Does Fibrin Sealant Reduces the Seroma After Immediate Breast Reconstruction Utilizing A Latissimus Dorsi Myocutaneous Flap?

Purpose : The most common complication of latissimus dorsi myocutaneous flap in breast reconstruction is the formation of a seroma in the back. Classically accepted surgical practice for the prevention of seroma is the insertion of drains during operation. As an alternative, many clinical studies have shown that fibrin sealant reduces seroma formation and we have investigated where there was a statistically significant difference in postoperative drainage and seroma formation when utilizing the fibrin sealant on the site of latissimus dorsi harvested for the purpose of immediate breast reconstruction after skin sparing partial mastectomy.

Methods : The study was a randomized clinical trial conducted at single center with a specialized breast unit. Total 46 patients underwent immediate breast reconstruction utilizing a latissimus dorsi myocutaneous transposition flap. 23 patients performed without fibrin sealant(control) and the next 23 performed with the use of aerosolized fibrin sealant. All flaps were elevated with manual dissection and electrocautery by the same surgeon and were analyzed as to the potential benefits of fibrin sealant. The analysis is conducted by matching patients according to age, weight of breast specimen, dimensions of the latissimus dorsi flap, and body mass index using the Kolmogorov-Smirnov test, the correlation analysis and repeated measure ANOVA .

Results : The cumulative drainage fluid volume was statistically higher in control group until postoperative day 2, but the fibrin sealant group showed slightly more drainage from postoperative day 3.(Fig 1.) Comparing the donor site, the fibrin sealant group showed more drainage from postoperative day 4 and the drain was removed 2 days faster in the control group.(Fig 2.)

Conclusions : The use of fibrin sealant resulted in no reduction of seroma formation. Because the benefits from the fibrin sealant are not clear, the use of fibrin sealant must be fully discussed with the patients before its use, as a part of informed consent. 

Fig 1. Volume of drain output during two weeks

Fig 2. Volume of drain output in donor site