York 1989. Pp 3-17.