To describe the use of fibrin glue as a suture substitute for portions of glaucoma drainage device (GDD) surgery.
Retrospective non‐randomised case–control study reviewing 28 consecutive cases of GDD implantation using traditional suture material compared with 14 consecutive cases of GDD implantation using Tisseel fibrin glue (Baxter AG, Vienna, Austria) for portions of the procedure. The fibrin glue was used to close the conjunctiva, secure the pericardium patch graft and secure the tube to the sclera. Three‐month follow‐up data for each group as well as data on operating times, postoperative conjunctival inflammation, drugs used for glaucoma and intraocular pressure (IOP) were evaluated. Statistical analysis was carried out using analysis of variance.
The mean (SD) age of the patients in the suture group (17 men and 11 women) was 56.6 (10.5) years and that in the Tisseel‐assisted group (8 men and 6 women) was 54.7 (8.6) years (p = 0.56). No significant differences were observed in IOP levels at any time point between the two groups. No significant differences were found for the need for postoperative glaucoma drops or postoperative complication rates in both groups. Conjunctival inflammation was more pronounced in the suture group (p = 0.002) using a standard scale for comparison. The mean (SD) time of surgery was significantly less for the Tisseel‐assisted group, 15.0 (3.11) min, than for the suture group, 25.93 (4.04) min (p<0.001).
Tisseel fibrin glue seems to be a safe substitute for some of the sutures used in GDD surgery. Use of Tisseel seems to have no effect on IOP control or complications, whereas it considerably improved postoperative conjunctival inflammation and reduced time of surgery. Further studies are needed to better understand the role of fibrin glue in GDD implantation.
To evaluate and compare the efficacy and tolerance of fibrin glue and sutures for closing conjunctival wounds in strabismus surgery.
In a prospective trial, we performed strabismus surgery using limbal incisions. Conjunctival wounds were closed with fibrin glue in 20 eyes of 20 patients (fibrin group) and 8-0 polyglactin suture in 20 eyes of 20 patients (suture group). Postoperative pain, tearing, and inflammation were compared at 1 day, 1 week, 3 weeks, and 6 weeks after surgery. Conjunctival incision healing was also investigated.
One day and one week post-operatively, pain and tearing scores were lower in the fibrin group (p = 0.000, respectively). Mean surgery time was significantly shorter in the fibrin (48 ± 5 minutes) than the suture group (63 ± 7 minutes) (p = 0.000). Inflammation was significantly more severe in the suture group until 3 weeks postoperative (p = 0.000, respectively), but conjunctival healing did not differ between the groups. Hyperemia appeared more prominent in the fibrin group 3 and 6 weeks after surgery (p = 0.087 and 0.000, respectively). Two eyes in the fibrin group showed conjunctival gaps of more than 2 mm, which closed spontaneously by three weeks after surgery. No allergic reactions or infections developed.
Fibrin glue proved to be as effective as sutures in closing conjunctival wounds. It provides more comfortable early postoperative courses and might be considered as an alternative to sutures in strabismus surgery.
Conjunctival wound closure; Fibrin tissue adhesive; Polyglactin suture; Strabismus surgery
BMP-2 is known to accelerate fracture healing and might also enhance osseointegration and implant fixation. Application of recombinant BMP-2 has a time-limited effect. Therefore, a gene transfer approach with a steady production of BMP-2 appears to be attractive. The aim of this study was to examine the effect of locally applied BMP-2 plasmids on the bone-implant integration in a non-weight bearing rabbit tibia model using a comparatively new non-viral copolymer-protected gene vector (COPROG).
Sixty rabbits were divided into 4 groups. All of them received nailing of both tibiae. The verum group had the nails inserted with the COPROG vector and BMP-2 plasmids using fibrin glue as a carrier. Controls were a group with fibrin glue only and a blank group. After 28 and 56 days, these three groups were sacrificed and one tibia was randomly chosen for biomechanical testing, while the other tibia underwent histomorphometrical examination. In a fourth group, a reporter-gene was incorporated in the fibrin glue instead of the BMP-2 formula to prove that transfection was successful.
