title: Application of subcutaneous talc in hernia repair and wide subcutaneous dissection dramatically reduces seroma formation and postoperative wound complications.
abstract: Wound complications after large ventral hernia repairs when combined with wide subcutaneous dissection (OVHR/WSD) are common (33 to 66%). We evaluate a novel technique of applying talc to wound subcutaneous tissues to decrease wound complications. We accessed our prospectively collected  surgical outcomes database for OVHR/WSD procedures performed. Patients were divided into those that did and did not receive subcutaneous talc (TALC vs NOTALC). Demographics intraoperative and outcomes data were collected and analyzed. The study included 180 patients (n = 74 TALC, n  = 106 NOTALC). Demographics were all similar, but hernias were larger in the TALC group. TALC patients had their drains removed earlier (14.6 vs 25.6 days; P < 0.001) with dramatic reduction in postoperative seromas requiring intervention (20.8 to 2.7%; P < 0.001)  and cellulitis (39.0 to 20.6%; P = 0.007). Short-term follow-up demonstrates significantly higher recurrence rates in the NOTALC group with each recurrence related to infection. The use of talc in the subcutaneous space of OVHR/WSD results in significantly earlier removal of subcutaneous  drains, fewer wound complications, and a decrease in early hernia recurrence. Use of talc in the subcutaneous space at the time of wound closure is an excellent technique to decrease wound complications in large subcutaneous dissections.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Charlotte, North Carolina, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Klima
authors.forename: Rita A
authors.initials: RA
authors.lastname: Brintzenhoff
authors.forename: Victor B
authors.initials: VB
authors.lastname: Tsirline
authors.forename: Igor
authors.initials: I
authors.lastname: Belyansky
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.forename: Stanley
authors.initials: S
authors.lastname: Getz
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D049291:Seroma / Q000517:prevention & control*; D040521:Subcutaneous Tissue / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000379:methods; D013627:Talc / Q000008:administration & dosage*
chemical_list: D013627:Talc