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PubMed1997

Comparison of the bonding power of various autologous fibrin tissue adhesives.

OBJECTIVE: Three known autologous fibrin tissue adhesives were evaluated for bonding power on Silastic and animal and human tissues. These adhesives were also injected into living tissue to determine if any of these fibrin glues cause inflammatory or deleterious reactions when kept in living tissue for a sustained period. METHODS: In Part I of our study, blood was drawn from 59 healthy volunteers, and autologous fibrin tissue adhesives were manufactured using the cryoprecipitation (AFTA-C), ammonium sulfate (AFTA-A), and ethanol/freezing (AFTA-E) methods. Blocks were then prepared using Silastic, porcine dermis, and human dura mater and bonded together for 10 or 30 minutes using the three adhesives. The blocks were then separated while bonding power was measured. In Part II of our study, 0.01 mL AFTA-C, AFTA-A, or AFTA-E was injected subcutaneously into the auricles of 60 rats. The rats were then killed 3, 7, 14, or 21 days later, and the auricles were examined histologically for signs of toxicity. RESULTS: The bonding powers of AFTA-E and AFTA-C were found to be statistically similar, and both were statistically stronger than AFTA-A. The injection of AFTA-A, AFTA-E, and AFTA-C into rat auricles did not cause any adverse effects. CONCLUSIONS: All three methods for manufacturing AFTA are effective in producing a reliable, stable fibrin glue. However, AFTA-E and AFTA-C demonstrate stronger bonding power than AFTA-A. In addition, all three forms of AFTA produce no undesirable tissue changes when injected into rat auricles.

Animals↗
PubMed1999

Repair of fistulas-in-ano using autologous fibrin tissue adhesive.

PURPOSE: Our goal was to determine if autologous fibrin tissue adhesive derived from the precipitation of fibrinogen using a combination of ethanol and freezing, could be used to completely close both simple and complex fistulas-in-ano. METHODS: A 26-patient pilot study was performed in which 100 ml of a patient's blood was drawn 90 minutes before surgery. Autologous fibrin tissue adhesive was prepared. In the operating room the patient underwent an examination under anesthesia, and the primary and secondary fistula tract openings were attempted to be identified. The fistula tract was curetted, and autologous fibrin tissue adhesive was injected into the secondary fistula tract opening until fibrin glue was seen coming from the primary opening. A petroleum jelly gauze was then applied over the secondary opening, and the patient was sent home. Follow-up visits were scheduled for one week, one month, three months, and one year later. RESULTS: Twenty-six patients received autologous fibrin tissue adhesive fistula injections, with a mean follow-up of 3.5 months. Initial results were encouraging. Twenty-one of 26 patients (81 percent) had successful initial closure of their fistulas. Two of five failures were injected a second time, and one closed, giving an overall successful closure rate of 85 percent (22/26 patients). Of five patients who failed, mean time to failure was 3.8 weeks. In addition, there was no evidence of infection or complications related to the procedure. CONCLUSION: Our initial results are optimistic and require further support through longer follow-up data. Fibrin glue treatment of anorectal fistulas offers a unique mode of management that is safe, simple, and easy for the surgeon to perform. By using autologous fibrin tissue adhesive the patient avoids the risk of anal incontinence and the discomfort of prolonged wound healing which may be associated with fistulotomy.

Adult↗
PubMed1997

Octylcyanoacrylate tissue adhesive versus suture wound repair in a contaminated wound model.