Implant fixation strength was significantly lower after 28 and 56 days in the verum group. Histomorphometry supported the findings after 28 days, showing less bone-implant contact.
In the fourth group, successful transfection could be confirmed by detection of the reporter-gene in 20 of 22 tibiae. But, also systemic reporter-gene expression was found in heterotopic locations, showing an undesired spreading of the locally applied gene formula.
Our results underline the transfecting capability of this vector and support the idea that BMP-2 might diminish osseointegration. Further studies are necessary to specify the exact mechanisms and the systemic effects.
BMP-2; gene transfer; non viral gene vector; COPROG; implant healing; fibrin glue
To compare the effect of using fibrin glue or 10-0 nylon sutures on the clinical outcome of patients undergoing pterygium excision and conjunctival autografting.
We retrospectively reviewed the medical records of 52 eyes from 46 patients who underwent pterygium excision and conjunctival autografting and were followed up for more than 3 months. The operation duration, postoperative inflammation, complications, and recurrence rates were compared between groups of 20 patients (22 eyes) for whom fibrin glue was used (fibrin glue group) and 26 patients (30 eyes) for whom suturing was performed with 10-0 nylon (suture group) in pterygium excision and conjunctival autografting.
The operation duration was 27.71 (5.22) minutes in the fibrin glue group and 43.30 (8.18) minutes in the suture group (p = 0.000). Seven days after the operation, the fibrin glue group showed milder conjunctival inflammation than the suture group (p = 0.000). Postoperative complications and corneal recurrence rates were not statistically different between the two groups.
The use of fibrin glue in pterygium excision with conjunctival autografting is likely to be a more effective, safer procedure than suturing.
Conjunctival autograft; Fibrin glue; Pterygium excision
This randomized prospective study investigated the effect of fibrin glue use on drainage duration and overall drain output after lumpectomy and axillary dissection in breast cancer patients. A total of 100 patients undergoing breast lumpectomy and axillary dissection were randomized to a fibrin glue group (N=50; glue sprayed onto the axillary dissection site) or a control group (N=50). Outcome measures were drainage duration, overall drain output, and incidence of seroma. Overall, the fibrin glue and control groups were similar in terms of drainage duration, overall drain output, and incidence of seroma. However, subgroup analysis showed that fibrin glue use resulted in a shorter drainage duration (3.5 vs. 4.7 days; p=0.0006) and overall drain output (196 vs. 278 mL; p=0.0255) in patients undergoing level II or III axillary dissection. Fibrin glue use reduced drainage duration and overall drain output in breast cancer patients undergoing a lumpectomy and level II or III axillary dissection.
Fibrin Tissue Adhesive; Axillary Lymph Node Excision; Lymphatic Drainage; Breast Neoplasms
The EOMs are particularly adaptive to changes induced by recession and tenotomy surgery, responding with modulations in fiber remodeling and myosin expression and also with changes in antagonist and contralateral muscles. These results suggest the possibility that these processes are manipulated immediately after surgery to improve surgical success rates.
Surgical recession of an extraocular muscle (EOM) posterior to its original insertion is a common form of strabismus surgery, weakening the rotational force exerted by the muscle on the globe and improving eye alignment. The purpose of this study was to assess myosin heavy chain (MyHC) isoform expression and satellite cell activity as defined by Pax7 expression in recessed EOMs of adult rabbits compared with that in muscles tenotomized but not recessed and with that in normal control muscles.
The scleral insertion of the superior rectus muscle was detached and sutured either 7 mm posterior to its original insertion site (recession surgery) or at the same site (tenotomy). One day before euthanatization, the rabbits received bromodeoxyuridine (BrdU) injections. After 7 and 14 days, selected EOMs from both orbits were examined for changes in fast, slow, neonatal, and developmental MyHC isoform expression, Pax7 expression, and BrdU incorporation.
Recession and tenotomy surgery resulted in similar changes in the surgical EOMs. These included a decreased proportion of fast MyHC myofibers, an increased proportion of slow MyHC myofibers, and increased BrdU-positive satellite cells. Similar changes were seen in the non-operated contralateral superior rectus muscles. The ipsilateral inferior rectus showed reciprocal changes to the surgical superior rectus muscles.
