Prospective control study using fibrin sealants and Harmonic® scalpel in Latissimus Dorsi flap transfer

Background: Latissimus dorsi flap (LD) is used in breast reconstruction procedure, although donor site fluid collection rate is a frequent complication. To decrease the rate of fluid collection, quilting sutures and/or fibrin sealants were proposed, with alternate results. The primary objective of this study was to assess the effectiveness of Tisseel® in association with Harmonic Synergy® blade system to reduce this complication. Materials and methods: Between 2010 and 2012, twenty consecutive patients undergoing immediate unilateral breast reconstruction with LD were enrolled in the study (Group A) and matched with 20 patients in which LD was raised with electrocautery (Group B), and 20 patients in which LD was harvest with Harmonic® (Group C). After informed consent acquisition, Harmonic® was used in Group A to raise the LD, but differed from other groups because fibrin glue was applied to donor site prior closure. In all groups donor site drainage measurements at 24, 48 hours, total drain volume, days to drain removal, operation time and complication rate were recorded. Pearson’s Chi-squared, ANOVA and Bonferroni post-hoc tests were used to analyze data. Results: Data analysis did not show any statistical difference. Prolonged drains output ≥ 15 days was observed in one patient of Group A and C, and in three patients of Group B. Conclusion: Although combined use of Harmonic® and Tisseel® presents a low donor site fluid collection rate, the fibrin glue role seems not to have further beneficial effects in reducing the postoperative serous drainage or to lead to an early drain removal when compared to Harmonic® scalpel only.