BACKGROUND: Octylcyanoacrylate tissue adhesive is a topical wound closure that precludes the need for foreign bodies (sutures) to close wounds. It also has an in vitro antimicrobial effect when standard disc sensitivity tests are used. METHODS: To determine whether contaminated wounds closed with octylcyanoacrylate tissue adhesive will have a lower infection rate compared with wounds closed with 5-0 monofilament sutures, we designed a randomized, blinded, experimental animal study. Two incisions were made on 20 albino guinea pigs. The wounds were contaminated with 10(5) Staphylococcus aureus ATCC 12600 and randomly assigned to be closed with either topical octylcyanoacrylate tissue adhesive or percutaneous 5-0 polypropylene suture. Five days later the adhesive and sutures were removed, and a section of the wound was given to a histopathologist blinded to the type of wound closure. The wound was determined to be infected if inflammatory cells with intracellular cocci were seen. The rest of the wound was opened and examined for clinical evidence of infection. Quantitative bacteriologic analysis was performed. RESULTS: Five wounds in the tissue adhesive group were sterile on day 5, whereas all sutured wounds had positive cultures (25% versus 0%, p < 0.05). Fewer wounds in the tissue adhesive group were determined to be infected by histologic and clinical criteria (0% versus 55%, p < 0.001, and 20% versus 65%, p < 0.01, respectively). Agreement on the determination of infection by histologic and clinical criteria yielded a kappa coefficient of 0.46 (95% confidence interval [GI], 0.19 to 0.73). An infection criterion of 10(5) colony-forming units/gm of tissue correlated poorly with clinical and histologic infection rates (0.19 [95% CI, -0.06 to 0.44] and 0.13 [95% CI, -0.05 to 0.31], respectively). CONCLUSIONS: Contaminated wounds closed with sutures had higher infection rates compared with those reported with topical tissue adhesive. The amount of colonization may not be an accurate method to determine infection.

Animals↗
PubMed2002

A randomised, controlled trial comparing a tissue adhesive (2-octylcyanoacrylate) with adhesive strips (Steristrips) for paediatric laceration repair.

OBJECTIVE: To compare the tissue adhesive 2-octylcyanoacrylate (Dermabond) with adhesive strips, Steristrips in paediatric laceration repair. METHOD: Children with suitable lacerations were randomly allocated for wound closure with either a tissue adhesive or adhesive strips. Thirty children were treated in each group. Linear Visual Analogue Scores were used to judge parents' and nurses' opinions of the application of each treatment. A similar scoring system was used to judge the cosmetic outcome as viewed by parents and a plastic surgeon. Complications and trial failures were noted. RESULTS: Complete data were available for 44 of the children. Parents viewed the treatments as equally acceptable. In contrast those performing the procedure judged the tissue adhesive more difficult to apply. Scores of cosmetic outcome by both parents and the plastic surgeon showed no significant difference in the treatment method used. There were four children in the tissue adhesive group and one from the adhesive strip group in whom the wounds were unable to be closed. CONCLUSION: Both tissue adhesives and adhesive strips are excellent "no needle" alternatives for the closure of suitable paediatric lacerations. This study suggests that the techniques are similar in efficacy, parental acceptability, and cosmetic outcome. The choice as to which is used may come down to economics and operator preference.

Child↗
PubMed1991

Effect of tissue adhesives and suture patterns on experimentally induced teat lacerations in lactating dairy cattle.

Tissue adhesives and suture materials were evaluated for repair of experimentally induced teat lacerations in 6 lactating dairy cows. Group-1 teat lacerations were not closed and served as nonsutured controls. Group-2 lacerations were closed in three layers (mucosa, submucosa, and skin) by use of 3-0 polydioxanone. Group-3 lacerations were closed by use of N-butyl cyanoacrylate monomer tissue adhesive. Group-4 lacerations were closed by use of a combination of sutures and tissue adhesive. All cows were milked by machine. Healing was observed for 28 days, then cows were slaughtered, and teats were recovered for further study. Evaluation revealed failure of healing of all layers with formation of large fistulas in 3 of 4 nonsutured control teats in group 1. All 6 teat lacerations in groups 2 and 3 healed satisfactorily with no fistulas. Five of 6 teats in group 4 had partial healing of skin and mucosa with no fistulas, and 1 teat failed to heal and developed a small fistula. Data indicated that closure of experimentally induced teat lacerations with three layers of fine absorbable suture or closure with tissue adhesive alone gave good results and satisfactory healing of all layers. However, when sutures and tissue adhesive were used together, foreign body reaction was marked, and the skin and submucosa healed only partially. Sutures appeared to entrap the tissue adhesive, resulting in a foreign body reaction.

Animals↗
PubMed1988

Fibrinogen prepared from small blood samples for autologous use in a tissue adhesive system.