The EOMs are extremely adaptive to changes induced by recession and tenotomy surgery, responding with modulations in fiber remodeling and myosin expression. These adaptive responses could be manipulated to improve surgical success rates.
To evaluate the efficacy and biotolerance of the Adal‐1 adhesive for muscle sealing in strabismus surgery.
27 eyes were included in the study: 17 in the control group and 10 in the study group. Surgery was performed on the recession of the horizontal rectus muscles. In the control group the muscle was joined to the sclera by a Vicryl 7/0 suture. In the study group, the Adal‐1 adhesive was used instead. The efficacy of the sealing of the muscle to the sclera and the biotolerance of the surrounding tissues were evaluated.
The muscular recession in the control group was 8.17 (SD 2.38) with displacement of the sealing point of 0.02 (1.7) mm. In the group sealed with adhesive, the muscular recession was 9.09 (3.08) and the displacement was 0.15 (1.56) mm, with no significant differences between the techniques (p<0.05). The inflammation of the surrounding tissues in the immediate postoperative period was greater with the suture technique (p>0.05), but there were no differences in the other postoperative periods (Mann‐Whitney U test).
Adal‐1 was an effective and safe alternative to sutures in muscle recession for strabismus surgery in this study.
bioadhesives; muscle sealing; strabismus surgery
Axillary lymphadenectomy or sentinel biopsy is integral part of breast cancer treatment, yet seroma formation occurs in 15-85% of cases. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies with controversial results.
Thirty patients over 60 years underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray were applied to the axillary fossa in 15 patients; the other 15 patients were treated with harmonic scalpel.
Suction drainage was removed between post-operative Days 3 and 4. Seroma magnitude and duration were not significant in patients receiving fibrin glue compared with the harmonic scalpel group.
Use of fibrin glue does not always prevent seroma formation, but can reduce seroma magnitude, duration and necessary evacuative punctures.
To investigate the effect of surgery type on the postoperative astigmatism in pterygium surgery.
Settings and Design:
Retrospective comparative clinical trial.
Materials and Methods:
Data of 240 eyes that underwent pterygium excision were investigated. Following removal of the pterygium, patients underwent 5 different types of surgeries: Conjunctival autograft with sutures (CAG-s) or fibrin glue (CAG-g), conjunctival rotational flap (CRF), or amniotic membrane transplantation with either suture (AMT-s) or with glue (AMT-g). The preoperative and postoperative keratometric measurements, evaluated using an automated keratorefractometer, were noted.
The overall changes in BCVA and astigmatic degree were evaluated using Wilcoxon signed rank test. The difference in astigmatic values between groups was calculated using one way analysis of variance (ANOVA).
The most commonly performed procedure was CAG-s (N = 115), followed by CAG-g (N = 53), CRF (N = 47), AMT-s (N = 15), and AMT-g (N = 10). Following surgery, astigmatic values decreased from 3.47 ± 2.50 D to 1.29 ± 1.07 D (P < 0.001, paired t test). The changes in astigmatism was significantly related to the preoperative size of the pterygium (ρ = 3.464, P = 0.005). The postoperative astigmatism correlated with preoperative astigmatism (ρ = 0.351, P < 0.001, Spearman correlation analysis). The changes in astigmatic values was not related to the method of surgery (P = 0.055, ANOVA).
Pterygium results in high corneal astigmatism, which decreases to an acceptable level following excision. According to our study, the type of grafting as CAG, CRF or AMT or the use of suture or glue to fixate the graft does not have a significant effect on the change in astigmatism degree.
