Fibrin Sealant Significantly Decreases Postoperative Drainage in Breast Reconstruction by Deep Inferior Epigastric Perforator (DIEP) Flap

Abstract

Serosanguinous drainage after breast reconstruction by deep inferior epigastric perforator (DIEP) flap constitute with the microsurgical monitoring, the main limiting factors for patient discharge. Fibrin sealant has already been studied to reduce post breast surgery drainage. The authors are presenting their experience in secondary breast reconstruction by DIEP flap with the use of sprayed fibrin sealant.Twenty-one female patients aged 28 to 63 years old who underwent secondary breast reconstruction after mastectomy for cancer between October 2004 and June 2007 have been reviewed. These patients were separated into two groups. In group 1, patients (n=9) received two drains placed under the flap and in the axillary area. In group 2, (n=12) the DIEP flaps and thoracic areas were sprayed with fibrin sealant (Tissucol(®)) before the two drains inset.No adverse effect were reported, with a 36-month median follow-up. Drainages volumes or durations were not correlated to the patients' Body Mass Index (BMI). Lower drained volumes were collected from the thoracic region (372ml versus 629mL) and thoracic drains were removed earlier (5.5 days versus 6.9 days) in group 2. The length of stay was also significantly reduced after fibrin sealant use (5.5 days versus 7.22 days with P=0.0305 by log rank test).This study is a rare clinical one on fibrin sealant use to decrease postoperative drainage in breast reconstruction by DIEP flap. Fibrin sealant significantly decreased the postoperative drainage volume and duration.