Hemostatic Net in Rhytidoplasty: Analysis of 160 Consecutive Patients
Although various methods have been used to prevent hematomas after surgery, none has been demonstrated to be completely effective. Surgical drains do not necessarily prevent hematomas, and when removed they can cause hematomas. Tissue sealants may decrease the risk of hematomas, however, has limitations as high cost, potential to cause allergic reactions, and transmit infectious diseases. Compressive dressing is another method used to prevent complications. Nevertheless, they have the potential to compromise flap vascularization, and could be uncomfortable.
Auervald and Auervald have developed and published their technique to prevent hematoma in facelift, the hemostatic net. The net can be done with many interrupted sutures or with a running suture transfixing the skin and grasping the underling tissue. The literature reports no cases of hematomas when the net has been used, which demonstrates the efficacy of the net.
This study aims to do a retrospective analysis of patients submitted to facelift with hemostatic net.
Methods/Technique: A retrospective analysis of the medical records of patients submitted to rhytidectomy performed between July 2019 and 2022, at the Dr Jerônimo Clinic in Ibitinga, São Paulo, Brazil.
The procedures were performed by a single surgeon, the main author, J.M.S.
The variables and outcomes analyzed were age, gender, comorbidities, body mass index (BMI), surgery time, length of hospital stay and complications.
The hemostatic net was performed with a Nylon 5-0 in a running suture, transfixing the skin and grasping the underling tissue. These was applied in all the dissected areas of the face and neck. During patient hospitalization the hemostatic net was observed every each 3 hours, and cleaned every 6 hours. It was removed 48 hours later the procedure, before the patient discharge
Results/Complications: A total of 160 medical records were analyzed, 80 of which were submitted to SMAS plication and 80 the Deep Plane technique. 150 (93.7%) were female patients and 10 (6.3%).
The mean age was 54.8 ± 7.8 years. The average BMI was 24.5 ± 2.7 Kg/m²; 78 patients had comorbidity, the most frequent being arterial hypertension in 43 individuals, and hypothyroidism in 27. There were 5 active smokers patients. (Table 1).
The mean surgical time was 327.5 ± 70.2 minutes. The length of hospital stay was 2.2 ± 0.63 days.
A total of 14 complications occurred in 11 patients (6.8%). Neuropraxia was the most common, in 7 patients (4.4%), followed by 4 seromas (2.5%), 1 infection (0.6%), 1 late hematoma (0.6%), and 1 sialoma (0.6%) . Table 2.
The late hematoma occurred in the post operative day 10. All the other complications were related to the facelift technique.
Reapproach was necessary in one case, to treat the late hematoma.
No patients have complained about scar formation or modifications in the pattern of skin pigmentation in the hemostatic net points or area.
Conclusion: The hemostatic net is a safe procedure to prevent hematoma in the post operative period of facelift. The application of this technique resulted in lower incidence or no hematoma.