Fibrin glue doesn't prevent seromas after tummy tuck

Seroma - a post-operative fluid collection - is the most common complication after a tummy tuck.  It happens in about 5-10% of abdominoplasties.  Surgeons generally try to prevent this problem by using one of three strategies - suction drains, internal "quilting" sutures or fibrin glue. Each technique has its advocates, and arguments about which technique is best persist at the plastic surgery meetings.

So, a comparison study of the techniques was inevitable. In the study I'm reviewing today, published in Aesthetic Plastic Surgery, 43 tummy tuck patients were divided into 3 groups, receiving either drains, quilting sutures or fibrin glue during closure of their tummy tuck. Ultrasound scanning was then used to check for the presence or absence of fluid at 15 and 30 days post-op.

Results: both quilting sutures and drains worked significantly better than fibrin glue.  Seromas were less common at 30 days than at 15 days in all treatment groups.

Comment:  This result pleases me, since I use one of the better techniques (drains) when I perform a tummy tuck.  Also, fibrin glue is quite expensive,so avoiding its use saves some money for the patient.  The fibrin glue, even though it sounds high-tech and modern, failed to perform here.  The results of using fibrin glue during facelift surgery have also been unimpressive in other studies.

In general, seromas are more common if:

- liposuction is performed at the same time as a tummy tuck,

- in patients that are having an abdominoplasty following gastric bypass surgery with massive weight loss

Fortunately, most of the time, even if a seroma appears, it's a minor, short-term nuisance, and is easily handled.

Seromas and plastic surgery

It's medical terminology time. Today's word is "seroma". Read this, and impress your friends with your knowledge!

A seroma is a fluid collection which may show up after surgery. Different than a hematoma, (which is a collection of blood within the tissues) a seroma is typically a watery, yellow-colored fluid pocket that has accumulated in one main area beneath the skin. Seroma fluid looks a lot like the fluid you would see inside a large blister. Seromas are considered a minor complication - more of an annoyance, really - after surgery.

Surgeries in which large dissection pockets are created, such as a tummy tuck, a body lift operation, a mastectomy, or certain types of breast reconstructions have a higher rate of developing these fluid accumulations. It can happen after liposuction, too. Some times the patient just notices the area getting larger without any particular symptoms, sometimes seromas cause a low-grade burning sensation in the area.

We try to prevent these annoying seromas by several methods: compression, use of surgical drainage tubes, or internal "quilting" sutures. Each surgeon has their favorite method, and there is still debate at plastic surgery meetings about which technique is best. For example, the drain tubes used after a tummy tuck help to prevent a seroma from accumulating, allowing the tissue layers to heal back together correctly.

How do you know if you have a seroma? In the classic case, we look for a "fluid wave" during the post-operative check-up. This is where we lightly tap on the skin in one area, and see or feel the skin moving back and forth (like an ocean wave) somewhere nearby. Big seromas can look like a water balloon jiggling beneath the skin. Ultrasound scans can also be used to detect seromas.

The treatment is to aspirate the fluid. Usually this can be easily done with a needle and syringe, and a little local anesthesia. Once the fluid is out, it looks and feels better.

Seromas seem to occur more frequently in our body lift / gastric bypass patients, but can happen to anyone. Fortunately, for most people, after an aspiration or two, they go away and don't typically cause any long term issues.

Breast Augmentation & Surgical Drains

Recently, a patient asked me if I used surgical drains as part of my routine when performing breast augmentation surgery. It's a thoughtful question - as there are a few surgeons locally who do use drains during breast augmentation surgery, removing them at the first or second postoperative visit. Drains, by the way, are small diameter, soft plastic tubes, which are used to remove fluid from a surgical area. They commonly have a bulb-type collection reservoir at one end of the tubing, while the other end has a perforated segment placed beneath the skin, near the involved surgical area.

I don't think they are necessary for the routine, first-time breast augmentation patient. In my opinion, drains are uncomfortable, they leave a small additional scar at their exit site, slow down the speed of the patient's return to everyday activities, and complicate a straightforward post-operative recovery process. In general, I only use drains if their benefit outweighs their drawbacks.

Here's the science: In a recent review, published in Aesthetic Plastic Surgery, a retrospective study of over 3000 breast augmentation patients in the United Kingdom showed that the use of surgical drains actually increased the risk of postoperative infections fivefold! No benefits of drains were seen in this study.

I do use drains in breast cases where there is a significant chance of a postoperative seroma, such as following capsulectomies, some forms of complex revisional breast surgery, large volume breast reductions, and explantations.