How safe is TissuGlu for a tummy tuck?

Question

A person is considering a tummy tuck and have read about TissuGlu and how this can speed up the recovery time as well as mitigate the need for drains. Do they use this in your practice and if not why?Don't see much on RealSelf about it...thanks!

York Jay Yates, MD · Answer

Drainless tummy tuck is the direction the tummy tuck is going.   Why shouldn’t it be, patients really hate drains and if the complication rate is the same, drainless wins.   I predict TissuGlu drainless TT will be one of the hottest things next year and we will start hearing more and more about it.   On a more traditional level, progressive tension sutures are used to go drainless the majority of the time.  I started using progressive tension sutures with the idea of going drainless a couple of years ago.   For the first few cases I did BOTH progressive tension sutures and drains, just to see what I wouldn’t be draining.   There was often more serous drainage than I would feel comfortable leaving and now do both drains and PTS.  IMO the progressive tension sutures improve the scar quality and get the drains out faster, but I’m just too conservative to go without (I would never fault another PS for feeling differently as the seroma rate is very low).    Back to TissuGlu, I did my first drainless TT with TissuGlu this week and was more than impressed to this point.   The flap felt more secure and I’m sure the dead-space is less than with traditional PTS.   We know that motion, friction and dead-space are the recipe for seroma formation and TissuGlu seemed to help these factors.  Update to follow.

Peter D. Geldner, MD · Answer

I do not use TissuGlu. That isn't to say that I wont, but as of now, I'm not that interested. Though It has substantial promise as an adjunct to drainless abdominoplasty, roughly one quarter of patients could require insertion of a drain at a later time. Most of my abdominoplasties also involve liposuction in a technique described as lipo-abdominoplasty. I would not use TissuGlu in that setting. Even progressive tension suturing techniques may result in seroma formation. As much as we try to avoid the use of drains, if we are creative in the choice of drain and surgical techniques, they are a minor nuisance. I would make my decision of surgeon to be based on results and your level of trust, not on the use of one particular product,

Nelson Castillo, MD · Answer

Thank you for sharing your question.  This is a good option in select patients to help minimize the need for surgical drains as are the more traditional quilting and progressive tension sutures.  Hope this helps.

Jed H. Horowitz, MD, FACS · Answer

Over the years, surgeons have improved procedures and found ways to eliminate the need for #drains commonly used in a #tummy #tuck or #abdominoplasty, and a variety of other operations. If you go to a plastic #surgeon who uses drains, or if your situation requires drains, they usually stay in 3-5 days but may be required to remain in longer. A newer option now can include the use of tissue #glue to adhere the abdominal #skin to the #muscle; eliminating any space that previously required a drain and an alternative to sutures in a tummy tuck. I have found that most of my patients do very well with the exception of those have large areas of liposuction or lipo-abdominoplasty. I may use drains on a case by case basis for these patients. Any extra fluid may be reabsorbed back into the body without the use of drains. I may use drains on a case by case basis for these patients. Your board certified plastic surgeon will recommend the type best suited for you. The most important decision to be made before performing any surgical procedure is determining whether you are an ideal #candidate.

John L. Burns Jr., MD · Answer

This procedure is excellent for small tummy tucks with minimal liposuction.  A standard or mini tummy tuck procedure will do well with TissueGlu.  There is a small additional fee for the cost of the Tissue Glu

Andrew Smith, MD, FACS · Answer

TissuGlu is an internal adhesive that is designed to work by creating multiple points of contact between tissue layers to minimize dead space where fluid can accumulate during recovery. The body’s natural response to any surgical procedure, such as an abdominoplasty (or tummy tuck), is to generate fluid, but TissuGlu is designed to reduce dead-space, therefore minimizing fluid accumulation. There is still a risk that fluid accumulation may occur, just as there is with drains. However, TissuGlu allows my patients to return to their normal activity more quickly and can recover without drains. I’ve found the procedure to be very safe and my patients appreciate having a shorter recovery period. Please talk with your doctor about the risks and benefits of TissuGlu.

John LoMonaco, MD, FACS · Answer

Looking at the product, it passed FDA approval by a narrow margin. The only research study shows that it definitely lowers the chances of a seroma if drains are not used, yet nearly 20% of patients still developed a seroma, and of these individuals slightly over 7% had to have seroma drainage and a drain placed later.   The product was NOT used in patients who had liposuction, and NOT used in weight-loss patients. It is not an inexpensive product either.  I would consider using it, but not without explaining the risks and uncertainties to my patients.

Scott C. Sattler, MD, FACS · Answer

I think a cost-effective and very sdafe way to eliminate dead-space between tummy tuck flap and underlying muscle/fascia layer is to use progressive tension sutures. The use of tissue adhesive on such a broad surface area prone to flexion and torsional forces does not make sense to me.

E. Ronald Finger, MD · Answer

My experience with tissue glue has not been favorable with facelifts.I strongly recommend the drainless tummy tuck, which involved sutures called "Progressive Tension Sutures." After using this technique for 7 years without a single seroma, and I perform about 40 tummy tucks a year, this is the technique that I recommend. Quite a bit of tension can be achieved with these progressive tension sutures which would not be possible with any kind of glue.Plus, with the drainless TT and mentioned sutures, the complication is much lower, there is less post operative recovery time, less pain, and none of the dreaded drains for 5-10 days. And because of the tension that can be placed on these mentioned sutures, the abdomen is tighter.Thank you for your question, and good luck.

Alexander G. Nein, MD, MS, FACS · Answer

TissuGlu is safe (FDA approved) and works very well to seal the muscle layer to the fat layer in a tummy tuck. The disadvantage is that it is relatively expensive and very few patients are willing to pay the extra amount for it. There are alternatives (in some cases) to placing drains. The technique we use commonly is to sew the tummy tuck flap down to the muscle layer in a progressive fashion during the closing portion of the operation. It adds a few minutes to the procedure but certainly can avoid the need for drains.

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