Topische Applikation von Tranexamsäure im Rahmen der subkutanen Mastektomie bei Frau-zu-Mann Transidentität

Zusammenfassung

Abstrakt Einleitung Tranexamsäure (TXA) ist ein antifibrinolytisches Medikament, das zur Therapie von Blutungen als auch zur Blutungsprophylaxe verwendet werden kann. Die Anwendung in der plastischen und rekonstruktiven Chirurgie ist bisher äußerst begrenzt. Unseres Wissens fehlen bisher veröffentlichte Daten zur topischen Anwendung von TXA bei subkutaner Mastektomie transidenter Patienten.

Methoden Es erfolgte eine retrospektive Datenanalyse von Patienten, die eine subkutanen Mastektomie bei Frau-zu-Mann Transidentität erhielten. Insgesamt wurden 22 Patienten mit topisch applizierter TXA behandelt, während 29 Patienten als Vergleichsgruppe dienten. Primärer Endpunkt war die Menge der Wundsekretion in den ersten 48 h nach der Operation. Sekundäre Endpunkte waren die Dauer der Drainage und das Auftreten von Nachblutungen.

Ergebnisse Innerhalb der ersten 48 h zeigte sich in der Gruppe der TXA Patienten eine durchschnittliche Menge von 97±50 ml im Vergleich zu 180±111 ml in der Kontrollgruppe (p<0,01). Es zeigte sich eine signifikant geringere Fördermenge über den Gesamtzeitraum in der Gruppe der TXA Patienten 113±86 ml vs. 265±197 ml. Die Verweildauer der Drainagen lag in der TXA Gruppe bei 2,3±0,7 Tagen, während die Drainagen in der Kontrollgruppe im Durchschnitt 3,4±1,3 Tage in situ waren (p<0,01). In der Gruppe der mit TXA behandelten Patienten zeigte sich eine Tendenz zu einer geringeren Anzahl an Nachblutungen (9 vs. 17 %).

Diskussion Es zeigte sich eine signifikante Reduktion der Fördermenge über die Drainage innerhalb der ersten 48 h sowie über den Gesamtzeitraum nach topischer Applikation von TXA. Des Weiteren kam es zu einer Verkürzung des Zeitraums mit einliegender Drainage bei den mit TXA behandelten Patienten. Die vorliegende Studie konnte einen signifikanten Vorteil für die topische Anwendung von TXA bei subkutaner Mastektomie bei Frau-zu-Mann transidenten Patienten zeigen.

Abstract

Introduction Tranexamic acid (TXA) is an antifibrinolytic drug that can be used to treat and prevent bleeding. Its application in plastic and reconstructive surgery has been very limited to date. To our knowledge, there is a lack of published data on the topical application of TXA in transgender patients undergoing subcutaneous mastectomy.

Methods We performed a retrospective data analysis of female-to-male transgender patients who underwent subcutaneous mastectomy. A total of 22 patients were treated with topical TXA, while 29 patients served as controls. The primary endpoint was the amount of wound secretion in the first 48 hours after surgery. Secondary endpoints were the duration of drainage and the occurrence of postoperative bleeding.

Results Within the first 48 hours, the TXA group had an average drain volume of 97±50 ml compared with 180±111 ml in the control group (p<0.01). There was a significantly lower flow rate over the entire period in the group of TXA patients (113±86 ml vs. 265±197 ml). The time of drains in situ was 2.3±0.7 days in TXA patients, while the drains in the control group were in place for an average of 3.4±1.3 days (p<0.01). In the group of patients treated with TXA, there was a tendency towards a lower number of postoperative bleeding and haematoma (9vs. 17%).

Discussion There was a significant reduction in the amount of drain fluid within the first 48 hours and over the entire period after topical application of TXA. Also there was a reduction in the length of time patients had a drain in place in the TXA-treated patients. This study demonstrated a significant advantage for the topical application of TXA in subcutaneous mastectomy in female-to-male transgender patients.

Schlüsselwörter

Brustchirurgie - Transsexualismus<Interdisziplinäre plastische Chirurgie - Tranexamsäure

