Effects of Ankaferd® blood stopper on the postoperative outcomes of breast surgery for gynecomastia and breast hypertrophy

Yıl 2022, Cilt: 15 Sayı: 2, 43 - 53, 15.01.2023

Selman Hakkı Altuntaş , Fuat Uslusoy , Ömer Faruk Dilek , Asım Aydın

Öz

Bleeding after skin closure is a disturbing complication commonly observed in almost all kind of surgical operations. Ankaferd blood stopper (ABS), a topical hemostatic agent of plant origin, has been registered for the management of clinical hemorrhages when the conventional methods to control bleeding by ligature and/or hemostatic measures are ineffective . This study investigated whether topical ABS application alters postoperative bleeding complications in patients undergoing symmetrical red uction mammoplasty or symmetrical subcutaneous mastectomy in a randomized, placebo-controlled, double-blind design. Twenty-two patients underwent either reduction mammoplasty (n=13) or subcutaneous mastectomy (n=9). ABS or placebo was randomized between both breasts in the same patient. Total amount running from the drain was found significantly greater in ABS group in comparison to the placebo group. Hematoma was seen in one case, seroma in 8 cases and infection and wound healing problem requiring intervention in 6 cases. Hematoma complication occured in placebo group and a significant difference was not found between groups in terms of this complication. Of the 8 seroma complications all were in ABS group. Relationship between seroma development and ABS use was found significant. Similarly, all of 6 cases who developed infection and wound healing problem requiring intervention were in ABS group. Infection and wound healing problem requiring intervention were also found to be significantly correlated with ABS use. Any finding suggesting a constant hemostatic effect on the post-surgical hemorrhages despite conventional hemostatic methods could not be obtained in this study.

