Will a Fibrin Sealant be Effective as a Seroma Reductant and a Hemostatic Agent in Breast Reconstruction Using a Latissimus Dorsi Flap?

Abstract

BackgroundThe latissimus dorsi (LD) flap is widely used in breast cancer reconstruction, but donor-site morbidity is one of the major limitations of this surgery. Donor-site seroma is the most common complication. To prevent seroma formation, we consider the use of a fibrin sealant (FS) because of its hemostatic and sealing effects. In this study, we investigate the effect of a FS on seroma prevention and as a hemostatic agent at the LD donor site. Methods A retrospective study was conducted from 2011 to 2015. Herein, we analyzed the preoperative status, changes in the hemoglobin (Hb) level according to the postoperative day, postoperative drain amount, and the drain removal time. Results The decline in the Hb level was not statistically significantly less in the FS group than in the control group. Further, the difference in the drain amount between the 2 groups was not statistically significant either. The seroma rate and the drain removal time between the 2 groups also did not show any statistically significant difference. Conclusions The FS does not have hemostatic effect and the drain amount reduction in the early phase of recovery and does not prevent seroma. Therefore, an empirical use of the FS alone is no longer recommended to prevent seroma. In contrast, the quilting suture has been reported to be effective in seroma prevention. Therefore, it is necessary to study the effects of a combination of quilting sutures and the FS on seroma and the other risk factors of this surgical complication.

Fibrin Sealants Do Not Reduce the Rate of Seroma Formation in Postmastectomy Breast Reconstruction: A Systematic Review and Meta-analysis

“…16,17 Similarly, Lee et al conducted a retrospective cohort study demonstrating that fibrin sealant was neither effective as a hemostatic agent nor as a seroma reductant. 14 Among the individual cohorts analyzed in our study, Weinrach et al demonstrated a significant reduction in seroma formation following fibrin glue application. 18 Similarly, Ali et al and Hivelin et al found that fibrin glue led to a significant reduction in the duration of drainage and earlier drain removal following reconstruction.…”

“…16 17 Similarly, Lee et al conducted a retrospective cohort study demonstrating that fibrin sealant was neither effective as a hemostatic agent nor as a seroma reductant. 14…”

“…In a systematic review and meta-analysis conducted in 2017, Lee et al concluded that the use of quilting sutures and fibrin glue synergistically reduces the rate of seroma formation in LD flap donor sites; however, fibrin glue alone was not beneficial. 14 Seroma formation can also ensue in breast reconstruction using DIEP flaps, yet there have not been any consensus studies on the use of fibrin glue with DIEP flap breast reconstruction. We sought, therefore, to perform an updated systematic review and meta-analysis on the effect of fibrin sealant on the rate of seroma formation and duration of drainage following either LD or DIEP flap breast reconstruction.…”