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Fibrin sealants in soft tissue surgery of the head and neck: A systematic review and meta‐analysis of randomised controlled trials
Author(s) -
Bajwa M.S.,
TudurSmith C.,
Shaw R.J.,
Schache A.G.
Publication year - 2017
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/coa.12837
Subject(s) - medicine , randomized controlled trial , surgery , meta analysis , soft tissue , medline , relative risk , subgroup analysis , confidence interval , political science , law
Background Fibrin sealants ( FS ) are commercially available products used in surgical wounds as adjuncts to haemostasis and closure of dead space. The role of FS in soft tissue head and neck surgery has not been established. Objectives To assess whether FS improves wound‐related outcomes in patients undergoing soft tissue surgery of the head and neck anatomical region that would commonly require a drain. Type of review Systematic review and meta‐analysis of randomised controlled trials ( RCT s). Search strategy MEDLINE (1946‐2016), EMBASE (1974‐2016), PubMed (2016), CENTRAL (2016), ClinicalTrials.gov (2016), WHO International Clinical Trials Registry and Platform (2016), Research Gate (2016). Evaluation method Two independent reviewers screened and selected studies. Included studies were assessed for risk of bias and data extracted using a predetermined data collection form. Results Of the 421 studies that were screened, 11 RCT s met the inclusion criteria. There were two RCT s on thyroidectomy, three on “surgery involving neck dissection” (central or lateral), five on rhytidectomy and one on parotidectomy. There was a tendency for FS to reduce “mean total drainage volume” (mean difference −26.86 mL, 95% CI −43.41 to −10.31, I 2 =97%, P =.001). Subgroup analysis of thyroidectomy (mean difference −36.36 mL, 95% CI −72.82 to 0.10, I 2 =79%, P =.05), “surgery involving neck dissection” (mean difference −33.21 mL, 95% CI −70.01 to 3.59, I 2 =94%, P =.08) and rhytidectomy (mean difference −13.79 mL, 95% CI −17.57 to −10.01, I 2 =0%, P < .00001) concurred with the overall analysis. There was a suggestion that FS may reduce “mean retention time of drains” by 1.24 days (95% CI −3.32 to 0.85, I 2 =99%, P =.25) and “hospital length of stay” by 2.09 days (95% CI −5.18 to 0.99, I 2 =97%, P =.18), but this was not statistically significant. There was also a suggestion that FS may protect against adverse events ( RR 0.69, 95% CI 0.35 to 1.38, I 2 =0%, P =.29) and haematoma/seroma formation ( RR 0.49, 95% CI 0.22 to 1.07, I 2 =0%, P =0.07). Conclusions There was considerable heterogeneity within the RCT s included in this study, thus restricting definitive conclusions. FS has however shown a definite benefit in rhytidectomy and potential benefit in other soft tissue head and neck surgical procedures. Further pragmatic trials are required particularly in the field of lateral neck dissection.