Effect of Topical Tranexamic Acid on Seroma Formation in a Rat Mastectomy Model

Topical Application of Tranexamic Acid in Abdominoplasties Leads to Lower Drainage Volume and Earlier Drain Removal

Background

Tranexamic acid (TXA) is an antifibrinolytic agent that is successfully used in many medical fields to reduce blood loss. In plastic surgery, the systemic administration of TXA has been associated with less hematoma and seroma formation, and consequently, a reduction in the length of hospital stay (LOS). The aim of this study was to evaluate if the topical administration of TXA in patients undergoing abdominoplasty leads to a decrease in the daily drainage volume; earlier drain removal; and possibly, a shorter LOS.

Methods

In this single-center, comparative study, 60 patients undergoing abdominoplasty received either topical TXA treatment (n = 30; 1 g) or no treatment (n = 30). The primary endpoints were daily drainage volume, time until drain removal, and total LOS. Variables such as sex, age, body mass index, weight of resected skin and underlying fat, and concomitant liposuction were considered in the statistical analysis as covariates.

Results

In the TXA group, 54% less total drainage volume was observed (P < 0.01). The time until drain removal and LOS were reduced by 23% (P < 0.01) and 24% (P < 0.01), respectively, compared with the control group. Moreover, it was found that daily drainage volume increased with age.

Conclusions

Topical TXA administration reduces daily drainage volume, time until drain removal, and LOS significantly in patients undergoing abdominoplasty. Further studies analyzing the superiority of topical TXA compared with systemic TXA, as well as studies investigating the ideal TXA dosage could deliver further valuable information.

The Effects of Systemic Tranexamic Acid Administration on Drainage Volume, Length of Hospital Stay, and Postoperative Complications in Reduction Mammaplasty

Background: Reduction mammaplasty is a common, elective, and safe operation, usually executed in healthy patients. Nonetheless, postoperative complications like bleeding and seroma formation can occur and significantly complicate the postoperative course. Tranexamic acid (TXA), a commonly used antifibrinolytic drug, offers a novel approach to reduce these complications. This study aims to evaluate its effect on the rate of postoperative bleeding, drainage volume, length of hospital stay, and other postoperative complications in patients undergoing reduction mammaplasty. Method: A retrospective study on all patients undergoing reduction mammaplasty at the Department of Plastic, Reconstructive, and Aesthetic Surgery EOC between 2015 and 2022 was conducted. Patients were divided into the TXA group receiving systemic TXA for 48 h and the control group not receiving any TXA. All data were analyzed using nonparametric formulas. Results: A total of 209 breasts were included in the study, with 138 cases in the control group and 71 in the TXA group. Three cases requiring revision surgery due to bleeding were observed in the control group, whereas none were observed in the TXA group. Total drainage volume was significantly reduced in the TXA group compared to the control group (TXA: 41.6 mL vs. control: 53.8 mL; p = 0.012), resulting in a significant reduction in length of hospital stay (TXA: 1.6 days vs. control: 2.2 days; p = 0.0001). Conclusions: TXA is a well-tolerated drug that significantly reduces postoperative bleeding and drainage volume, resulting in earlier drain removal and reduced length of hospital stay. TXA should, therefore, be widely used in plastic surgery, especially as trends in healthcare systems necessitate more outpatient procedures and quicker postoperative recovery.

The Effects of Systemic Tranexamic Acid Administration on Drainage Volume, Duration of Drain Placement, and Length of Hospital Stay in Skin- and Nipple-Sparing Mastectomies with Immediate Expander-Based Breast Reconstruction

Background: Skin- (SSM) and nipple-sparing (NSM) mastectomies are frequently performed surgeries with a considerable risk for post-operative hematoma or seroma. Tranexamic acid (TXA) is a potent antifibrinolytic drug commonly used in many surgical fields but rather novel in plastic and, specifically, breast surgery. This study investigates the influence of TXA in patients undergoing SSM or NSM with expander-based reconstruction (EbR) on post-operative outcomes. Methodology: A retrospective study was conducted on 132 patients undergoing uni- or bilateral SSM or NSM with EbR between May 2015 and March 2022. Patients receiving systemic TXA treatment for 48 h following a standardized protocol were compared to those who received no treatment. Multivariable linear regression was performed to identify influencing factors and quantify their effect on drainage volume, duration of drain placement, length of hospital stay, post-operative bleeding, and seroma formation. Results: The 132 patients underwent a total of 155 mastectomies (72 in the TXA group, 83 in the control group). TXA significantly reduced drainage volume (-22.3 mL, p = 0.011). Duration of drain placement and length of hospital stay were significantly shorter in the TXA group (p < 0.001 and p = 0.001). No significant side effects were reported. Conclusion: TXA is a safe drug if administered respecting the well-defined contraindications. Systemic TXA administration significantly reduces drainage volume in patients undergoing SSM or NSM and should encourage surgeons to reconsider using drains in post-operative protocols. Duration of drain placement and length of hospital stay were significantly reduced in the TXA group but other factors like resection weight might have a more substantial impact.

Use of Tranexamic Acid in Gender-Affirming Mastectomy Reduces Rates of Postoperative Hematoma and Seroma

BACKGROUND

The established safety and efficacy of tranexamic acid (TXA) in minimizing perioperative blood loss has led to increased interest within plastic surgery. Prior studies have demonstrated decreased edema and ecchymosis and reduced rates of postoperative collection with administration of TXA; however, its use has not been reported in gender-affirming mastectomy. This represents the first study to evaluate the effects of TXA on postoperative outcomes in patients undergoing gender-affirming mastectomy.

METHODS

A single-center cohort study was performed analyzing all consecutive patients undergoing gender-affirming mastectomy with the senior author (R.B.-L.) between February of 2017 and October of 2022. Beginning in June of 2021, all patients received 1000 mg of TXA intravenously before incision and 1000 mg at the conclusion of the procedure. Patients were stratified according to intraoperative administration of TXA, with demographic characteristics, surgical characteristics, and postoperative outcomes compared between groups.

RESULTS

A total of 851 patients underwent gender-affirming mastectomy. Of these, 646 cases were performed without TXA, and 205 patients received intravenous TXA intraoperatively, as described previously. Patients who received TXA had significantly lower rates of seroma (20.5% versus 33.0%; P < 0.001) and hematoma (0.5% versus 5.7%; P = 0.002). There was no difference in rates of surgical-site infection ( P = 0.74). TXA use was not associated with increased rates of venous thromboembolism ( P = 0.42).

CONCLUSIONS

Intraoperative administration of TXA in patients undergoing gender-affirming mastectomy may safely reduce the risk of postoperative seroma and hematoma without increased risk of thromboembolic events. Additional data collection and prospective studies are warranted to corroborate these findings.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.