title: Reducing morbidity with surgical adhesives following inguinal lymph node dissections for the treatment of malignant skin tumors.
abstract: BACKGROUND
  Inguinal lymph node dissection (ILND) is associated with a high rate of morbidity. To evaluate the clinical benefit of surgical adhesives to reduce complications in patients undergoing ILND, we compared the use of TissuGlu(®) Surgical Adhesive and ARTISS(®) fibrin sealant with a control population.
  
  
  METHODS
  We conducted a retrospective analysis of patients undergoing ILND for metastatic malignant skin tumors at one hospital, Fachklinik Hornheide (Münster, Germany), from January 2011 through September 2013, assessing 137 patients with a total of 142 procedures.
  
  
  RESULTS
  Complications occurred in 22/60 procedures in the TissuGlu group (TG), in 8/17 in the ARTISS group (AG), and in 29/65 in the control group (CG). Prolonged drainage and seroma were recorded in 16 (26.7%), four (23.5%), and 26 (40%) respectively (non-significant). TG showed less extended drainage vs. CG (p=0.082). Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). With regard to wound infection, there was a 15% reduction in TG and 74% increase in AG group. Revision surgery was reduced by 36% in TG and increased by 54% in AG. Mean daily drain volumes were significantly lower in AG vs. CG (p=0.000). Mean total post-operative drain volume was lower in TG and AG vs. CG (p<0.001 among groups, CG vs. TG p<0.001, CG vs. AG p<0.001). The mean body mass index (BMI) was significantly higher in patients with complications, 29.4±5.8 vs. 25.3±4.1 (p=0.000).
  
  
  CONCLUSIONS
  The use of TissuGlu in our ILND patients was associated with a reduction in post-operative wound related complications and the need for revision surgeries compared to the control group. Daily drainage was significantly lower within the first 7 post-operative days with the use of ARTISS, but the benefit was lost due to the higher occurrence of wound infection and revision surgery. BMI above 29 is a risk factor for complications following ILND. (
  
  
  METHODS
  level IV, retrospective case study).
authors.affiliation: Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Stollwerck
authors.affiliation: Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Schlarb
authors.affiliation: Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Münstermann
authors.affiliation: Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Stenske
authors.affiliation: Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kruess
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Medicine, Fachklinik Hornheide, Münster, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Brodner
authors.affiliation: Department for Plastic Surgery and Hand Surgery, St. Marien Hospital, Berlin, Germany; Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Germany.
authors.forename: Björn Dirk
authors.initials: BD
authors.lastname: Krapohl
authors.affiliation: Department of Plastic and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Münster, Germany.
authors.forename: Albrecht F
authors.initials: AF
authors.lastname: Krause-Bergmann
keywords: complications; lymph node dissection; skin tumor; surgical adhesive
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