Defining the Role for Topically Administered Tranexamic Acid in Panniculectomy Surgery

Abstract

Background Abdominal panniculectomy after weight loss is a common procedure that despite associated high patient satisfaction continues to have a high post-operative complication profile. Several modifiable risk factors as well as surgical approaches, such as Scarpa’s fascia preservation, use of tissue adhesives, and progressive tension suture techniques. However, the use of tranexamic acid (TXA) has not been previously described in panniculectomy surgery. Objectives To improve the safety and predictability of this procedure, the authors aim to investigate the use of topically administered TXA during panniculectomy surgery to determine whether it reduces seroma, hematoma, and drain duration. Methods The authors retrospectively reviewed consecutive patients who underwent panniculectomy (January 2010 to January 2022). Pertinent perioperative details were collected. Outcome measures included: hematoma requiring surgical evacuation, clinically significant seroma requiring percutaneous aspiration, and drain duration. Patients with a history of thromboembolic diseases and those taking anticoagulation/antiplatelet medications were excluded. Patients who had received TXA were compared to a historical control group who had not received TXA. Results A total of 288 consecutive patients were included. Topical TXA was administered in 56 (19.4%) cases. The mean (standard deviation [SD]) follow-up was 43.9 (37.4) months [3.7 years]. The median (range) resection weight was 2.6 kg (0.15 – 19.96 kg). With regards to seroma and hematoma formation, the univariate logistic regression analysis demonstrated that the use of TXA did not reduce the likelihood of developing seroma or hematoma (odds ratio, OR= 1.7, 95% confidence interval, CI [0.56 – 4.8], p= 0.38 and OR= 2.1, 95% CI [0.4 – 11.8], p= 0.42), respectively. The mean (SD) duration of drains was slightly lower in the TXA group [18.1 (12.1) days vs 19.8 (13.9) days], however, this difference was not statistically significant, albeit clinically significant. TXA-related complications were not observed. Conclusions As the use of TXA in plastic surgical procedures continues to expand, the utility of TXA in panniculectomy and abdominoplasty has not been elucidated. Although prior studies support the use of tranexamic acid as a pharmacologic adjunct to help reduce hematoma and seroma, the use of TXA was not associated with a statistically significant reduction in seroma, hematoma, or drain duration following panniculectomy surgery. Prospective, randomized controlled studies on the use of TXA in panniculectomy or abdominoplasty are needed.

Rolle der Tranexamsäure in der Plastischen Chirurgie: eine systematische Überprüfung

“…2022 haben Weissler et al ebenfalls eine Arbeit zur topischen Anwendung von Tranexamsäure veröffentlicht. Die Autoren berichteten über die Anwendung von 3 g Tranexamsäure verdünnt mit 0,9% NaCl Lösung direkt auf der Wundoberfläche bei Pannikulektomien und stellten eine klinische Signifikanz bei der früheren Entfernung von Drainagen in der mit Tranexamsäure behandelten Gruppe fest 21 .…”