Amniotic membrane; astigmatism; autografting; fibrin tissue adhesive; pterygium; sutures
AIMS/BACKGROUND: In the course of adjustable strabismus surgery there is only a limited period after surgery before the formation of firm adhesions prevents successful adjustment. To determine if this period could be increased by the interposition of suitable physical barriers, the use of Interceed and polyglactin 910 mesh was investigated in an animal model. METHODS: A total of 39 rabbit eyes were divided into three groups. After recession of the superior rectus muscle (SRM), balanced salt solution was applied to the control group between the free muscle end and the sclera; in each of the two experimental groups, Interceed and polyglactin 910 mesh were applied. Delayed adjustment was performed once on each SRM at 1, 2, or 3 weeks postoperatively. The length and force of the adjustment, the degree of adhesions, and the degree of fibrous proliferation were recorded. RESULTS: Adjustment was not possible in any of the eyes in the control group. At 1 week postoperatively, adjustment was possible in four out of five eyes with Interceed and in three out of five eyes with polyglactin 910 mesh as a physical barrier. CONCLUSIONS: Interceed may be clinically useful in delaying the timing of adjustment up to 1 week. Further study of the use of other materials could be carried out to see if it was possible to delay the timing of adjustment for more than 1 week.
Some authors have suggested that a posterior fixation suture on the lateral rectus muscle is ineffective, due to the muscle's long arc of contact with the globe. We report a small case series of patients successfully treated using a lateral rectus posterior fixation suture.
The surgical database of one surgeon (JMH) was reviewed for all cases undergoing lateral rectus posterior fixation surgery for mechanical or paretic strabismus. In all cases, the lateral rectus muscle was disinserted from the sclera and a Mersilene posterior fixation suture was placed 17 mm to 19 mm back from the insertion. The lateral rectus muscle was simultaneously recessed in all cases using a novel approach to allow adjustment of the recession if needed, while maintaining the posterior fixation suture. Outcome was assessed at least one year following surgery.
Three patients were identified. Adduction deficit of the affected eye was caused by previous sinus surgery in two cases and scleral buckle surgery in one case. The lateral rectus posterior fixation suture on the unaffected eye induced the planned matching −1 limitation of abduction, with resulting improvement in incomitance of the exotropia and reduced angle of exodeviation on prism cover testing.
In this case series, a lateral rectus posterior fixation suture was useful in addressing incomitant exodeviations. It is unknown whether this technique is superior to alternative surgical approaches.
New sphincter-saving approaches have been applied in the treatment of perianal fistula in order to avoid the risk of fecal incontinence. Among them, the fibrin glue technique is popular because of its simplicity and repeatability. The aim of this review is to compare the fibrin glue application to surgery alone, considering the healing and complication rates.
We performed a systematic review searching for published randomized and controlled clinical trials without any language restriction by using electronic databases. All these studies were assessed as to whether they compared conventional surgical treatment versus fibrin glue treatment in patients with anal fistulas, in order to establish both the efficacy and safety of each treatment. We used Review Manager 5 to conduct the review.
The healing rate is higher in those patients who underwent the conventional surgical treatment (P = 0,68), although the treatment with fibrin glue gives no evidence of anal incontinence (P = 0,08). Furthermore two subgroup analyses were performed: fibrin glue in combination with intra-adhesive antibiotics versus fibrin glue alone and anal fistula plug versus fibrin glue. In the first subgroup there were not differences in healing (P = 0,65). Whereas in the second subgroup analysis the healing rate is statistically significant for the patients who underwent the anal fistula plug treatment instead of the fibrin glue treatment (P = 0,02).
In literature there are only two randomized controlled trials comparing the conventional surgical management versus the fibrin glue treatment in patients with anal fistulas. Although from our statistical analysis we cannot find any statistically significant result, the healing rate remains higher in patients who underwent the conventional surgical treatment (P = 0,68), and the anal incontinence rate is very low in the fibrin glue treatment group (P = 0,08). Anyway the limited collected data do not support the use of fibrin glue. Moreover, in our subgroup analysis the use of fibrin glue in combination with intra-adhesive antibiotics does not improve the healing rate (P = 0.65), whereas the anal fistula plug treatment compared to the fibrin glue treatment shows good results (P = 0,02), although the poor number of patients treated does not lead to any statistically evident conclusion. This systematic review underlines the need of new RCTs upon this issue.
To investigate whether a collagen fleece kept in place by fibrin glue might seal off a colorectal anastomosis, provide reinforcement, and subsequently improve anastomotic healing.
