Use Of Fibrin Sealant For Incision Reinforcement In Intraoral Free Flap Reconstruction Following Oncologic Resection

PURPOSE: Salivary leaks and fistulas are serious complications following head and neck free flap reconstruction that can delay the timely initiation of adjuvant therapies in oncologic patients. To reduce this risk, our plastic surgery service has adopted the use of fibrin sealant to reinforce intraoral suture lines, particularly in dependent areas, in patients undergoing free flap reconstruction with an intraoral skin paddle. This study evaluates the impact of fibrin sealant on surgical complications in patients undergoing oncologic reconstruction for head and neck cancer at our institution. We hypothesize that fibrin sealant will reduce the incidence of salivary leaks and fistula formation. METHODS: We identified 488 patients who underwent head and neck oncologic reconstruction with an intraoral skin paddle between April 2017-January 2025. Demographics, oncologic history, surgical details, and postoperative surgical complications were collected. Patients were stratified based on the use of intraoperative fibrin sealant. A multivariable logistic regression model adjusting for age, body mass index (BMI), chemotherapy, radiation, smoking status, and use of hardware evaluated the association between fibrin sealant application and surgical complications. Absolute risk reduction (ARR) was calculated as the difference in risk between fibrin sealant and non-fibrin sealant groups, and relative risk reduction (RRR) as the proportional reduction in risk relative to the control group. RESULTS: Of 488 patients, 63 (13%) received intraoperative fibrin sealant. The median age was 65 years, and the median BMI was 24.6 kg/m2. Overall, the two cohorts were similar in terms of demographics, adjuvant therapies, and comorbidities (Tables 1 and 2). There were significantly fewer instances of orocutaneous fistulas (p=0.02), wound dehiscence (p<0.001), and cellulitis (p=0.04) in patients who received fibrin sealant (Table 3). Multivariable analysis showed fibrin sealant lowered the incidence of wound dehiscence after adjusting for other variables (p=0.017; Table 4). Patients receiving fibrin sealant had a 91% RRR of developing wound dehiscence (ARR 0.15). CONCLUSION: This is the first study to evaluate fibrin sealant in patients undergoing intraoral free flap oncologic reconstruction. In this cohort, the incidence of orocutaneous fistula, wound dehiscence, and cellulitis was significantly lower in patients receiving fibrin sealant, and applying fibrin sealant reduces the relative risk of dehiscence by 91%. Our results suggest that fibrin sealant may act as an effective barrier to promote healing between the intraoral skin paddle and the surrounding mucosa.© 2026. Plastic Surgery Research Council | All rights reserved |*Source: https://ps-rc.org/meeting/Program/2026/34.cgi*