Minimization of complications in mastectomy: Standard wound closure (SWC) versus No-Drain-Surgical Adhesive: A non-randomized cohort comparison
Mastectomy remains associated with a disturbingly high rate of minor- which occasionally lead to major complications and revision surgery. Drains as SWC themselves are associated with increased patient discomfort, longer hospital stays and higher rates of minor complications. Recent reports have suggested that closure of dead space can be effectively achieved through the use of a resorbable adhesive (TissuGlu®). This technology is being used in several types of surgical procedures created, in some cases as an alternative to the use of drains.
Material and Methods:
We began working with this adhesive initially limited to revisions and patients at high risk of postoperative complications and expanded use to mastectomies in the general patient population in an attempt to measure the impact on key outcomes measures as cohort comparison (n = 40).
An analysis was done in 21 SWC and 19 TG pts (22/22 mastectomies), with patient demographics and surgical procedures being similar. No device related adverse events were reported, with an average of 239 days follow up. TG-patients had significantly shorter hospital stays (7.2/5.0) and fewer aspirations overall than SWC patients after drain removal (0.64/0.36). Improvements were also seen in minor (45%/25%) and maior complication rates (revisions) (14%/0%).
Preliminary positive results have been obtained with a lysine-based tissue adhesive used for chemical/mechanical closure of the dead space without drain placement. Prospective multicentric randomized studies should be performed to identify the most effective strategy.