The two-component tissue adhesive system where the one component is a concentrated human fibrinogen solution and the other component is a thrombin solution containing Ca2+ is becoming increasingly important in surgery. In the commercially available tissue adhesive, the fibrinogen is separated from pooled plasma. The risk of transmitting foreign immunogens and viruses, always present when foreign biological materials are used, will be eliminated if the fibrinogen is separated from the patient's own blood. A method using ethanol precipitation is described for preparing a concentrated fibrinogen solution from plasma separated from small amounts of blood. The method is fast, the final product can be obtained within 30-60 min after collection of the blood. The recovery is compared with the recovery obtained by separating the fibrinogen with ammonium sulfate precipitation and with cryoprecipitation. The method using ethanol is by far the most profitable, and the product is evaluated by experimental liver surgery in pigs.

Animals↗
PubMedDate not supplied

The role of fibrin tissue adhesives in flap necrosis in rats.

Flap necrosis is an important issue in surgery, and fibrin tissue adhesives, due to beneficial properties in preventing flap necrosis, were used in this study. Two groups, each comprising of 10 rats, were formed. Group I served as a control group, and fibrin tissue adhesive was applied to group II. The fibrinogen and thrombin concentrations in fibrin tissue adhesive were 30 mg/ml and 10 U/ml, respectively. The mean area of flap necrosis was 687.5 +/- 72.5 mm2 and 78.5 +/- 11.0 mm2 in the control and fibrin tissue adhesive groups (p < .0001), respectively. The percentage of flap necrosis was significantly lower in the fibrin tissue adhesive group compared to the control group (5.6% vs 49.1%) (p < .0001). Fibrin tissue adhesives decreased flap necrosis significantly compared to the control group.

Animals↗
PubMed1983

Tissue adhesive therapy for corneal perforations.

The current indications for and method of application of tissue adhesive are described. A method for an expanded utilisation of tissue adhesive is discussed. To study the effect of the introduction of tissue adhesive to The Wilmer Institute in 1974, the records of 104 consecutive non-traumatic corneal perforations or descemetoceles admitted to The Wilmer Institute from 1960 to 1980 were assessed retrospectively with follow-up being obtained from records or from referral physicians for 87 of these perforations. Forty-nine percent of the cases were caused by bacterial corneal ulcers, 13% by exposure, 12% by chemical burns, 6% by fungal keratitis, 5% by herpes simplex keratitis, and 15% were undiagnosed. Since the introduction of tissue adhesive in 1974, there has been an apparent trend towards a lower enucleation rate (6%) in the tissue adhesive treated group compared with 19% in perforations treated by other therapies.

Adolescent↗
PubMed2000

Preliminary experience with twenty perineal repairs using Indermil tissue adhesive.

OBJECTIVE: To assess the use of Indermil tissue adhesive for perineal repair. SETTING: Leeds General Infirmary, a teaching hospital with 4500 deliveries annually. METHOD: Over a period of five months, 20 women who sustained either a second degree tear or who had an episiotomy at vaginal delivery had their perineal skin repaired with Indermil tissue adhesive. They were followed up prior to discharge and then by telephone once discharged. RESULTS: Ten repairs followed normal vaginal deliveries, six were after ventouse deliveries, three after midcavity forceps delivery and one after a rotational forceps delivery. Three women noticed a burning sensation during application of adhesive. At follow up, 13 women were completely without problems, two complained of a sharp sensation from excess adhesive, one had silver nitrate applied at the six week check, two had small defects in the skin which healed well and in two women the skin edges broke down completely but did not need resuturing. CONCLUSION: Indermil tissue adhesive appears to be a safe and effective method of skin closure for episiotomies and second degree tears. The skin closure is quick and painless.

Delivery, Obstetric↗
PubMed1999

Technical manual for manufacturing autologous fibrin tissue adhesive.

