FIBRIN SEALANT REDUCES SEROUS DRAINAGE AND ALLOWS FOR EARLIER DRAIN REMOVAL AFTER AXILLARY DISSECTION - A RANDOMIZED PROSPECTIVE TRIAL

Fibrin sealant (FS) has been used successfully as an effective adhesiv e and hemostatic agent in a variety of surgical procedures. At the Uni versity of Virginia, autologous fibrin sealant is used to reduce the p otential accumulation of serous fluid after axillary dissection in pat ients undergoing modified radical mastectomy (MRM) for carcinoma of th e breast. Unilateral MRM, including level I and II axillary lymph node dissection, was performed upon 21 patients prospectively randomized i nto treatment and control groups. Surgical procedures between both gro ups differed only by the application of autologous FS prior to axilla closure in the treatment group. Drainage was collected and measured at 24-hour intervals following the operation. Drains were removed follow ing the measurement of 40 mi or less during a 24-hour interval. Cumula tive drainage for the first 3 postoperative days in the treatment grou p averaged 198 +/- 83 mi compared to 467 +/- 138 mi in the control gro up (P < 0.0003). Day of drain removal averaged 3.9 +/- 1.7 for the tre atment group and 6.9 +/- 1.2 for the control group (P < 0.0001). In th e treatment group, there was a reduction in cumulative drainage over t he first 3 days of 268 mi or 57 per cent, and there was a reduction in the number of days before drains can be removed of 3.0 days, or 43 pe r cent. We conclude that local application of FS significantly reduced the total drainage measured in patients undergoing MRM and enabled ea rlier drain removal.