BACKGROUND AND PURPOSE Flap donor site seromas are a common and frustrating complication following reconstructive surgery. Certain measures can be used to help prevent and/or treat seromas, including indwelling drains, quilting sutures, external compression garments, immobilization, serial aspirations, and sclerotherapy. Unfortunately, these measures are not uniformly successful, and chronic, refractory seromas can form. Fibrin sealant has been shown to reduce post-mastectomy fluid drainage when instilled into the axilla at the time of surgery. The purpose of this study was to determine if percutaneous instillation of fibrin sealant can be used to treat refractory donor site seromas.

MATERIALS AND METHODS Four patients over a 2-year period (2/28/2002-3/1/2004) developed a refractory donor site seroma and were treated with instillation of Tisseel fibrin sealant. Patients had undergone free TRAM flap breast reconstruction (n=3) or free latissimus dorsi muscle flap scalp reconstruction (n=1). The mean body mass index was 29.3 (range, 22-37). Two closed-suction drains were placed into the donor site during the original surgery, and the drains were removed when their output was less than 25ml/day for 2 consecutive days. A donor site seroma was considered recurrent if there was a clinically palpable fluid reaccumulation of 50 ml or greater after 2 or more complete aspirations and continuous compression therapy with a binder. The refractory seromas were treated with complete aspiration of seroma fluid and instillation of Tisseel fibrin sealant through a duel lumen catheter. The thrombin concentration of the Tisseel was diluted from 500 IU to 5 IU to increase polymerization time. Patients were evaluated for seroma recurrence with serial physical examinations by the attending surgeon.

RESULTS The last remaining drain was removed from the donor site after a mean of 15 days (range, 10-20 days). The seroma first developed a mean of 4.8 days (range, 0-9 days) after drain removal and contained a mean of 184 ml of fluid (range, 85-300ml). Patients underwent a mean of 2.75 (range, 2-4) aspiration procedures. One patient had an indwelling drain reinserted; this was removed 26 days later when the output was negligible but the seroma recurred. Definitive treatment with Tisseel instillation was performed in an office setting an average of 43 days (range, 31-58 days) postoperatively. All 4 patients had immediate and complete resolution of their refractory seroma following a single Tisseel instillation. There were no infections, fibrosis, or other complications and the procedure was well tolerated in all patients. The mean patient follow-up was 9.5 months (range, 3-17 months).

CONCLUSIONS Percutaneous instillation of Tisseel fibrin sealant appears to be an effective treatment for refractory donor site seromas. Ongoing clinical experience and controlled prospective randomized trials will be useful to define its role in seroma treatment.