PURPOSE: The aim of this article is to provide a concise and simple technical manual for manufacturing autologous fibrin tissue adhesive derived from the precipitation of fibrinogen using a combination of ethanol and freezing for surgery. METHODS: All materials and equipment needed to manufacture ethanol-based autologous fibrin tissue adhesive are listed. In addition, step-by-step instructions are provided to allow for easy and rapid fibrin adhesive production. RESULTS: Ethanol-based autologous fibrin tissue adhesive can be manufactured in under 60 minutes. Furthermore, at our institution the startup cost for manufacturing ethanol-based autologous fibrin tissue adhesive was under $2,500.00. CONCLUSION: Ethanol-based autologous fibrin tissue adhesive is a safe, reliable, and easily manufactured autologous fibrin tissue adhesive that can be made by a trained technician in any blood bank, pharmacy, or surgical laboratory.

Ethanol↗
PubMed2003

Evaluation of a new high-viscosity octylcyanoacrylate tissue adhesive for laceration repair: a randomized, clinical trial.

OBJECTIVE: Tissue adhesives have recently been approved for skin closure. Their low viscosity may result in inadvertent migration. The authors compared the tendency of the adhesive to migrate after laceration closure with a high- or low-viscosity octylcyanoacrylate (OCA). METHODS: This was a randomized, clinical trial set in university and community-based emergency departments. Participants included patients with simple traumatic lacerations. Patients were randomized to laceration closure with low- or high-viscosity OCA tissue adhesive. The outcome measured was immediate adhesive migration (interobserver agreement, kappa = 0.90). Data analysis was performed with proportions compared with chi-square and Fisher's exact tests. RESULTS: Eighty-four patients were randomized to low- (n = 42) or high- (n = 42) viscosity OCA tissue adhesive. Groups were similar in baseline patient and wound characteristics. The high-viscosity OCA was less likely to migrate than the lower-viscosity agent (21% vs. 78%, p < 0.001; odds ratio = 0.3, 95% confidence interval = 0.1 to 0.5). The proportion of patients who noted a sensation of heat during OCA application was higher in the high-viscosity groups (44% vs. 26% respectively, p = 0.11); however, all such patients in both groups would use the device again. At 14 days, there were no wound infections in either group. There was one dehiscence in the high-viscosity group. CONCLUSIONS: The high-viscosity OCA tissue adhesive was less likely to migrate than the lower-viscosity device. Wound dehiscence and infection rates were acceptably low in both treatment groups.

Adolescent↗
PubMed1984

Splenic repair by fibrin tissue adhesive and collagen fleece.

A new biogenic tissue adhesive has been used for repair of traumatic and incidental splenic lesions in 108 patients. The theoretical basis of fibrin adhesive application and technical details of this method, including the combination with a collagen fleece, are described. Complete hemostasis was achieved in 100 patients. In incidental splenic lesions the success rate of the method was 94%, and the overall salvage rate 87%. The corresponding figures for traumatic lesions were 87% and 60%, respectively. Postoperative complications developed in five patients, necessitating relaparotomy in four. In three of these patients complications were not related to the splenic repair. It can be concluded that the use of fibrin tissue adhesive is a safe and reliable method for repair in the majority of incidental and traumatic splenic injuries.

Adolescent↗
PubMed1993

Clinical experience with N-butyl cyanoacrylate (Nexacryl) tissue adhesive.

BACKGROUND: To investigate the indications, outcomes, and complications of N-butyl cyanoacrylate tissue adhesive for ocular clinical use. This tissue adhesive is under investigation by the Food and Drug Administration. METHODS: N-butyl cyanoacrylate was used as an investigational device on 44 patients at the authors' institution over a 2-year period. The charts of these patients were reviewed. RESULTS: The indications for glue application included corneal perforation (19 eyes), descemetoceles (9 eyes), leaking filtering blebs (6 eyes), stromal thinning (5 eyes), wound leaks (4 eyes), and exposure keratopathy (1 eye). A bandage contact lens was used over the dried tissue adhesive in 38 of the 44 eyes. Length of glue adherence ranged from 1 to 660 days (mean, 72 days). Outcome was penetrating keratoplasty (19 eyes), no further intervention (14 eyes), enucleation (4 eyes), surgical revision of a filter (2 eyes), scleral patch graft (1 eye), conjunctival transplant (1 eye), failed tarsorrhaphy (1 eye), suturing of wound (1 eye), and a lamellar graft (1 eye). Vision improved in 52% (23/44) of eyes. CONCLUSION: This tissue adhesive may soon be available to all ophthalmologists, and the authors' experience demonstrates that it is an effective method of temporary or permanent closure of an impending or frank perforation.

