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Tranexamic Acid and Hematoma Rates in Transmasculine Chest Surgery
D Medalie, MD
M Tran, MD
L Galbraith, MS4
Summa Health
2023-02-10
Presenter: Mike Tran
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Ananth S Murthy
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
Background
Minimizing surgical blood loss is imperative to avoid surgical morbidity, mortality, and aesthetic compromise. Pharmacologic prevention with tranexamic acid is gaining favor. In plastic surgery, however, a paucity of data still exists outside of craniofacial surgery. There are limited articles describing the use of TXA in breast cancer patients undergoing mastectomy or lumpectomy, but at present there is no literature regarding TXA administration in transmasculine chest surgery.
Methods
A prospective cohort study was conducted involving transmasculine patients undergoing chest reconstruction. The procedures were performed by a single surgeon at a single institution. Patients receiving perioperative TXA were compared to multiple historic control groups. The TXA protocol was 500mg iv and 500mg topical prior to incision (500mg TXA mixed into 1L of tumescent solution which was then infiltrated throughout the chest - 500cc each side). Other than TXA administration, all surgeries were performed with identical techniques and methods for achieving hemostasis. The primary outcome was hematoma requiring intervention any time post-operatively.
Results
125 consecutive patients (250 breasts) who received perioperative TXA were studied over a 8 month period. The control groups included historical cases that did not receive TXA (125 consecutive patients per 6-8 month time block for each of the past 5 years). The average hematoma rate was 3.5% in the control groups compared to 0.8% in the TXA group.
Conclusion
The combined use of TXA intravenously and topically in transmasculine chest surgery significantly reduced hematoma rates. The promising results of the study thus far encourages the ongoing expansion of TXA indications in plastic surgery.
