Tranexamic acid: a simple way to reduce drainage and bleeding in rhytidoplasty

Abstract

Background Hematoma is the most common complication in facelift surgery. It has a reported incidence ranging from 0.2 to 8%. Tranexamic acid (TXA) is an antifibrinolytic agent capable of minimizing blood loss, and its use in plastic surgery is quite new. The literature review indicates that there are no formal guidelines for dosing and standardization of TXA use. We sought to evaluate the efficacy of intraoperative local irrigation of TXA in reducing the incidence of hematomas in patients undergoing facelift surgery. Methods A prospective cohort observational comparative study was conducted between November 2018 and November 2019 with 30 patients undergoing primary facelift surgery at the Ivo Pitanguy Institute in Rio de Janeiro, Brazil. The participants were divided into two groups: group I, patients who underwent facelift with 2.5% topical TXA irrigation as a new routine of the service, and group II, patients who underwent facelift without topical TXA irrigation as a routine. Results Drainage output in the first 24 h, hematoma formation, and complication rate were evaluated. It was found that local intraoperative TXA irrigation reduces drainage output in the first 24 h by 71% compared with group II (median 10 ml (8-22 ml) versus 35 ml (19-50 ml); p = 0•009). The rate of postoperative complications (p = 0.1) and hematoma (p = 0.08) was lower in the group with intraoperative local irrigation with TXA. This was not statistically significant. Conclusion Local TXA irrigation seems to decrease bleeding and has been shown to be effective in reducing drainage output in the first 24 h postoperatively.Level of evidence: Level III, risk / prognostic study.

Safety and Outcomes in Multiplane Facial Rejuvenation with Tranexamic Acid: A Cohort Study

“…The populations of previous studies were smaller, and we used a different facelift technique. 27,31,47 To date, there are multiple ways to administer TXA including oral, topical, intravenous, and infiltration/tumescent administration, but there is no standard way in facial rejuvenation procedures. 28,48 Although other studies used TXA as irrigation, or by a local, tumescent, or intravenous route, 27,31,47 we used both local infiltration and the intravenous route with strict regulation of the doses to maximize optimal results without increasing the risk of side effects or related complications.…”

Modern use of tranexamic acid in facial plastic surgery

“…Compared with subjective appraisals of perioperative bleeding, drain output is readily quantifiable and may present a good indicator of the effectiveness of TXA. After the use of TXA-containing tumescent or irrigation, two studies reported drain output to be reduced by 70% on POD1 compared with the control, with 95% of drains having less than 25 mls output [6,30]. This led to a statistically significant increase in drains being removed on POD1.…”

Tranexamic acid in plastic surgery: routes of administration and dosage considerations

“…Serrano Reyes et al examined 24-h drainage output, complications, and hematoma formation post-rhytidectomy [2]. Overall, 20% of patients developed a hematoma; however, the drainage was 71% lower in the TXA group compared to the control group; 10 (range 8-22) ml vs. 35 (range 19-50) ml, respectively (p = 0.009) [2]. Fayman et al examined the effects of mixing TXA with diluted local anesthetic solution to make a tumescent solution that maximizes surgical success while simultaneously minimizing side effects.…”

“…Overall, beneficial outcomes of statistical significance in studies involving IV use of TXA in liposuction, mastectomy, rhinoplasty, septoplasty, and rhytidectomy procedures included decline in intraoperative bleeding [48,55], rate of postoperative hematoma [2,60], periorbital ecchymosis, decreased eyelid edema [48,52,55,63], shorter duration of surgery, improved surgical filed [51], increase of surgeon satisfaction, and a more rapid return to social activity (Table 3) [52].…”

“…Anti-fibrinolytic agents have been used in recent years to avoid such complications and to prevent predisposing the patients to higher rates of infection, compromised cosmetic outcomes, further surgical intervention, or the need for blood transfusions. [2] The use of tranexamic acid (TXA) in plastic surgery has been frequently described for the use in cranio-and maxillo-facial surgery [3]. Over the years, TXA has become an invaluable agent in the fields of orthopedic and cardiac surgery as a means to minimize blood loss [3].…”