Utility of autologous fibrin glue in the donor site of free abdominal flap for breast reconstruction: A randomized controlled study

Published:April 18, 2021DOI:



      Seroma formation at the donor site is a common complication of breast reconstruction using free abdominal flap. In this study, we assessed the benefits of use of autologous fibrin glue (AFG) at the donor site.


      This randomized controlled study compared AFG group (n = 61) with commercial fibrin glue (CFG) group (n = 79). Owing to the high volume of AFG (10 mL), AFG group received fibrin glue at both the anastomosis and the donor sites, whereas CFG group received fibrin glue only at the anastomosis site. Operative protocols and the criteria for postoperative drain removal were identical in both groups. Patient characteristics and abdominal discharge were compared between the two groups.


      Since anemia was a contraindication for use of AFG, preoperative Hb in CFG group was significantly lower than that in AFG group; other factors were comparable in the two groups. The mean total abdominal drain volumes on first postoperative day (POD1) and POD2 was (AFG vs. CFG) 130.9 vs. 169.4 mL (P < 0.001) and 131.0 vs. 162.8 mL (P = 0.03), respectively. On POD3, there was no significant difference in this respect (116.2 vs. 128.4 mL, P = 0.19). The mean time for removal of all abdominal drains was significantly lower in AFG group (7.4 vs. 8.4 days; P = 0.01).


      AFG reduced the discharge at the donor site of free abdominal flap, especially in the early postoperative period. AFG helped to reduce the abdominal drainage period.


