Hemostatic net in cervical and facial surgeries: evidence from a systematic review and meta-analysis

Hematoma remains the most frequent complication of cervicofacial surgeries. The hemostatic net (HN), a transcutaneous suture designed to minimize dead space and bleeding, has shown promise, but pooled evidence of its safety and efficacy is limited. Thus, we conducted this study to clarify the safety profile and complication rates associated with the use of HN in cervical and facial surgeries.

A systematic search of MEDLINE, Embase, Scopus, Cochrane, and Web of Science was performed through August 2025. Eligible studies involved adults undergoing cervical and/or facial surgery with HN, with no restrictions on suture caliber or spacing between stitches. The primary outcome was hematoma incidence; secondary outcomes included skin necrosis, seroma, infection, persistent skin marks, patient-reported satisfaction, and other adverse events.

Eleven studies including 3,393 patients (2,748 HN; 645 controls) were analyzed. Single-arm meta-analysis of HN cases showed low pooled rates for hematoma (0.6%; 95% confidence interval 0.4-1.0; low certainty), skin necrosis (0.4%; 95% confidence interval 0.1-1.0; low certainty), seroma (1.5%; 95% confidence interval 0.6-4.0; low certainty), infection (0.1%; 95% confidence interval 0.0-25.5), and persistent skin marks (0.6%; 95% confidence interval 0.2-2.1). Comparative analyses showed no significant difference for hematoma (risk ratio = 0.15; 95% confidence interval 0.01-3.20; very low certainty) or seroma (risk ratio = 1.06; 95% confidence interval 0.41-2.75; low certainty). Patient-reported satisfaction data were scarce and nonspecific.

The HN is a safe technique with very low complication rates, though evidence of superiority over standard surgery remains inconclusive due to limited certainty of meta-analyzed data, heterogeneity of surgical procedures, and the paucity of patient-reported outcomes.