2017-18 HSC Section 4 Green Book

Reprinted by permission of Aesthet Surg J. 2015; 35(3):229-234.

Facial Surgery

Aesthetic Surgery Journal 2015, Vol 35(3) 229 – 234 © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com DOI: 10.1093/asj/sju078 www.aestheticsurgeryjournal.com

A Systematic Examination of the Effect of Tissue Glues on Rhytidectomy Complications

Elizabeth A. Killion, MD; Charles H. Hyman, BA; Daniel A. Hatef, MD; Larry H. Hollier Jr., MD; and Neal R. Reisman, MD, JD

Abstract Background: Fibrin glue has widespread use in multiple fi elds of surgery. There have been numerous studies on the use of fi brin glue in facelifts, with no consensus regarding differences in outcomes. Objectives: This study compared the risk of hematoma, seroma, and the 24-hour drainage volume in all published prospective controlled trials. Methods: A MEDLINE search of English-language articles on fi brin glue and rhytidectomy published up to July 2013 yielded 49 citations. After screen- ing, we examined 7 relevant controlled trials. The DerSimonian and Laird random-effects model was used to perform the meta-analysis. Results: Seven controlled trials measuring the outcomes of fi brin glue in facelifts were used to estimate the pooled relative risk of complications and con- fi dence intervals. Hematoma formation was four times less likely with the use of fi brin glue (relative risk 0.25, P = .002). There was no signi fi cant reduction in seroma formation (relative risk 0.56, P = .19). There was not enough data to properly measure 24-hour drainage and ecchymoses. Conclusions: This analysis suggests that fi brin glue reduces the rates of hematoma formation, but does not signi fi cantly reduce the rates of seroma development.

Level of Evidence: 3

Accepted for publication October 23, 2014.

Therapeutic

facilitate clot formation. Additionally, many formations also contain aprotinin, a substance which prevents the body ’ s natural clot lysis process. The fi brin clot reduces postoperative bleeding by adhering adjacent surfaces to each other, in addition to restricting capillary fl ow. 2 Drs Killion and Hatef are Residents, Dr Hollier, Jr. is the Chief and Program Director, and Dr Reisman is a Clinical Professor, Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas. Mr Hyman is a Medical Student at Baylor College of Medicine, Houston, Texas. Corresponding Author: Larry H. Hollier, Jr, MD, Chief and Program Director, Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, 6701 Fannin St. CC 610.00, Houston, TX 77030, USA. E-mail: larryh@bcm.edu

While facelifts are generally considered to be a safe and effective procedure, hematoma is the most likely major com- plication, as a result of the large surface area created beneath the fl aps. The rate of hematoma formation varies signi fi - cantly; it has been cited to be as low as 1.86% and as high as 9%. 1 Hematomas, especially large ones, can lead to tissue necrosis, prolonged recovery from edema and ecchymoses, hyperpigmentation, and reduced patient satisfaction. There have been many attempts, with varying rates of success, to reduce the rate of hematoma after rhytidectomies, including by using drains and autologous platelet-rich plasma. Fibrin tissue adhesive, or fi brin glue, has been an area of interest for reducing hematoma, but the data in the literature have been inconsistent to date. Fibrin glue is composed primarily of fi brinogen derived from human plasma. In the application device, the fi brino- gen is activated by thrombin and stabilized by factor XIII to

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