      To read this article in full you will need to make a payment


        • 3rd Bostwick J
        • LO Vasconez
        • Jurkiewicz M.J
        Breast reconstruction after a radical mastectomy.
        Plast Reconstr Surg. 1978; 61: 682-693
        • Schusterman M.A.
        • Kroll S.S.
        • Weldon M.E.
        Immediate breast reconstruction: why the free TRAM over the conventional TRAM flap?.
        Plast Reconstr Surg. 1992; 90: 255-261
        • Feller A.M.
        • Hörl H.W.
        • Biemer E.
        The transverse rectus abdominis musculocutaneous free flap: a reliable alternative for delayed autologous tissue breast reconstruction.
        Ann Plast Surg. 1990; 25: 425-434
        • Arnez Z.M.
        • Smith R.W.
        • Eder E.
        • Solinc M.
        • Kersnic M.
        Breast reconstruction by the free lower transverse rectus abdominis musculocutaneous flap.
        Br J Plast Surg. 1988; 41: 500-505
        • Cho A.B.
        • Paulos R.G.
        • Bersani G.
        • et al.
        A reinforcement of the sutured microvascular anastomosis with fibrin glue application: a retrospective comparative study with the standard conventional technique.
        Microsurgery. 2017; 37: 218-221
        • Cho A.B.
        • Wei T.H.
        • Torres L.R.
        • et al.
        Fibrin glue application in microvascular anastomosis: comparative study of two free flaps series.
        Microsurgery. 2009; 29: 24-28
        • Kim J.T.
        • Kim Y.H.
        • Kim S.W.
        Effect of fibrin sealant in positioning and stabilizing microvascular pedicle: a comparative study.
        Microsurgery. 2017; 37: 406-409
        • Garvey P.B.
        • Buchel E.W.
        • Pockaj B.A.
        • et al.
        DIEP and pedicled TRAM flaps: a comparison of outcomes.
        Plast Reconstr Surg. 2006; 117: 1711-1719
        • Xu H.
        • Dong J.
        • Wang T.
        Bipedicle deep inferior epigastric perforator flap for unilateral breast reconstruction: seven years’ experience.
        Plast Reconstr Surg. 2009; 124: 1797-1807
        • Bercial M.E.
        • Sabino Neto M.
        • Ferreira L.M.
        • et al.
        Suction drains, quilting sutures, and fibrin sealant in the prevention of seroma formation in abdominoplasty: which is the best strategy?.
        Aesthetic Plast Surg. 2012; 36: 370-373
        • Rossetto L.A.
        • Garcia E.B.
        • Ferreira L.M.
        • et al.
        Seroma and quilting suture at the donor site of the TRAM flap in breast reconstruction: a prospective randomized double-blind clinical trial.
        Ann Plast Surg. 2014; 72: 391-397
        • McCarthy C.
        • Lennox P.
        • Clugston P.
        • et al.
        Use of abdominal quilting sutures for seroma prevention in TRAM flap reconstruction.
        Ann Plast Surg. 2005; 54: 361-364
        • Hart A.M.
        • Duggal C.
        • Losken A.
        • et al.
        A Prospective Randomized Trial of the Efficacy of Fibrin Glue, Triamcinolone Acetonide, and Quilting Sutures in Seroma Prevention after Latissimus Dorsi Breast Reconstruction.
        Plast Reconstr Surg. 2017; 139: 854-863
        • Titley O.G.
        • Spyrou G.E.
        • Fatah M.F.
        Preventing seroma in the latissimus dorsi flap donor site.
        Br J Plast Surg. 1997; 50: 106-108
        • Lee K.T.
        • Mun G.H.
        Fibrin Sealants and Quilting Suture for Prevention of Seroma Formation Following Latissimus Dorsi Muscle Harvest: a Systematic Review and Meta-analysis.
        Aesth Plast Surg. 2015; 39: 399-409
        • Bailey S.H.
        • Oni G.
        • Saint-Cyr M.
        • et al.
        Latissimus dorsi donor-site morbidity: the combination of quilting and fibrin sealant reduce length of drain placement and seroma rate.
        Ann Plast Surg. 2012; 68: 555-558
        • Ali S.N.
        • Gill P.
        • Sterne G.D.
        • et al.
        The combination of fibrin glue and quilting reduces drainage in the extended latissimus dorsi flap donor site.
        Plast Reconstr Surg. 2010; 125: 1615-1619
        • Aitken D.R.
        • Hunsaker R.
        • James A.G.
        Prevention of seromas following mastectomy and axillary dissection.
        Surg Gynecol Obstet. 1984; 158: 327-330
        • Kulber D.A.
        • Bacilious N.
        • Peters E.D.
        • et al.
        The use of fibrin sealant in the prevention of seromas.
        Plast Reconstr Surg. 1997; 99: 842-849
        • Bacilious N.
        • Kulber D.A.
        • Peters E.D.
        • et al.
        Harvesting of the latissimus dorsi muscle: a small animal model for seroma formation.
        Microsurgery. 1995; 16: 646-649
        • Gilly F.N.
        • Francois Y.
        • Sayag-Beaujard A.C.
        • et al.
        Prevention of lymphorrhea by means of fibrin glue after axillary lymphadenectomy in breast cancer: prospective randomized trial.
        Eur. Surg. Res. 1998; 30: 439-443
        • Sanders R.P.
        • Goodman N.C.
        • Amiss L.R.
        Effect of fibrinogen and thrombin concentrations on mastectomy seroma prevention.
        J. Surg. Res. 1996; 61: 65-70
        • Hivelin M.
        • Heusse J.L.
        • Lantieri L.
        • et al.
        Fibrin sealant decreases postoperative drainage in immediate breast reconstruction by deep inferior epigastric perforator flap after mastectomy with axillary dissection.
        Microsurgery. 2011; 31: 18-25
        • Dinsmore R.C.
        • Harris J.A.
        • Gustafson R.J.
        Effect of fibrin glue on lymphatic drainage after modified radical mastectomy: a prospective randomized trial.
        Am. Surg. 2000; 66: 982-985
        • Vaxman F.
        • Kolbe R.
        • Stricher F.
        • et al.
        Does fibrin glue improve drainage after axillary lymph node dissection? Prospective and randomized study in humans.
        Eur. Surg. Res. 1995; 27: 346-352
        • Medl M.
        • Mayerhofer K.
        • Peters-Engl C.
        • et al.
        The application of fibrin glue after axillary lymphadenectomy in the surgical treatment of human breast cancer.
        Anticancer Res. 1995; 15: 2843-2845
        • Butler C.E.
        Treatment of refractory donor-site seromas with percutaneous instillation of fibrin sealant.
        Plast Reconstr Surg. 2006; 117: 976-985
        • Schettino A.M.
        • Franco D.
        • Franco T.
        • et al.
        Use of autologous fibrin glue (platelet-poor plasma) in abdominal dermolipectomies.
        Aesthetic Plast Surg. 2012; 36: 1296-1301
        • Kjaergard H.K.
        • Weis-Fogh U.S.
        • Sørensen H.
        • et al.
        Autologous fibrin glue–preparation and clinical use in thoracic surgery.
        Eur J Cardiothorac Surg. 1992; 6: 52-54
        • Carter G.
        • Goss A.
        • Lloyd J.
        • et al.
        Tranexamic acid mouthwash versus autologous fibrin glue in patients taking warfarin undergoing dental extractions: a randomized prospective clinical study.
        J Oral Maxillofac Surg. 2003; 61: 1432-1435
        • Tawes Jr, R.L.
        • Sydorak G.R.
        • DuVall T.B.
        Autologous fibrin glue: the last step in operative hemostasis.
        Am J Surg. 1994; 168: 120-122
        • Cardon A.
        • Chakfé N.
        • Thaveau F.
        • et al.
        Sealing of polyester prostheses with autologous fibrin glue and bone marrow.
        Ann Vasc Surg. 2000; 14: 543-552
        • Kouketsu A.
        • Nogami S.
        • Fujiwara M.
        • et al.
        Clinical evaluations of autologous fibrin glue and polyglycolic acid sheets as oral surgical wound coverings after partial glossectomy.
        J Craniomaxillofac Surg. 2016; 44: 964-968
        • Christenson J.T.
        • Kalangos A.
        Autologous fibrin glue reinforced by platelets in surgery of ascending aorta.
        Thorac Cardiovasc Surg. 2004; 52: 225-229
        • Thorn J.J.
        • Sørensen H.
        • Weis-Fogh U.
        • et al.
        Autologous fibrin glue with growth factors in reconstructive maxillofacial surgery.
        Int J Oral Maxillofac Surg. 2004; 33: 95-100
        • Wu X.
        • Ren J.
        • Gu G.
        • et al.
        Autologous platelet rich fibrin glue for sealing of low-output enterocutaneous fistulas: an observational cohort study.
        Surgery. 2014; 155: 434-441
        • Karaçal N.
        • Cobanoğlu U.
        • Ambarcioğlu O.
        • et al.
        The effect of fibrin glue on fat graft survival.
        J Plast Reconstr Aesthet Surg. 2007; 60: 300-303
        • Vakalopoulos K.A.
        • Wu Z.
        • Kroese L.
        • et al.
        Mechanical strength and rheological properties of tissue adhesives with regard to colorectal anastomosis: an ex vivo study.
        Ann Surg. 2015; 261: 323-331
        • Satake T.
        • Muto M.
        • Maegawa J.
        • et al.
        Contralateral Unaffected Breast Augmentation Using Zone IV as a SIEA Flap During Unilateral DIEP Flap Breast Reconstruction.
        J Plast Reconstr Aesthet Surg. 2019; 72: 1537-1547