Flap adhesion and effect on postoperative complication rates using Tissuglu® in mastectomy patients

INTRODUCTION Post-mastectomy seroma and related complications are common problems in modern oncological surgery. Occurrence rates of up to 59% have been reported in literature. High-risk patients, that is, those who have undergone previous surgeries, present with a high body mass index, have had radiation or chemotherapy, present a particular challenge. Noninvasive measures such as fibrin-based sealants have thus far not been able to effectively reduce complications associated with fluid accumulation. A recent study using a lysine-derived urethane adhesive named TissuGlu® however, showed promising results in patients after abdominoplasty. METHODS 32 consecutively recruited patients received a mastectomy using a gold standard mastectomy technique as well as TissuGlu® flap fixation. A control group of 173 patients, having received a gold standard mastectomy-only, was analyzed retrospectively, totaling 205 patients. Primary endpoints were post-discharge seroma formation and revision surgery/re-hospitalization. Secondary endpoints were initial seroma volume, postoperative pain, hematoma formation and day of drain removal. RESULTS No significant difference in seroma formation was demonstrated. The revision surgery/re-hospitalization rate was reduced from 6.9 to 0%, though this did not reach significance. Significant improvement could be shown in the TissuGlu® group regarding time to drain removal (17% decrease), and hematoma formation (14% decrease). No difference was shown in postoperative pain. CONCLUSION Although patient numbers are still small, advantages in revision surgery/re-hospitalization rate, hematoma formation as well as time to drain removal was shown for the TissuGlu® group. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.