Purpose: The number of patients undergoing bariatric surgery for morbid obesity has been rapidly increasing. After these patients have lost their excess weight they are faced with a new set of problems relating to excess skin and abdominal wall laxity. One of the most common areas patients approach the plastic surgeon for body contouring and skin reduction is the abdominal area. Abdominoplasty in the Non-Massive Weight Loss(NMWL)patient has been reported to have a seroma rate of 10% postoperatively. The Massive Weight Loss (MWL)patient presents added challenges with the incidence of seroma being reported as high as 30%. To reduce the incidence of seromas in our MWL patients, we began using a fibrin tissue sealant (Tisseel, Baxter Co.)prior to closing the wound. We reviewed the results of MWL patients that had a combined incisional hernia repair and abdominoplasty. Method: A retrospective review of 50 consecutive patients from March 2002 to December 2003 status post open bariatric surgery who underwent closed (Without opening hernia sac.)incisional hernia repair with overlay mesh and combined abdominoplasty. Twenty-five patients had commercial fibrin sealant (Tisseel)applied during the procedure and twenty-five did not. All the patients recieved 10 mg. Vitamin K sub q pre-operatively; 10 fr. flat blake drains x 4, On-Q pain pump with dual infusion catheters intra-operatively and an abdominal binder post-operatively. Results: All patients were followed for 6 months following their procedure. In the group which did not recieve fibrin sealant 52% (13/25) developed a seroma. Of these 13 patients with seromas, 92% (12/13) were aspirated in the office for a total of 2405cc's (Total of 27 aspirations.); 38% (5/12)of the patients with seromas required a CT or ultra sound guided aspiration and drain placement. In the group that recieved fibrin tissue sealant, 7 patients (7/25 or 28%)developed a seroma, of these 6 patients were aspirated for a total of 690cc's (Total of 10 aspirations.; 2 paients required ultrasound, but no drain placement. Conclusion: Using a fibrin sealant in an abdominoplasty is a safe and effective alternative to reduce the incidence of seromas in the MWL patient. We have found that the use of fibrin tissue sealant in this high risk population significantly reduces the number and size of post-operative seromas.
View Synopsis (.doc format, 58.0 kb)