Anahtar Kelimeler

ANKAFERD, hemostasis, hemorrhage, bleeding

Kaynakça

• Kennedy SA, Irvine RA, Westerberg BD, Zhang H. Meta-analysis: prophylactic drainage and bleeding complications in thyroid surgery. J Otolaryngol Head Neck Surg. 2008;37(6):768-773.
• Gaines RJ, Dunbar RP. The use of surgical drains in orthopedics. Orthopedics. 2008;31(7):702-705.
• Neaman KC, Hansen JE. Analysis of complications from abdominoplasty: a review of 206 cases at a university hospital. Ann Plast Surg. 2007;58(3):292-298.
• Collis N, McGuiness CM, Batchelor AG. Drainage in breast reduction surgery: a prospective randomised intra-patient trail. Br J Plast Surg. 2005;58(3): 286-289.
• Zoumalan R, Rizk SS. Hematoma rates in drainless deep-plane face-lift surgery with and without the use of fibrin glue. Arch Facial Plast Surg. 2008;10(2): 103-107.
• Lejour M. Vertical mammaplasty: early complications after 250 personal consecutive cases. Plast Reconstr Surg. 1999;104(3):764-770.
• John Bostwick. Plastic and Reconstructive Breast Surgery. Vol. 1. St. Louis, Missouri. 2000, p:480.
• Scott GR, Carson CL, Borah GL. Maximizing outcomes in breast reduction surgery: a review of 518 consecutive patients. Plast Reconstr Surg. 2005; 116(6):1633-1639; Discussion 1640-1.
• Henry SL, Crawford JL, Puckett CL. Risk factors and complications in reduction mammaplasty: novel associations and preoperative assessment. Plast Reconstr Surg. 2009;124(4):1040-1046.
• Mandrekas AD, Zambacos GJ, Anastasopoulos A, Hapsas DA. Reduction mammaplasty with the inferior pedicle technique: early and late complications in 371 patients. Br J Plast Surg. 1996;49(7):442-446.
• Hussien M, Lee S, Malyon A, Norrie J, Webster M. The impact of intraoperative hypotension on the development of wound haematoma after breast reduction. Br J Plast Surg. 2001;54(6):517-522.
• Buenaventura S, Severinac R, Mullis W, Beasley M, Jacobs W, Wood D. Outpatient reduction mammaplasty: a review of 338 consecutive cases. Ann Plast Surg. 1996;36(2):162-166.
• Stevens WG, Gear AJ, Stoker DA, Hirsch EM, Cohen R, Spring M, et al. Heck RT. Outpatient reduction mammaplasty: an eleven-year experience. Aesthet Surg J. 2008;28(2):171-179.
• Tan J, Timmons MJ, Watt DA. Breast reduction surgery without drains. J Plast Reconstr Aesthet Surg. 2007;60(10):1168-9.
• Corion LU, Smeulders MJ, Van Zuijlen PP, Van der Horst CM. Draining after breast reduction: a randomised controlled inter-patient study. J Plast Reconstr Aesthet Surg. 2009;62(7):865-868.
• Wrye SW, Banducci DR, Mackay D, Graham WP, Hall WW. Routine drainage is not required in reduction mammaplasty. Plast Reconstr Surg. 2003; 111(1):113-117.
• Lanitis S, Starren E, Read J, Heymann T, Tekkis P, Hadjiminas DJ, et al. Surgical management of gynaecomastia: outcomes from our experience. Breast. 2008;17(6):596-603.
• Colombo-Benkmann M, Buse B, Stern J, Herfarth C. Indications for and results of surgical therapy for male gynecomastia. Am J Surg. 1999;178(1):60-63.
• Handschin AE, Bietry D, Hüsler R, Banic A, Constantinescu M. Surgical management of gynecomastia--a 10-year analysis. World J Surg. 2008;32(1):38-44.
• Tashkandi M, Al-Qattan MM, Hassanain JM, Hawary MB, Sultan M. The surgical management of high-grade gynecomastia. Ann Plast Surg. 2004; 53(1):17-20.
• Laituri CA, Garey CL, Ostlie DJ, St Peter SD, Gittes GK, Snyder CL. Treatment of adolescent gynecomastia. J Pediatr Surg. 2010;45(3):650-654.
• Beyazit Y, Kekilli M, Haznedaroglu IC, et al. Ankaferd hemostat in the management of gastrointestinal hemorrhages. World Journal of Gastroenterology 2011;17:3962-3970.
• Beyazit Y, Kurt M, Kekilli M, et al. Evaluation of Hemostatic Effects of Ankaferd as an Alternative Medicine. Alternative Medicine Review 2010; 15:329-336.
• Haznedaroglu BZ, Beyazit Y, Walker SL, et al. Pleiotropic cellular, hemostatic, and biological actions of Ankaferd hemostat. Crit Reviews Oncol Hematol. 2012;83(1):24-32.
