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 Dr. Abergel |
Aesthetic surgeons are also increasingly finding success with use of the sealant as a type of glue for the face that seals capillary vessels and has been shown to accelerate healing time and recovery. Surgeons inject the sealant under the skin during a facelift to help the skin reattach to the muscle. Santa Monica, Calif., cosmetic surgeon R. Patrick Abergel, M.D., tells Cosmetic Surgery Times that he has used the sealant on several hundred patients and has consistently seen favorable results.
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Fibrin sealant is sold under various commercial names, including Tisseel (Baxter), Crosseal (Johnson & Johnson) and FloSeal (Baxter). The product, originally approved by the FDA in 1998, is actually a two-component system that includes a highly concentrated fibrinogen that acts with other plasma proteins as a sealer, combined with thrombin and calcium, which act as hardeners.
Together, the components mimic the final stage of the blood coagulation process — fibrinogen is converted into fibrin when applied to the tissue surface with the thrombin. The process is cross-linked by factor XIIIa and a mechanically stable fibrin network is established.
SEALANT STUDIES Studies on fibrin sealant's efficacy include a prospective, randomized, double-blind trial in which 20 patients receiving facelifts had fibrin sealant on either the right or left side of the face, with the contralateral side serving as a control. Oliver and colleagues found that, after 24 hours of monitoring post-op drainage, the sides treated with fibrin sealant had a median drainage of 10 ml, while drainage on the control side was 30 ml. The researchers concluded that the reduction in post-operative drainage could help reduce pain and bruising and the need for drains could be avoided.
In addition to facial surgery, one of the key uses plastic surgeons have found for the fibrin sealant has been in bariatric surgery, according to Susan Kaweski, M.D., F.A.C.S., chairman of the Technology Assessment Committee for the American Society of Plastic Surgeons.
"A lot of plastic surgeons removing excess skin after bariatric surgery are using [fibrin sealant] in order to be able to seal the wound and help prevent seroma formation." While the cost may be an issue for some surgeons in choosing not to use fibrin sealant, Dr. Kaweski says the benefits can justify the expense.
"The cost may be an issue, but the cost of having a seroma post-op could be much more," she says. "I'd rather spend a little more and put the fibrin glue on the area because, in the long run, the seroma could cost a lot more money."
