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Use Of Fibrin Sealant For Incision Reinforcement In Intraoral Free Flap Reconstruction Following Oncologic Resection
Brianna M. Peet, BS, Arianna Sidoti, MD, Jonas A. Nelson, MD, MPH, Evan Matros, MD, MPH, MMSc, Farooq Shahzad, MBBS, FACS, FAAP, Francis D. Graziano, MD.
Memorial Sloan Kettering, New York, NY, USA.
PURPOSE: Salivary leaks and orocutaneous fistulas are serious complications following oncologic head and neck free flap reconstruction. Our plastic surgery service has adopted fibrin sealant to reinforce intraoral suture lines. This study evaluates the impact of fibrin sealant on surgical complications in patients undergoing oncologic reconstruction for head and neck cancer.
METHODS: 488 patients underwent head and neck oncologic reconstruction with intraoral skin paddle between April 2017-January 2025. Patients were stratified based on intraoperative fibrin sealant application. A multivariable logistic regression model adjusted for age, body mass index (BMI), chemotherapy, radiation, smoking status, and use of hardware.
RESULTS: Of 488 patients, 63 (13%) received intraoperative fibrin sealant. Median age was 65, and median BMI was 24.6 kg/m2. The cohorts were similar in terms of demographics, adjuvant therapies, and comorbidities. There were significantly fewer instances of orocutaneous fistulas (p=0.02), wound dehiscence (p<0.001), and cellulitis (p=0.04) in patients who received fibrin sealant. Multivariable analysis showed fibrin sealant lowered the incidence of wound dehiscence after adjusting for other variables (p=0.017). Patients receiving fibrin sealant had a 91% relative risk reduction of developing wound dehiscence (absolute risk reduction 0.15).
CONCLUSION: Fibrin sealant significantly lowered the incidence of orocutaneous fistula, wound dehiscence, and cellulitis in patients undergoing intraoral free flap oncologic reconstruction, and applying fibrin sealant reduced the relative risk of dehiscence by 91%. Our results suggest that fibrin sealant may act as an effective barrier to promote healing between the intraoral skin paddle and the surrounding mucosa.
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