• Goker H, Haznedaroglu IC, Ercetin S, et al. Haemostatic actions of the folkloric medicinal plant extract Ankaferd Blood Stopper. J Int Med Res 2008; 36:163-170.
• Demiralp DO, Haznedaroglu IC, Akar N. Functional proteomic analysis of Ankaferd(R) Blood Stopper. Turk J Hematol 2010; 27:70-77.
• Yılmaz E, Gulec S, Haznedaroglu IC, Akar N. The effects of Ankaferd® Blood Stopper on transcription factors in HUVEC and erythrocyte protein profile. Turk J Hematol. 2011;28:276-285.
• Al B, Yildirim C, Cavdar M, Zengin S, Büyükaslan H, Kalender ME. Effectiveness of Ankaferd blood stopper in the topical control of active bleeding due to cutaneous-subcutaneous incisions. Saudi Med J 2009;30:1520-1525.
• Balcik OS, Koroglu M, Cipil H, Kaftan O, Maral S, Gurel A, et al. A Placebo-Controlled, Randomized, Double-Blinded, Cross-Over Phase I Clinical Study to Demonstrate Safety of Ankaferd Blood Stopper Topical Usage In Healthy Volunteers. Int J Lab Hem 2010;32(Suppl 1):126-127.
• Beyazit Y, Kart T, Kuscu A, et al. Successful management of bleeding after dental procedures with application of blood stopper: a single center prospective trial. J Contemp Dent Pract 2011;12:379-384. Iynen I, Bozkus F, San I, et al. The hemostatic efficacy of Ankaferd Blood Stopper in adenoidectomy. International J Pediatric Otorhinolaryngology 2011;75:1292-1295.
• Karaman A, Baskol M, Gursoy S, et al. Endoscopic topical application of ankaferd blood stopper in gastrointestinal bleeding. J Altern Complement Med 2012; 18:65-68.
• Ngan PG, Iqbal HJ, Jayagopal S, Sillitoe AT, Dhital SK, Juma A. When to use drains in breast reduction surgery? Ann Plast Surg. 2009;63(2):135-137.
• Hall-Findlay EJ. Vertical breast reduction with a medially based pedicle. Operative strategies. Aesthetic Surgery Journal 2002;22(2):185-195.
• Blomqvist L, Sellman G, Strömbeck JO. Reduction mammaplasty with adrenaline infiltration: effects on perioperative bleeding. Scand J Plast Reconstr Surg Hand Surg.1996;30(1):29-32.
• Boljanovic S, Axelsson CK, Elberg JJ. Surgical treatment of gynecomastia: liposuction combined with subcutaneous mastectomy. Scand J Surg. 2003; 92(2):160-162.
• Metaxotos NG, Asplund O, Hayes M. The efficacy of bupivacaine with adrenaline in reducing pain and bleeding associated with breast reduction: a prospective trial. Br J Plast Surg. 1999;52(4):290-293.
• DeBono R, Rao GS. Vasoconstrictor infiltration in breast reduction surgery: is it harmful? Br J Plast Surg. 1997;50(4):260-262.
• Cohen J. Is blood transfusion necessary in reduction mammaplasty patients? Ann Plast Surg. 1996;37(1): 116-118.
• Walden JL, Schmid RP, Blackwell SJ. Cross-chest lipoplasty and surgical excision for gynecomastia: a 10-year experience. Aesthet Surg J. 2004;24(3):216-223.
• Varma SK, Henderson HP. A prospective trial of adrenaline infiltration for controlling bleeding during surgery for gynaecomastia. Br J Plast Surg. 1990; 43(5):590-593.
• Lejour M. Vertical mammaplasty and liposuction of the breast. Plast Reconstr Surg. 1994;94(1):100-114.
• Wiesman IM, Lehman JA Jr, Parker MG, Tantri MD, Wagner DS, Pedersen JC. Gynecomastia: an outcome analysis. Ann Plast Surg. 2004;53(2):97-101.
• Bilgili H, Kosar A, Kurt M, Onal IK, Goker H, Captug O, et al. Hemostatic efficacy of Ankaferd Blood Stopper in a swine bleeding model. Med Princ Pract. 2009;18(3):165-169.
• Kilic O, Gonen M, Acar K, Yurdakul T, Avunduk MC, Esen HH, et al. Haemostatic role and histopathological effects of a new haemostatic agent in a rat bladder haemorrhage model: an experimental trial. BJU Int. 2010;105(12):1722-1725.
• Huri E, Akgül T, Ayyildiz A, Üstün H, Germiyanoğlu C. Hemostatic role of a folkloric medicinal plant extract in a rat partial nephrectomy model: controlled experimental trial. J Urol. 2009;181(5): 2349-2354.
