Application of a Fibrin Sealant (Tissucol) in Head and Neck Cancer Reconstruction

Abstract

Background: Obliteration of dead space to prevent postoperative hematoma and the prevention of neck wound infections are critical for successful head and neck reconstruction. This report describes a strategy that involves the use of a fibrin sealant (Tissucol, Baxter Corp.) to minimize postoperative complications following head and neck cancer ablation. Patients and Methods: This study included 64 patients who underwent ablative oral cancer surgery and radical neck lymph node dissection. Of these, 27 were treated with Tissucol after cancer ablation, whereas 37 were not; these 37 patients formed the control group. After flap inset and pedicle reperfusion, Tissucol was sprayed onto the dead space present in the deep neck lesions, and gentle manual pressure was immediately applied. Postoperatively, the drainage amount and the wound condition were assessed routinely. Results: Following Tissucol application, all the flaps survived without any pedicle compromise. The occurrence of postoperative neck hematoma was found to be significantly lower in the study group than in the control group (7% versus 27%, p＜0.01). Further, the neck wound drainage amount was also found to be lower in the patients of the study group than in the control group (142.1±19.0 ml versus 239.4±48.9 ml; p=0.07). No statistical differences were noted in the occurrence of oral wound infection between the groups (14.8% versus 16.2%, p=1.00). However, although oral wound infection and subsequently orocutaneous fistula was observed in the study group, it did not invade the deep neck areas. Satisfactory results were achieved in all patients, without any major complications. Conclusion: Tissucol could apparently minimize the occurrence of postoperative hematoma and decrease the neck wound drainage amount, thereby reducing the incidence of postoperative complications.