Wistar rats underwent a 1-cm left-sided colonic resection followed by a 4-suture end-to-end anastomosis. They were then randomly assigned to one of three treatment groups: no additional intervention (control, n = 20), the anastomosis covered with fibrin glue (fibrin glue, n = 20), the anastomosis covered with a collagen fleece, kept in place with fibrin glue (collagen fleece, n = 21). At either 3 or 7 days follow-up, anastomotic bursting pressure was measured and tissue was obtained for histology and collagen content assessment after which animals were sacrificed.
Three rats in the control (15%), three in the fibrin glue (15%), and one in the collagen group (4.8%) died due to anastomotic complications (P = 0.497). Anastomotic bursting pressures were not significantly different between groups at 3 and 7 days follow-up (P = 0.659 and P = 0.427, respectively). However, bowel obstructions occurred significantly more often in the collagen group compared to the control group (14/21 vs. 3/20, P = 0.003). Collagen contents were not different between groups, but histology showed a more severe inflammation in the collagen group compared to the other groups at both 3 and 7 days follow-up.
A collagen fleece kept in place by fibrin glue does not improve healing of colonic anastomoses in rats. Moreover, this technique induces significantly more bowel obstructions in rats, warranting further study before being translated to a clinical setting.
Anastomotic dehiscence; Rat; Fibrin glue; Collagen fleece; Bursting pressure
Backgrounds and aim
In recent decades, fibrin glue has appeared as an alternative treatment for high perianal fistulas. Early results seemed promising, with high success rates being reported. However, with increasing follow-up, the enthusiasm was tempered because of disappointing results. The aim of this retrospective study was to assess the additional value of fibrin glue in combination with transanal advancement flap, compared to advancement flap alone, for the treatment of high transsphincteric fistulas of cryptoglandular origin.
Materials and methods
Between January 1995 and January 2006, 127 patients were operated for high perianal fistulas with an advancement flap. After exclusion of patients with inflammatory bowel disease or HIV, 80 patients remained. A consecutive series of 26 patients had an advancement flap combined with obliteration of the fistula tract with fibrin glue. Patients were matched for prior fistula surgery, and the advancement was performed identically in all patients. In the fibrin glue group, glue was installed retrogradely in the fistula tract after the advancement was completed and the fistula tract had been curetted.
Minimal follow-up after surgery was 13 months [median of 67 months (range, 13–127)]. The overall recurrence rate was 26% (n = 21). Recurrence rates for advancement flap alone vs the combination with glue were 13% vs 56% (p = 0.014) in the group without previous fistula surgery and 23% vs 41% (p = 0.216) in the group with previous fistula surgery.
Obliterating the fistula tract with fibrin glue was associated with worse outcome after rectal advancement flap for high perianal fistulas.
Rectal fistula; Surgery; Recurrence; Fibrin glue; Advancement
To determine if exogenously injected bone marrow derived platelet-rich plasma (PRP) plus bone morphogenetic protein (BMP)-2 could accelerate the healing of bone-tendon junction injuries and increase the junction holding strength during the early regeneration period.
A direct injury model of the bone-tendon junction was made using an Achilles tendon-calcaneus bone junction in a rabbit. In the PRP/BMP-2/fibrin group, 0.05 mL of bone marrow derived PRP and 100 ng/mL of BMP-2 both incorporated into 0.1 mL of fibrin glue were injected into Achilles tendon-calcaneus bone junctions. The effect of the intervention was tested by comparing the results of an intervention group to a control group. The results of biomechanical testing, and histological and gross analyses were compared between the 2 groups at the following time points after surgery: 2 weeks, 4 weeks, and 8 weeks.
Histologic examinations showed that woven bone developed in tendon-bone junctions at 2 weeks after surgery in the PRP/BMP-2/fibrin group. Mechanical test results showed no significant difference between the PRP/BMP-2/fibrin and control groups at 2 and 4 weeks after surgery, but the mean maximal load in the PRP/BMP-2/fibrin group was significantly higher than in the control group (p < 0.05) at 8 weeks after surgery.
