Fibrin Sealant for Fasciocutaneous Flaps

ABSTRACT

Fibrin sealant is used in many areas of surgery. We present a novel aspect of flap insetting in the ischial region using fibrin spray to seal the transferred tissue. We analyzed 10 patients suffering from decubital ulcers and assessed drainage output, time of drain removal, as well as complications following fasciocutaneous flap surgery. Patients were randomized to receive sprayed fibrin glue (study group) or not (control group) before wound closure. The mean drainage time was 4 ± 1 days in the study group and 6 ± 1 days in the control group (p = 0.06). The mean drainage volume was 100 ± 20 mL in the study group and 168 ± 30 mL in the control group (p < 0.01). Fibrin sealant led to reduced drainage volumes and duration of drainage, indicating a beneficial effect of the application of fibrin glue in fasciocutaneous flap surgery for pressure sore coverage.

KEYWORDS

Fibrin glue - fasciocutaneous flaps - seroma - hematoma - pressure sore

REFERENCES

• 1 Say C C, Donegan W. A biostatistical evaluation of complications from mastectomy.  Surg Gynecol Obstet. 1974;  138 370-376
• 2 Weinrach J C, Cronin E D, Smith B K, Collins Jr D R, Cohen B E. Preventing seroma in the latissimus dorsi flap donor site with fibrin sealant.  Ann Plast Surg. 2004;  53 12-16
• 3 Carless P A, Henry D A. Systematic review and meta-analysis of the use of fibrin sealant to prevent seroma formation after breast cancer surgery.  Br J Surg. 2006;  93 810-819
• 4 Kulber D A, Bacilious N, Peters E D, Gayle L B, Hoffman L. The use of fibrin sealant in the prevention of seromas.  Plast Reconstr Surg. 1997;  99 842-849 discussion 850-851
• 5 Patel V P, Walsh M, Sehgal B, Preston C, DeWal H, Di Cesare P E. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty.  J Bone Joint Surg Am. 2007;  89 33-38
• 6 Moore M, Burak Jr W E, Nelson E et al.. Fibrin sealant reduces the duration and amount of fluid drainage after axillary dissection: a randomized prospective clinical trial.  J Am Coll Surg. 2001;  192 591-599
• 7 Daniel R K, Hall E J, MacLeod M K. Pressure sores—a reappraisal.  Ann Plast Surg. 1979;  3 53-63
• 8 Gosain A K, Lyon V B. Plastic Surgery Educational Foundation DATA Committee . The current status of tissue glues: part II. For adhesion of soft tissues.  Plast Reconstr Surg. 2002;  110 1581-1584
• 9 Currie L J, Sharpe J R, Martin R. The use of fibrin glue in skin grafts and tissue-engineered skin replacements: a review.  Plast Reconstr Surg. 2001;  108 1713-1726
• 10 Ulusoy A N, Polat C, Alvur M, Kandemir B, Bulut F. Effect of fibrin glue on lymphatic drainage and on drain removal time after modified radical mastectomy: a prospective randomized study.  Breast J. 2003;  9 393-396
• 11 Akhtar S, Spyrou G E, Fourie R. Our early experience in the use of tissue glue to reduce the incidence of seroma formation from the latissimus dorsi flap donor site.  Plast Reconstr Surg. 2005;  116 347-348
• 12 Bold E L, Wanamaker J R, Zins J E, Lavertu P. The use of fibrin glue in the healing of skin flaps.  Am J Otolaryngol. 1996;  17 27-30
• 13 Wang J Y, Goodman N C, Amiss Jr L R et al.. Seroma prevention in a rat mastectomy model: use of a light-activated fibrin sealant.  Ann Plast Surg. 1996;  37 400-405
• 14 Butler C E. Treatment of refractory donor-site seromas with percutaneous instillation of fibrin sealant.  Plast Reconstr Surg. 2006;  117 976-985
• 15 Langer S, Guenther J M, DiFronzo L A. Does fibrin sealant reduce drain output and allow earlier removal of drainage catheters in women undergoing operation for breast cancer?.  Am Surg. 2003;  69 77-81
• 16 Marchac D, Sándor G. Face lifts and sprayed fibrin glue: an outcome analysis of 200 patients.  Br J Plast Surg. 1994;  47 306-309
• 17 Oliver D W, Hamilton S A, Figle A A, Wood S H, Lamberty B G. A prospective, randomized, double-blind trial of the use of fibrin sealant for face lifts.  Plast Reconstr Surg. 2001;  108 2101-2105 discussion 2106-2107
• 18 Toman N, Buschmann A, Muehlberger T. [Fibrin glue and seroma formation following abdominoplasty].  Chirurg. 2007;  78 531-535
• 19 Hsieh P, Chen L B. Behavior of cells seeded in isolated fibronectin matrices.  J Cell Biol. 1983;  96 1208-1217
• 20 Toda K, Tuan T L, Brown P J, Grinnell F. Fibronectin receptors of human keratinocytes and their expression during cell culture.  J Cell Biol. 1987;  105(6 Pt 2) 3097-3104
• 21 Weiss E, Yamaguchi Y, Falabella A, Crane S, Tokuda Y, Falanga V. Un-cross-linked fibrin substrates inhibit keratinocyte spreading and replication: correction with fibronectin and factor XIII cross-linking.  J Cell Physiol. 1998;  174 58-65
• 22 Michel D, Harmand M F. Fibrin seal in wound healing: effect of thrombin and [Ca2+] on human skin fibroblast growth and collagen production.  J Dermatol Sci. 1990;  1 325-333