2017-18 HSC Section 4 Green Book
Killion et al
Table 1. Prospective Trials Investigating the Role of Fibrin Glue in Rhytidectomy
Study
Random Blind
Control
Group
Age
Sides of Faces
Sealant
Volume (mL)
Outcome Measured
Oliver et al. 4
Yes
Yes
Self
Test
44-70 M55
20
Beriplast
1
24-hour drainage
Control
44-70 M56
20
Fezza et al. 5
Yes
No
Non-self
Test
54-75 M64.1
48
Hemaseel
1
Hematoma, seroma, eccymoses
(aerosolized)
Control
48-87 M65.2
48
Marchac et al. 3
Yes
No
Self
Test
42-72 M60
30
Tisseel
Not mentioned Hematoma, seroma, 24-hour drainage
Control
30
Kamer and Nguyen 6
Yes
Non-self
Test
45-81 M58
100
Not specified
1
Hematoma, seroma
(aerosolized)
Control
45-78 M59
100
Lee et al. 7
Yes
Yes
Self
Test
Not reported
9
Crosseal
Hematoma, seroma, eccymoses
Control
9
Hester et al. 8
Yes
Yes
Self
Test
43-70 M55.1
45
FS VH S/D 4 s-apr (aerosolized)
0.02-0.04
Hematoma, seroma, eccymoses, 24-hour drainage
Control
45
Hester et al. 9
Yes
Yes
Self
Test
40-71 M54.4
75
FS VH S/D 4 s-apr (aerosolized)
0.02-0.04
Hematoma, seroma, 24-hour drainage
Control
75
over 2300 published reports in the surgical literature. 12 Likewise, fi brin glue has become increasingly popular in facial aesthetic surgery. There have been promising reports on the use of fi brin glue in lower transcutaneous blepharo- plasty and endoscopic brow lifts. 13 , 14 Fibrin glue sealants are used extensively throughout surgery to augment hemostatis. To fully understand the glue ’ s mechanism of action, it is important to understand the coagulation cascade. In the fi nal steps of the cascade, fi brinogen and factor XIII are activated by thrombin. The fi brin molecules form a polymer that is then strengthened by factor XIII, which initiates fi brin crosslinking. Fibrin glue facilitates these interactions by creating an environment that optimiz- es the interaction of these proteins. The delivery device contains two components. The fi rst is fi brinogen and factor XIII, as well as other facilitative plasma proteins. The second major component is thrombin, which is often pooled with calcium chloride and aprotinin, a protein that prevents fi brinolysis, prolonging the eventual breakdown of the material. Fibrin-derived adhesives have the distinct bene fi t over synthetic adhesives of being reabsorbable and biocompatible. Traditionally, fi brin glue has been derived via autologous or homologous plasma puri fi cation, al- though synthetic fi brin sealants have been introduced com- mercially and have been included in this meta-analysis. There are few side effects: mostly allergic reactions and the theoretical fear of transmitting infectious disease in homologous-derived forms. Retrospective studies showed favorable results for fi brin glue in reducing the incidence of hematoma in rhytidectomy
Table 2. Postoperative Hematoma Pooled Relative Risk
Study
Relative Risk
95% Confidence Interval
Percent Weight
Fezza et al 5
0.2
0.0098
4.059
10.41
Marchac et al. 3
0.333
0.0141
7.869
6.25
Kamer and Nguyen 6
0.5
0.1268
1.971
25.00
Lee et al. 7
0.2
0.0109
3.660
10.41
Hester et al. 8
0.066
0.0039
1.133
31.25
Hester et al. 9
0.25
0.0286
2.184
16.66
0.25
0.1034
0.6042
Pooled
Heterogeneity chi-squared = 1.89 (d.f. = 5), P = .864. Test of RR = 1: z = 3.08, P = .002.
Kamer and Nguyen, hematomas were broken down into “ localized ” and “ expanding. ” 6 These numbers were both included in the analysis as hematoma complications. Although hematoma was the primary focus of this system- atic analysis, a trend was also noted towards reductions in seroma; however, it was not of statistical signi fi cance (rela- tive risk 0.56, P = .19). The secondary objective in measur- ing ecchymoses was abandoned, as they were only noted in the studies by Hester et al., Lee et al., and Fezza et al., and none reported standard deviations. 5 , 7 - 9 Because of their clinical effectiveness and rapidly ex- panding commercial availability, fi brin glues have become prevalent in nearly every surgical fi eld. There have been
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