Bone marrow derived PRP and BMP-2 in fibrin glue accelerated healing in a rabbit model of tendon-bone junction injury.
Bone-tendon junction; Achilles tendon; Bone marrow derived platelet rich plasma; Bone morphogenetic protein
Protecting the anastomotic integrity using suture or staple line reinforcement remains an important goal for ongoing research. The present comprehensive study aims to establish the effects of fibrin glue on the early phase of anastomotic healing in the rat intestine.
One hundred and eight young adult male Wistar rats underwent resection and anastomosis of both the ileum and colon. In half, fibrin glue was applied around the anastomoses. Parameters for repair included wound strength, both bursting pressure and breaking strength at days 1, 3, and 5 after operation; hydroxyproline content; and histology, the latter also after 7 days.
A transient colonic ileus was observed in the experimental group. Anastomotic breaking strength was always similar in both the control and fibrin glue groups. Anastomotic bursting pressures remained low at days 1 and 3, without any differences between the groups. In both groups, the bursting pressure increased sharply (p < 0.001) between days 3 and 5. At day 5, the bursting pressure in the fibrin glue group remained below than that in the controls, although only significantly (p = 0.0138) so in the ileum. At day 5, but not at day 7, the wounds in the fibrin glue group contained less collagen. Other aspects of microscopic wound architecture appeared to be the same.
There is no justification for using fibrin glue on patent anastomoses constructed under low-risk conditions. Its potential benefit under conditions where chances for anastomotic leakage are enhanced needs further investigation.
Anastomoses; Intestine; Fibrin glue; Rat; Seal
One of the limitations of many bridging
experiments in neural transplantation is that the
CNS tissues cannot be sutured. Fibrin glue is a
two-component system derived from whole
blood which, when mixed, reproduces the final
stage of blood coagulation and solidifies. Many
experimental studies of humans and animals
show that fibrin glue repair of peripheral nerves
is almost equivalent to microsurgical sutures. In
this study, we attempted to extend its use to
CNS tissues and transplants. Two techniques
were tried: (1) Bilateral parietal knife cuts were
performed by stereotaxic technique in six rats.
Fibrin glue was applied in the right-side cortical
lesion. Immunohistochemistry using antisera to
tyrosine hydroxylase (TH), glial fibrillary acidic
protein (GFAP), laminin and neurofilament
(NF) was essentially similar between the control
and treatment groups. The immunoreactivity of
each marker revealed no significant differences
between the two groups on days 1, 7 and 30.
There was no difference in terms of gliosis or
microvascular proliferation. (2) Embryonic day
16 fetal locus coeruleus was grafted together
with E16 cortex to the anterior chamber of sympathectomized
eyes. In the six eyes of the glue
treatment group, the parietal cortical piece and
the locus coeruleus piece were joined together
before grafting by immersing them in the
solution of fibrin glue. In the eight eyes of the
control group, pieces of parietal cortex and locus
coeruleus were introduced individually and approximated
by gently pressing the cornea. The
sizes of double grafts showed no significant
difference between groups during six weeks
postgrafting. The immunohistochemical pictures
using antisera against TH, GFAP and laminin
were similar in both groups. Catecholaminergic
fibers from the grafted locus coeruleus were
found bridging over into the parietal cortical
piece in both the control and treatment groups.
There was no significant difference in TH-positive
nerve fiber density between tissue glue joined
and control double intraocular grafts. In
conclusion, fibrin glue can be used as an adhesive
agent in CNS tissues without hampering
the outgrowth of neurites or causing adverse
tissue reactions in fetal or adult nervous tissues.
Background and objectives: The purposes of this study were to demonstrate that laser soldering is safe and effective for tissue bonding in dural reconstruction and to compare this new reconstruction technique to an established one. Study design: A temperature-controlled fiberoptic CO2 laser system or fibrin glue were used for in vitro dural defect reconstruction in two groups of pigs. The CO2 laser technique was also used for dural reconstruction in live pigs. Results: The burst pressure of the reconstructed dura by the laser system was significantly higher than that of fibrin glue (mean pressure 258.5 ± 117.3 cm H2O and 76.8 ± 47.2 cm H2O, respectively). There were no postoperative complications and no signs of thermal damage to the dura, fascia, or underlying tissue on histological analysis following the in vivo CO2 laser experiments. Conclusions: Temperature-controlled laser soldering is an effective technique for dural repair. It creates a strong tissue bonding with no thermal damage to the tissue. The burst pressure of the reconstructed dura done with laser soldering is significantly higher than that of fibrin glue.
