Fibrin sealant does not decrease seroma output or time to drain removal following inguino-femoral lymph node dissection in melanoma patients: A randomized controlled trial (NCT00506311)

Melinda M Mortenson,Anthony Lucci,Jeffrey E Lee,Paul F Mansfield,Yan Xing,Storm Weaver,Merrick I Ross,Jeffrey E Gershenwald,Janice N Cormier

doi:10.1186/1477-7819-6-63

Melinda M Mortenson, Anthony Lucci + Show 7 more

Open Access

https://doi.org/10.1186/1477-7819-6-63

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Abstract

BackgroundThis study assessed the impact of closed suction drains and evaluated whether the intraoperative use of a fibrin sealant decreased time to drain removal and wound complications in melanoma patients undergoing inguino-femoral lymph node dissection.MethodsA pilot study (n = 18) assessed the impact of a closed suction drain following inguino-femoral lymph node dissection. A single-institution, prospective trial was then performed in which patients were randomized to a group that received intraoperative application of a fibrin sealant following inguino-femoral lymph node dissection or to a control group that did not receive sealant.ResultsThe majority of the patients enrolled felt the drains caused moderate or severe discomfort and difficulties with activities of daily living. Thirty patients were then randomized; the median time to drain removal in the control group (n = 14) was 30 days (range, 13–74) compared to 29 days (range, 11–45) in the fibrin sealant group (n = 16; P = 0.6). Major and minor complications were similar in the two groups.ConclusionPostoperative closed suction drains were associated with major patient inconvenience. Applying a fibrin sealant at the time of inguino-femoral lymph node dissection in melanoma patients did not reduce the time to drain removal or postoperative morbidity. Alternative strategies are needed.

Highlights

This study assessed the impact of closed suction drains and evaluated whether the intraoperative use of a fibrin sealant decreased time to drain removal and wound complications in melanoma patients undergoing inguino-femoral lymph node dissection
A 50% incidence of complications following inguino-femoral lymph node dissection (ILND) in melanoma patients has been reported, and some studies have indicated that the incidence of short-term and long-term morbidity from ILND may be as high as 75% [4,5,6,7]
Strategies that can be used to prevent postoperative fluid accumulation, thereby reducing the length of time closed suction drains (CSD) are in place or even eliminating the use of the drains, potentially will decrease morbidity and increase the quality of life of patients undergoing ILND for melanoma

Summary

Introduction

This study assessed the impact of closed suction drains and evaluated whether the intraoperative use of a fibrin sealant decreased time to drain removal and wound complications in melanoma patients undergoing inguino-femoral lymph node dissection. Patients who have comorbidities that compromise their ability to walk, patients who have had complicated incisions for previous operations, obese patients, or patients who have locally advanced disease may experience even higher rates of postoperative morbidity Despite these risks, therapeutic lymphadenectomy is generally performed for patients with confirmed nodepositive stage III melanoma because it is the only potentially curative treatment. Strategies that can be used to prevent postoperative fluid accumulation, thereby reducing the length of time CSDs are in place or even eliminating the use of the drains, potentially will decrease morbidity and increase the quality of life of patients undergoing ILND for melanoma

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