• Tokgöz H, Karakaya K, Hanci V, Abduşoğlu M, Erol B, Türksoy O, et al. Protective value of a folkloric medicinal plant extract against mortality and hemorrhage in a life-threatening renal trauma model. Urology. 2010;75(6): 1515.e9-14.
• Kurt M, Kaçar S, Onal İK, Akdoğan M, Haznedaroğlu İC. Ankaferd Blood Stopper as an effective adjunctive hemostatic agent for the management of life-threatening arterial bleeding of the digestive tract. Endoscopy 2008;40:E262.
• Kosar A, Cipil HS, Kaya A, Uz B, Haznedaroglu IC, Goker H, et al. The efficacy of Ankaferd Blood Stopper in antithrombotic drug-induced primary and secondary hemostatic abnormalities of a rat-bleeding model. Blood Coagul Fibrinolysis. 2009;20(3):185-190.
• Cipil HS, Kosar A, Kaya A, Uz B, Haznedaroglu IC, Goker H, et al. In vivo hemostatic effect of the medicinal plant extract Ankaferd Blood Stopper in rats pretreated with warfarin. Clin Appl Thromb Hemost. 2009;15(3):270-276.
• Teker AM, Korkut AY, Gedikli O, Kahya V. Prospective, controlled clinical trial of Ankaferd Blood Stopper in children undergoing tonsillectomy. Int J Pediatr Otorhinolaryngol. 2009;73(12):1742-1745.
• Teker AM, Korkut AY, Kahya V, Gedikli O. Prospective, randomized, controlled clinical trial of Ankaferd Blood Stopper in patients with acute anterior epistaxis. Eur Arch Otorhinolaryngol. 2010;267(9): 1377-13781.
• Kurt M, Dişibeyaz S, Akdoğan M, Saşmaz N, Aksu S, Haznedaroğlu İC. Endoscopic application of Ankaferd BloodStopper as a novel experimental treatment modality for upper gastrointestinal bleeding: A case report. Am J Gastroenterol 2008;103(8);2156-2158.
• Ibis M, Kurt M, Onal IK, Haznedaroglu IC. Successful management of bleeding due to solitary rectal ulcer via topical application of Ankaferd blood stopper. J Altern Complement Med. 2008;14(9):1073-1074.
• Kurt M, Oztas E, Kuran S, Onal IK, Kekilli M, Haznedaroglu IC. Tandem oral, rectal, and nasal administrations of Ankaferd Blood Stopper to control profuse bleeding leading to hemodynamic instability. Am J Emerg Med. 2009;27(5):631.e1-2.
• Dogan OF, Ozyurda U, Uymaz OK, Ercetin S, Haznedaroglu I. New anticoagulant agent for CABG surgery. 4th Clinical Vascular Biology Congress, Antalya, Turkey. 7-1 May 2008. (European Journal of Clinical Investigation 38: 341).
• Huri E, Akgül T, Ayyildiz A, Germiyanoğlu C. Hemostasis in retropubic radical prostatectomy with Ankaferd BloodStopper: a case report. Kaohsiung J Med Sci. 2009;25(8):445-447.
• Ozaslan E, Purnak T, Yildiz A, Akar T, Avcioglu U, Haznedaroglu IC. The effect of Ankaferd blood stopper on severe radiation colitis. Endoscopy. 2009;41 Suppl 2:E321-2.
• Ozaslan E, Purnak T, Yildiz A, Haznedaroglu IC. A new practical alternative for tumoral gastrointestinal bleeding: Ankaferd blood stopper. Dig Liver Dis. 2010;42(8):594-595.
• Tuncer I, Doganay L, Ozturk O. Instant control of fundal variceal bleeding with a folkloric medicinal plant extract: Ankaferd Blood Stopper. Gastrointest Endosc. 2010;71(4):873-875.
• Shorbagi A, Sivri B. Successful management of a difficult case of radiation proctopathy with Ankaferd BloodStopper: a novel indication (with video). Gastrointest Endosc. 2010;72(3):666-667.
• Karaman K, Bostanci EB, Ercan M, Kurt M, Teke Z, Reyhan E et al. Topical Ankaferd application to presacral bleeding due to total mesorectal excision in rectal carcinoma. J Invest Surg. 2010;23(3):175.
• Sonmez M, Baltacioğlu E, Sarac O, Erkut N. The use of Ankaferd blood stopper in a patient with Glanzmann's thrombasthenia with gingival bleeding. Blood Coagul Fibrinolysis. 2010;21(4):382-383.
• Yavaş Y, Yılmaz S. The effect of ankaferd hemostatic agent on the formation of postoperative seroma in rat radical mastectomy and axillary lymph node dissection model. Afyon Kocatepe University Medical Faculty, General Surgery Department. Specialty Thesis in Medicine (Thesis No:260395). 2009:1-70.