Anterior skull base; reconstruction; dura; CO2
To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft.
A prospective randomised clinical trial was carried out in 58 eyes of 58 patients operated for primary nasal pterygium. Autologous conjunctival graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision. In 29 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive (Beriplast P) and in 29 eyes with 8-0 Virgin silk sutures. The Mann-Whitney U test was used for statistical analysis. Postoperative patient discomfort (pain, stinging, watering) and biomicroscopic findings (hyperemia, edema) were graded. Patients were followed up at least for six months.
Subconjunctival hemorrhage occured under the graft in one patient in group 1. In seven cases of group 2, sutures were removed at the 15th day because of granulomatous tissue reaction. Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in one case of group 1, and 2 cases of group 2. Average surgery cost was higher (P<0.05) and surgery time was shorter (P<0.05) in fibrin group.
Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.
fibrin glue; limbal autograft; pterygium surgery
Polyethylene glycol (PEG) hydrogel is a biocompatible semi-adherent gel like substance that can potentially augment nerve repair much like a fibrin sealant. Potential advantages of this substance include fast preparation and set up time, as well as adhesion inhibiting properties. The purpose of this study was to perform an initial evaluation of PEG hydrogel in this application.
The sciatic nerves of 29 rats were transected and repaired using two 10-0 nylon sutures and either PEG hydrogel or fibrin glue. After 10 weeks, contraction forces of the reinnervated muscles were evaluated and histological assessment of scar tissue performed.
Muscle strength testing revealed the average ratio of experimental to control sides for the fibrin glue group was 0.75 and for the PEG hydrogel group was 0.72 (no significant difference). Longitudinal sections through the nerve repair site showed no significant difference in nerve diameter but did demonstrate a significant reduction in scar thickness in the PEG hydrogel group (p < 0.01).
Though further study is necessary to fully evaluate, PEG hydrogel results in less scar tissue formation and equivalent muscle recovery as fibrin sealant when applied as a nerve glue in a rodent sciatic nerve repair model.
An artificial dermal matrix such as Integra (Integra Life Sciences Corporation, USA) provides a wound bed template for vascular and fibrocyte ingrowth as well as collagen remodelling. Dermal repair leads to epidermal and basement membrane regeneration. Burn wounds in particular have been shown to benefit from Integra by enhanced wound healing.
To evaluate the effect of fibrin glue to modify the integration of Integra in large excised cutaneous wounds. It was hypothesized that applying fibrin glue on a wound bed would reduce the time needed for matrix vascularization and incorporation of Integra and take of the cultured keratinocytes.
Four separate full-thickness wounds were created on the dorsum of two swine. Wound beds were randomly assigned to either application of fibrin glue or no application of fibrin glue before application of Integra. Full-thickness biopsies were performed at days 7, 14, 21, 29 and 35. On day 21, keratinocytes were applied either as sheets or aerosolized fibrin glue suspension.
Histological analysis revealed a wave of inflammatory cells and early granulation tissue ingrowth into the Integra from the fascia below on day 7. Only this initial phase was augmented by application of fibrin glue to the wound bed. By day 14, most and by day 21, all of the Integra thickness was incorporated. Accelerated dermal repair proceeded from the base with new collagen deposition in Integra spaces. There was no evidence of keratinocyte engraftment, although re-epithelialization occurred at wound edges extending onto the incorporated Integra.
It appears there is an acceleration of early phase (day 7 to day 21) dermal incorporation with fibrin glue application to the wound bed, perhaps secondary to increased cellular migration. Day 21 appears to be too early to apply cultured keratinocytes either as sheets or aerosolized suspension.
