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.  The higher incidence rates are reported in obese patients, in men, and when liposuction is performed in addition to the surgery.

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.  In all cases standard abdominoplasties were performed: the rectus fascia was plicated over the midline, excess skin was removed, and the umbilicus was inset.  In group II the sealant spray was applied over the abdominal fascia after insetting the umbilicus.  Sutures were used along the incision to align the skin, and firm compression was applied over the flap for 5 minutes.  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 in 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.

Results:  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:  The fibrin sealant (Tisseel) was effective in preventing prolonged drainage and serosanguinous fluid collections after abdominoplasty.