Sunday, October 8, 2006
10390

Fibrin Sealants: Use in Abdominoplasty

Burt M. Greenberg, MD and Dmitri Koumanis, MD.

Complications of abdominoplasty surgery include seroma formation leading to fat necrosis, wound infection and bleeding Fibrin sealants have been shown to increase wound healing and reduce ecchymosis and edema after rhytidectomy. Hemostasis is achieved with fibrin glue by achieving the final step in blood coagulation whereby fibrinogen is transformed into fibrin.Tisseel and Vitagel are two commercially available hemostatic agents.Tisseel uses pooled human fibrinogen and thrombin,as well as bovine aprotinin to form a hemostatic layer. Vitagel uses autologous fibrinogen and platelets in combination with bovine thrombin and collagen,to form a hemostatic layer that includes a fibrin-collagen scaffold. A statistical evaluation of 72 patients evenly divided into three groups was studied. An aerosol sealant (Tisseel:Baxter)and a topical viscous sealant were (Vitagel:Orthovita)was compared against controls. Factors analyzed included (1)Jackson Pratt output;(2)time to drain removal;(3)flap integrity;(4)seroma rate (5) complications and (6) cost.Our results indicated a (1) reduction in seroma formation (2) decreased drain output with a statistical P value (p<0.05;(3)no difference in aerosol versus topical applications.Drains were removed an average of two days earlier in experimental groups We recommend fibrin sealant as an adjunct in abdominoplasty and discuss future studies and applications in plastic surgery. .