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Fibrin glue for the treatment of persistent lymphatic drainage
W G Giberson1, P M McCarthy, B H Kaufman
1Section of Pediatric Surgery, Mayo Clinic, Rochester, MN.
Insights
Fibrin glue effectively treated persistent postoperative serous drainage from an abdominal wall tumor resection in a pediatric patient. This safe and painless biologic sealant promoted normal wound healing without fluid reaccumulation.
Area of Science:
- Pediatric Surgery
- Biomaterials Science
- Wound Healing
Background:
- Lymphangiomatous tumors can present diagnostic and therapeutic challenges in pediatric patients.
- Postoperative serous drainage is a common complication following tumor resection, potentially delaying wound healing.
- Persistent drainage necessitates effective management strategies to prevent complications.
Observation:
- A 7-year-old girl experienced significant postoperative serous drainage (up to 300 mL/day) after abdominal wall lymphangiomatous tumor resection.
- Conventional methods like external pressure were insufficient to control the persistent drainage.
- A novel approach involving fibrin glue application to the draining tract was implemented.
Findings:
- Fibrin glue, prepared from homologous plasma, was injected into the draining tract.
- Simultaneous injection of fibrinogen and thrombin, followed by sustained pressure, successfully sealed the tract.
- No further drainage was observed, and the wound healed normally at 2- and 14-week follow-ups.
Implications:
- Fibrin glue represents a safe, painless, and effective biologic sealant for managing persistent postoperative wound drainage.
- Homologous fibrin glue minimizes the risk of viral transmission.
- This case highlights a successful minimally invasive treatment for complex wound complications in pediatric surgery.
Abstract:
A 7-year-old girl underwent resection of an abdominal wall lymphangiomatous tumor. Postoperative serous drainage, up to 300 mL per day, developed despite application of external pressure to the wound. Thirty-three days after the initial procedure, fibrin glue was applied to the draining tract. Concentrated fibrinogen was prepared from one unit of blood donated by the patient's mother. Ten milliliters fibrinogen and 10 mL thrombin (1,000 U/mL) were injected simultaneously through the wound drain as it was slowly removed, and pressure was reapplied for 48 hours. No further drainage occurred, and at 2- and 14-week follow-up examinations the wound had healed normally without reaccumulation of fluid. Fibrin glue successfully sealed this persistently draining abdominal wall tract. It is a painless, safe, and effective biologic sealant, and when prepared from homologous plasma it carries a low risk of virus transmission.