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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