Burns; Fibrin glue; Integra; Keratinocytes; Neodermis, Skin replacement; Tissue Engineering
Rectourethral fistulas (RUFs) in adults are rare and could result from complicated trauma, and prostatic or rectal surgery. RUFs have been treated initially by using primary repair and omental interposition with or without a colostomy during surgery. Recurrent RUFs require complex surgery, such as a low rectal resection and coloanal anastomosis, an interposition flap of the datos muscle or gracilis muscle, and others. Recently, transanal rectal flap advancement and fibrin glue injection have provided an effective occlusion of RUFs. However, no reports about this technique exist for cases of recurrent RUFs. We report a case of a recurrent RUF successfully repaired by using transanal rectal flap advancement combined with fibrin glue injection into the fistula tract. The postoperative course was uneventful without complications. At the 1-year follow-up, no complications such as urethral stricture or recurrence existed, and voiding was normal without anal incontinence.
Rectourethral fistula; Transanal rectal flap advancement; Fibrin glue
Suturing is a time consuming task in ophthalmology and suture induced irritation and redness are frequent problems. Postoperative wound infection and corneal graft rejection are examples of possible suture related complications. To prevent these complications, ophthalmic surgeons are switching to sutureless surgery. A number of recent developments have established tissue adhesives like cyanoacrylate glue and fibrin glue as attractive alternatives to sutures. A possible and promising new application for tissue adhesives is to provide a platform for tissue engineering. Currently, tissue glue is being used for conjunctival closure following pterygium and strabismus surgery, forniceal reconstruction surgery, amniotic membrane transplantation, lamellar corneal grafting, closure of corneal perforations and descematoceles, management of conjunctival wound leaks after trabeculectomy, lid surgery, adnexal surgery and as a hemostat to minimise bleeding. The purpose of this review is to discuss the currently available information on fibrin glue.
Blepharoplasty; cyanoacrylate glue; fibrin glue; fibrinogen; pterygium; stem cells; thrombin
Fibrin glue created from a patient's own blood can be used as a carrier to deliver cells to the specific site of an injury. An experimental model for optimizing various permutations of this delivery system in vivo was tested in this study. Harvested equine meniscal sections were reapposed with fibrin glue or fibrin glue and equine bone marrow-derived mesenchymal stem cells (BMSCs). These constructs were then implanted subcutaneously in nude mice. After harvesting of the constructs, BMSC containing constructs showed significantly increased vascularization, and histology showed subjectively decreased thickness of repair tissue and increased total bonding compared to fibrin alone constructs. This model allowed direct comparison of different meniscal treatment groups while using a small number of animals. This in vivo model could be valuable in the future to optimize fibrin and cellular treatments for meniscal lesions in the horse and potentially humans as well.
Aim: To determine the effect of polyurethane film with sustained release dexamethasone (SRD) in delayed adjustable strabismus surgery.
Methods: A prospective, masked observer, controlled study was performed in rabbits. Thirty four rabbit eyes were divided into three groups. After recession of the superior rectus muscle (SRM), polyurethane film with or without SRD, or balanced salt solution was applied beneath and over SRM in the polyurethane-dexamethasone group (group P-D), polyurethane group (group P), and the control group (group C), respectively. Delayed adjustment was performed once on each SRM at 4 and 6 weeks postoperatively by a masked observer. The possible length to adjust and the necessary force required for the adjustment, as well as the degree of any adhesions, were also evaluated.
Results: In the control group, adjustment was impossible in all of the eyes at 4 and 6 weeks postoperatively. In group P-D, adjustment was possible in 11 out of 11 eyes (11/11) 4 weeks postoperatively and in 10/11 eyes 6 weeks postoperatively. In group P, adjustment was possible in 9/11 eyes 4 weeks postoperatively and in 10/12 eyes 6 weeks postoperatively.
Conclusions: Use of polyurethane film with and without SRD could delay adjustment in most eyes for up to 6 weeks postoperatively. Polyurethane is helpful for delaying adjustment in rabbit eyes until 6 weeks postoperatively without the need for frequent topical instillation of steroids.
polyurethane; dexamethasone; strabismus; surgery; rabbits