DOES FIBRIN SEALING INHIBIT THE DEVELOPME NT OF LYMPHOCYSTS FOLLOWINGRADICAL LYMPH-NODE DISSECTIONS

Surgical approaches to the groin and axilla, almost radical lymphnode dissections (RLND) are followed frequently by lymphocysts. In a prospe ctive randomized study of 30 inguinal or axillary RLND we used at half of the cases 1 ml of the two-component fibrin glue (Tissucol), applie d as a spray to seal the wound at the end of the operation. At 27 pati ents not only a prophylactic RLND but a selective hyperthermic cytosta tic perfusion of the extremity was performed because of a locally adva nced malignant tumor. There was no difference between the two groups o f patients in age, diagnosis, surgical technique, and follow-up. In tw o cases of the fibrin glue (FG)-group and in 4 cases of the control gr oup a second intervention because of a local wound healing problem had to be performed. The mean amount of postoperative drainage fluid was 1065 +/- 822 ml at the FG-group and 1332 +/- 1093 ml at the control gr oup. Also postoperative drainage time (9 vs. 12 days) and postoperativ e hospital stay (18 vs. 22 days) were shorter at the FG-group, however , without statistical significance. 11 of 14 patients of the FG-group and 10 of 14 patients of the control group had normal scars after lymp hadenectomy without signs of lymphocysts at the clinical follow-up. At our high risk patients (very high amount of postoperative drainage fl uid in comparison to other series) prophylactic fibrin glue sealing af ter RLND could not prevent lymphocysts and lymphatic fistulae.