The most common expected early outcomes and complications from many types of plastic surgery are various types of undesired fluid collections. These are caused by bleeding (bruising and hematomas) as well as prolonged lymphatic leaks. (seromas)
While the body has many natural clotting and healing mechanism to limit the occurrence or extent of these fluid collections, they can be frequently overwhelmed or not optimally effective. Plastic surgeons are well aware of this potential and employ a variety of strategies to help including intraoperative electrocautery and hemostatic materials as well as the use of postoperative drains and pressure dressings.
The past decade has seen the advent of adjunctive biologic approaches that can be applied during surgery to work with the body’s natural hemostatic and healing mechanisms. One such agent is VITAGEL.This is an FDA-approved, composite liquid hemostat that combines the thrombin and collagen with the patient’s own plasma. When applied to human tissues, Vitagel creates an adherent gel and an impermeable barrier to blood flow. This helps control bleeding and facilitates healing using the patient’s own biology.
Vitagel is promoted as a surgical hemostatic product that combines microfibrillar collagen with thrombin, fibrinogen, and platelets. This unique combination of components forms a 3-D scaffold of collagen and fibrin which is augmented with activated platelets.This is created during surgery by using a draw of the patient’s blood which is spun down by a centrifuge to create an extract of plasma and platelets. This is then mixed with prepackaged thrombin and collagen to create the final hemostatic product. By using the patients own blood, the risk of viral transmission associated with products containing pooled human donor components is eliminated.
One very unique component of Vitagel is the microfibrillar collagen. Collagen is a well known essential element for both inducing the coagulation cascade as well as promoting healing. The microfibrillar structure allows for better coherence of the collagen fibers to irregularly shaped bleeding sites.This type of collagen also aids the healing process through the formation of a biologically active 3-D scaffold for cellular ingrowth and fibroblast attachment. Such a scaffold becomes a template for new tissue growth. This is unlike any other surgical hemostatic agent.
Vitagel can also be applied to the surgical site in a variety of ways including a standard spray and a powered aerosolized mist. This ensures optimal coating of the tissues even into the smallest crevices.
Vitagel has great application for many plastic surgery procedures that involve the creation of large skin and tissue flaps. Such procedures as tummy tuck and facelifts, for example, involved the undermining of large tissue flaps for which drains are commonly used and the risk of hematomas and seromas are well known. The use of Vitagel would help decrease these risks and may either eliminate the use of drains or reduce the length of time they are in after surgery. At the least the amount and duration of postoperative bruising and swelling may be lessened.
Dr. Barry Eppley
Indianapolis, Indiana