Adolescent↗
PubMed2005

The efficacy of fibrin tissue adhesives in pleurodesis in rats.

In search for a new sclerosing agent for pleurodesis, fibrin tissue adhesive is compared to tetracycline for its efficacy in rats. Twenty-four albino Wistar rats were divided into 3 groups. Groups 1, 2, and 3 were given intrapleural isotonic saline, 35 mg/kg tetracycline, and fibrin tissue adhesive with fibrinogen and thrombin concentrations of 30 mg/mL and 10 U/mL, respectively. Rats were evaluated for macroscopic pleural adhesions and mean values of macroscopic scoring were compared among the groups. Fibrin tissue adhesive- and tetracycline-treated rats had significantly more adhesions compared to the control group, whereas fibrin tissue adhesive was more effective for pleurodesis than tetracycline and no deaths or major side effects were observed in any rat. Thus, fibrin tissue adhesive was found as a more effective sclerosing agent than tetracycline for pleurodesis in rats.

Animals↗
PubMed2003

Experience with the use of tissue adhesives in pediatric endoscopic surgery.

BACKGROUND: Due to technological improvements, the use of tissue adhesives and glues for tissue approximation and hemostasis in surgery has increased. We report our preliminary experience with this technology in pediatric endosurgery. METHODS: Between 1997 and 2000, we employed tissue adhesives in 48 pediatric patients during laparoscopic procedures. In 25 patients, the glue was adopted for the hemostasis of parenchimal organs (liver in 24 cases and spleen in one). In three cases, the glue was used to repair organ perforation, in 19 it was used to close the distal part of a patent processus vaginalis in case of congenital inguinal hernia. In the final case, the glue was adopted to achieve optimal airtightness in case of pulmonary biopsy. The glue was injected with the aid of a needle positioned transparietally. RESULTS: The procedure was easy and rapid in all cases, and there were no problems or complications related to glue positioning at a mean follow up of 51 months. CONCLUSION: Tissue adhesives are a very versatile product for use in pediatric laparoscopic surgery. It is likely that their usage will increase as the technology improves and more effective products are developed.

Biopsy↗
PubMed1983

Experimental use of fibrin tissue adhesive in middle ear surgery.

The biocompatibility of a new tissue adhesive was tested. Its major advantages are adhesions, hemostasis, and the promotion of wound healing. In experimental surgery on 43 middle ears of chinchillas, documented by histological evidence obtained 45 days after operation, the validity of the following two hypotheses was established. That fibrin tissue adhesive placed upon the footplate of the stapes is biologically compatible, biodegradable and does not cause toxic, inflammatory or foreign body reactions, or other tissue damage to middle ear structures. That a small piece of bone glued on the long process of the incus with fibrin tissue adhesive shows permanent tissue union. In addition, in cases where the inner ear was accidentally opened by surgically subluxating the stapes and adhesive was free to enter the vestibule, evidence was obtained that there was no damage to inner ear structures. This finding deserves further investigation.

Animals↗
PubMed1998

The tissue adhesive indermil and its use in surgery.

Indermil, in relation to the tissue adhesives described remains the state of the art with regard to function and clinical outcome. The advantage of an inventory sterile tissue adhesive that is to say one that is in the clinic or operating theatre ready for immediate use on demand is the requirement of modern surgical practice. Cost factors are also an important consideration in today's environment. A research study by the Department of Health Economics at the University of York found the cost of the Indermil tissue adhesive system equivalent to absorbable sutures and produced projected savings per patient in relation to conventional sutures with respect to theatre time and return patients' visits (6). In parallel a survey of patients showed 90% would prefer wound closure by an adhesive in relation to traditional sutures. There are few areas of surgical practice which cannot find some application for tissue adhesives. The growing international interest in adhesives and their application would confirm their importance and potential in surgery.

Enbucrilate↗