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The Application of Subcutaneous Talc in Panniculectomies and Subcutaneous Advancement Flaps with Concomitant Hernia Repair Reduces Drain Duration and Post-Operative Wound Complications
David A. Klima, MD, Stanley B. Getz, Jr., MD, Rita A. Brintzenhoff, MD, Christin L. Carpenter, MHA, B. Todd Heniford, MD.
Carolinas HealthCare System, Charlotte, NC, USA.
PURPOSE- Wound complications in patients undergoing large ventral hernia repairs requiring extensive tissue dissection and panniculectomy (OVHR/PAN) occur in 18-50% of procedures. This study evaluates a novel technique involving the application of talc to subcutaneous tissue of OVHR/PAN patients in order to decrease the rate of wound complications.
METHODS- Demographics, peri-operative data, and long-term outcomes of patients undergoing concomitant OVHR/PAN were evaluated with a prospectively collected surgical outcomes database at our institution from 1999-2010. Patients were divided into two groups; one of which did not receive talc (NOTALC) and one of which had subcutaneous talc applied prior to closure (TALC).
RESULTS- 180 patients met criteria for study inclusion, with 74 in the TALC group and 106 in the NOTALC group. Demographics were statistically similar between TALC and NOTALC groups (p<0.05) and included mean age (55.7+/-13.2 v 53.5+/-11.6 years) ASA scores (2.6+/-0.66 v 2.5+/-0.5) and tobacco use (21% v 21%). BMI was significantly less in the TALC group (33.6+/-8.9 v 37.3+/-8.8 kg/m2, p=0.03), but defect size was significantly larger (258+/-195 v 213+/-281cm2, p=0.02). The TALC group had a significant decrease in the rate of seromas requiring intervention from 20.8% to 2.7% (p<0.001), cellulitis from 39.6% to 20.5% (p=0.007) and need for oral antibiotics from 36.8% to 23.3% (p=0.05). The TALC group also had a significantly earlier drain removal from 25.6+/-19.1 to 14.6+/-7.0 days (p<0.001). When BMI was controlled for, the rate of seromas requiring intervention, cellulitis, oral antibiotics and drain duration remained statistically significant (p<0.05).
CONCLUSIONS- The subcutaneous application of talc for OVHR/PAN patients demonstrated decreased rate of post-operative cellulitis, need for oral antibiotics, drain duration and seroma formation requiring intervention. These differences held true after controlling for BMI and despite larger defect sizes. The use of subcutaneous talc in patients undergoing large ventral hernia repair is a promising agent to help decrease wound complications.
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