Key words

subcutaneous mastectomy - subcutane Mastektomie - tranexamic acid - transgender

Publication History

Received: 24 March 2022

Accepted: 05 May 2022

Article published online:
13 September 2022

• Literatur

• 1 Habbab LM, Semelhago L, Lamy A. Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis. Thorac Cardiovasc Surg 2020; 68: 212-218 DOI: 10.1055/s-0039-1691748.
• 2 Ker K, Edwards P, Perel P. et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012; 344: e3054 DOI: 10.1136/bmj.e3054.
• 3 McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs 2012; 72: 585-617 DOI: 10.2165/11209070-000000000-00000.
• 4 Horrow JC, Van Riper DF, Strong MD. et al. The dose-response relationship of tranexamic acid. Anesthesiology 1995; 82: 383-392 DOI: 10.1097/00000542-199502000-00009.
• 5 Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. Br J Surg 2013; 100: 1271-1279 DOI: 10.1002/bjs.9193.
• 6 Poeran J, Rasul R, Suzuki S. et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ 2014; 349: g4829 DOI: 10.1136/bmj.g4829.
• 7 Rohrich RJ, Cho MJ. The Role of Tranexamic Acid in Plastic Surgery: Review and Technical Considerations. Plast Reconstr Surg 2018; 141: 507-515 DOI: 10.1097/PRS.0000000000003926.
• 8 Cuccolo NG, Kang CO, Boskey ER. et al. Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes. Plast Reconstr Surg Glob Open 2019; 7: e2316 DOI: 10.1097/GOX.0000000000002316.
• 9 Wolter A, Diedrichson J, Scholz T. et al. Sexual reassignment surgery in female-to-male transsexuals: an algorithm for subcutaneous mastectomy. J Plast Reconstr Aesthet Surg 2015; 68: 184-191 DOI: 10.1016/j.bjps.2014.10.016.
• 10 Frederick MJ, Berhanu AE, Bartlett R. Chest Surgery in Female to Male Transgender Individuals. Ann Plast Surg 2017; 78: 249-253 DOI: 10.1097/SAP.0000000000000882.
• 11 Cregten-Escobar P, Bouman MB, Buncamper ME. et al. Subcutaneous mastectomy in female-to-male transsexuals: a retrospective cohort-analysis of 202 patients. J Sex Med 2012; 9: 3148-3153 DOI: 10.1111/j.1743-6109.2012.02939.x.
• 12 Knox ADC, Ho AL, Leung L. et al. A Review of 101 Consecutive Subcutaneous Mastectomies and Male Chest Contouring Using the Concentric Circular and Free Nipple Graft Techniques in Female-to-Male Transgender Patients. Plast Reconstr Surg 2017; 139: 1260e-1272e DOI: 10.1097/PRS.0000000000003388.
• 13 Yee BE, Wissler RN, Zanghi CN. et al. The effective concentration of tranexamic acid for inhibition of fibrinolysis in neonatal plasma in vitro. Anesth Analg 2013; 117: 767-772 DOI: 10.1213/ANE.0b013e3182a22258.
• 14 Kalavrouziotis D, Voisine P, Mohammadi S. et al. High-dose tranexamic acid is an independent predictor of early seizure after cardiopulmonary bypass. Ann Thorac Surg 2012; 93: 148-154 DOI: 10.1016/j.athoracsur.2011.07.085.
• 15 Koster A, Borgermann J, Zittermann A. et al. Moderate dosage of tranexamic acid during cardiac surgery with cardiopulmonary bypass and convulsive seizures: incidence and clinical outcome. Br J Anaesth 2013; 110: 34-40 DOI: 10.1093/bja/aes310.
• 16 Manji RA, Grocott HP, Leake J. et al. Seizures following cardiac surgery: the impact of tranexamic acid and other risk factors. Can J Anaesth 2012; 59: 6-13 DOI: 10.1007/s12630-011-9618-z.
• 17 Martin K, Knorr J, Breuer T. et al. Seizures after open heart surgery: comparison of epsilon-aminocaproic acid and tranexamic acid. J Cardiothorac Vasc Anesth 2011; 25: 20-25 DOI: 10.1053/j.jvca.2010.10.007.
• 18 Murkin JM, Falter F, Granton J. et al. High-dose tranexamic Acid is associated with nonischemic clinical seizures in cardiac surgical patients. Anesth Analg 2010; 110: 350-353 DOI: 10.1213/ANE.0b013e3181c92b23.
• 19 Lecker I, Wang DS, Kaneshwaran K. et al. High Concentrations of Tranexamic Acid Inhibit Ionotropic Glutamate Receptors. Anesthesiology 2017; 127: 89-97 DOI: 10.1097/ALN.0000000000001665.
• 20 Takagi H, Ando T, Umemoto T. et al. Seizures associated with tranexamic acid for cardiac surgery: a meta-analysis of randomized and non-randomized studies. J Cardiovasc Surg (Torino) 2017; 58: 633-641 DOI: 10.23736/S0021-9509.17.09877-9.
• 21 collaborators C-t, Shakur H, Roberts I. et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376: 23-32 DOI: 10.1016/S0140-6736(10)60835-5.
• 22 Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389: 2105-2116 DOI: 10.1016/S0140-6736(17)30638-4.
• 23 Ng W, Jerath A, Wasowicz M. Tranexamic acid: a clinical review. Anaesthesiol Intensive Ther 2015; 47: 339-350 DOI: 10.5603/AIT.a2015.0011.
• 24 Ker K, Beecher D, Roberts I. Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database Syst Rev 2013; CD010562 DOI: 10.1002/14651858.CD010562.pub2.
• 25 Li J, Zhang Z, Chen J. Comparison of efficacy and safety of topical versus intravenous tranexamic acid in total hip arthroplasty: A meta-analysis. Medicine (Baltimore) 2016; 95: e4689 DOI: 10.1097/MD.0000000000004689.
• 26 Lin C, Qi Y, Jie L. et al. Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty: A meta-analysis. Medicine (Baltimore) 2016; 95: e5344 DOI: 10.1097/MD.0000000000005344.
• 27 Ausen K, Fossmark R, Spigset O. et al. Randomized clinical trial of topical tranexamic acid after reduction mammoplasty. Br J Surg 2015; 102: 1348-1353 DOI: 10.1002/bjs.9878.
• 28 Ausen K, Hagen AI, Ostbyhaug HS. et al. Topical moistening of mastectomy wounds with diluted tranexamic acid to reduce bleeding: randomized clinical trial. BJS Open 2020; 4: 216-224 DOI: 10.1002/bjs5.50248.
• 29 Hadad E, Wiser I, Rosenthal A. et al. Suction drains in esthetic breast implant exchange are associated with surgical site infections: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2017; 70: 1635-1640 DOI: 10.1016/j.bjps.2017.06.034.
• 30 Keskin M, Sutcu M, Cigsar B. et al. Necessity of suction drains in gynecomastia surgery. Aesthet Surg J 2014; 34: 538-544 DOI: 10.1177/1090820X14526598.
• 31 Matarasso A, Wallach SG, Rankin M. Reevaluating the need for routine drainage in reduction mammaplasty. Plast Reconstr Surg 1998; 102: 1917-1921 DOI: 10.1097/00006534-199811000-00016.