title: Prospective control study using fibrin sealants and Harmonic® scalpel in Latissimus Dorsi flap transfer.
abstract: BACKGROUND
  Latissimus dorsi flap (LD) is used in breast reconstruction procedures, although prolonged donor site drainage is a frequent complication. To decrease this problem, 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 the Harmonic Synergy® blade system to reduce this complication.
  
  
  METHODS
  Between 2010-2012, 20 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 harvested with Harmonic® (Group C). After informed consent acquisition, Harmonic® was used in Group A for LD harvesting, but differed from other groups as fibrin glue was applied to the donor site prior to closure. In all groups donor site drainage measurements at 24 and 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 the data.
  
  
  RESULTS
  Data analysis did not show any statistical difference. Prolonged drains output ≥ 15 days occurred in one patient of Group A and C, and in three Group B patients.
  
  
  CONCLUSIONS
  Although the combined use of Harmonic® and Tisseel® presents a low donor site fluid collection rate, the fibrin glue seems not to have further beneficial effects in reducing the post-operative serous drainage or to lead to an early drain removal when compared to Harmonic® only.
authors.affiliation: a Plastic Surgery Unit, S Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Roma , Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Longo
authors.affiliation: a Plastic Surgery Unit, S Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Roma , Italy.
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Grippaudo
authors.affiliation: a Plastic Surgery Unit, S Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Roma , Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Laporta
authors.affiliation: a Plastic Surgery Unit, S Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Roma , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pagnoni
authors.affiliation: a Plastic Surgery Unit, S Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Roma , Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Santanelli di Pompeo
mesh_terms: D000328:Adult; D000368:Aged; D004564:Electrocoagulation; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D011446:Prospective Studies; D064171:Superficial Back Muscles / Q000637:transplantation*; D013524:Surgical Flaps; D014014:Tissue Adhesives / Q000627:therapeutic use*; D060053:Transplant Donor Site; D014464:Ultrasonic Therapy / Q000295:instrumentation*
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives
keywords: Breast reconstruction; Latissimus Dorsi flap; fibrin sealants; harmonic blade; prolonged fluid drainage