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PubMed2000

Increased carboplatin concentration in liver tumors through temporary flow retardation with starch microspheres (Spherex) and gelatin powder (Gelfoam): an experimental study in liver tumor-bearing rabbits.

Regional chemotherapy of primary and secondary malignant liver tumors is superior to systemic therapy. The regional advantage can be further increased by flow retardation. Absorbable gelatin powder (Gelfoam) and starch microspheres (Spherex) may serve as embolizing agents because of their particle size and embolization time. Carboplatin was for the first time applied as a cytostatic agent in regional chemotherapy. Embolization and flow retardation times were measured. The embolization time of Gelfoam was 27 min, and that of starch microspheres (Spherex), 7 min, on average. Mean flow retardation of Gelfoam was 153 min, and that of starch microspheres (Spherex) 38 min. The concentration differences in systemic and regional chemotherapy were determined in VX-2 liver tumor-bearing rabbits. In regional chemotherapy, the tumor concentration was increased by a factor of 3.6 compared with systemic therapy. Coapplication with an embolizing agent increased the tumor concentration of carboplatin by a factor of 44 to 47. Concentrations of absorbable gelatin powder (Gelfoam) and starch microspheres (Spherex) did not differ significantly.

Animals↗

PubMed2005

Development of a resorbable macroporous cellulosic material used as hemostatic in an osseous environment.

The control of bleeding is a frequently encountered therapeutic problem, particularly during dental surgery. The most efficient substances used to resolve this problem are not risk-free because of their animal or human origins, so cellulosic materials are potentially of interest. The aim of this study was to develop a resorbable macroporous cellulosic material for use as a resorbable hemostatic agent in bone sites. The degradation and the cytocompatibility of the cellulosic material versus controls were evaluated and its behaviour in vivo was studied. An original process using calcium carbonate powder as inverse matrix was used to develop a macroporous material. In order to predegrade the cellulosic material for hemostatic use, oxidation was performed with periodate. A dialdehyde component unstable at physiological pH was thus obtained. The material was found to have cytotoxicity, biocompatibility, and resorption properties similar to control but its hemostatic power was higher.

Absorbable Implants↗

PubMed1979

Flexor tendon healing and adhesion formation after Sterispon wrapping: a study in the rabbit.

The influence of Sterispon (Allen & Hanbury) wrapping on the healing of the rabbit flexor digitorum profundus tendon sutured within the digital sheath was studied. Control tendons healed in 2 weeks in association with thick adhesions. The wrapped tendons were surrounded with fewer adhesions, but 50% separated. Healing was delayed until adhesions reached the suture site. A sheath of a single layer of mesothelial cells formed on the surface of the Sterispon opposite the tendon and this markedly reduced adhesions at the suture site. The cellular reaction was bland. Sterispon wrapping had a similar effect on tendon healing and adhesion formation as wrapping with other non-absorbable substances and the results support the theory that healing in the digital sheath is necessarily mediated through the formation of adhesions. Sterispon wrapping has been helpful after tenolysis operations.

Animals↗

PubMed1977

Biocompatibility and bioabsorption of microfibrillar collagen hemostat in experimental animals.

The effects of Microfibrillar Collagen Hemostat (MCH) and Gelfoam after surgical implantation into incision sites of the liver, kidney, and brain were studied in beagle dogs, rabbits, and beagle dogs, respectively. The results of these experimental animal studies suggest that MCH is comparable to Gelfoam with respect to biocompatibility, rate of bioassimilation, and a lack for adverse systemic effects. The brain, liver, and kidney tissues responded comparably to MCH and Gelfoam with a mild to moderate infiltration of macrophages and mononuclear cells. Most of the hemostatic compound had disappeared from the incision sites by Day 28 and completely disappeared by Day 84. The tissue degree response was interpreted as a factor in the process of bioassimilation of the two hemostatic materials. Both hemostatic compounds contributed to adhesion formation in the experimental models. The incidence of adhesions was somewhat lower for MCH than for Gelfoam, but both produced more adhesions than were found at the control sites. The adhesions were only to the adjacent structures and always localized to the surgical site. When MCH or Gelfoam is used under conditions similar to those in the present experimental study, where tissue approximation is impaired, and where growth of granulation tissue is stimulated by the physical presence of the hemostatic compound, there is the possibility for increased incidence of adhesion formation. However, when an intraperitoneal absorbable hemostatic compound is desired, the present studies in experimental animals suggest that MCH will be safe by exhibiting minimal tissue reaction.

Absorption↗

PubMed1981

Absorbable implants in nondrainage procedures for repair of retinal detachment.

Our experience in 1,700 consecutive cases of retinal surgery for the repair of nontraumatic, rhegmatogenous retinal detachments using a modified technique involving a nondrainage procedure with an absorbable implant was presented. We found that 228 of these 1,700 cases fell into our criteria for the use of this technique. We discussed the indications and contraindications for both the operative procedure and for the absorbable implant, and it is our belief that this technique is a valuable addition to the methods available to the retinal surgeon for the treatment of certain selected cases of retinal detachment.

Drainage↗

PubMed1993

Closure of oroantral communication using guided tissue regeneration and an absorbable gelatin membrane.

Surgical intervention into the maxillary posterior area can lead to inadvertent communication with the maxillary sinus. Spontaneous healing of 1 to 2 mm openings can occur. However, in patients with larger oroantral communications and those with a history of sinus disease, surgical closure is often indicated. Acute and chronic oroantral fistula and sinusitis can occur as a result of inadequate treatment. The most common causes of complications include inadequate site preparation, flap closure, flap necrosis, infection, and patient non-compliance. A technique for the closure of oroantral communications using guided tissue regeneration is described. This technique utilizes an absorbable gelatin film (membrane), allogenic bone graft material (DFDBA), and non-resorbable expanded polytetrafluoroethylene (ePTFE) membrane. The gelatin membrane prevents displacement of graft material into the antrum and sinus epithelial cell migration, while the ePTFE membrane promotes selective cell population with subsequent regeneration of the osseous wall of the oroantral defect.

Aged↗

PubMedDate not supplied

The effect of FloSeal on mucosal healing after endoscopic sinus surgery: a comparison with thrombin-soaked gelatin foam.

BACKGROUND: The optimal form of nasal packing after endoscopic sinus surgery (ESS) still has not been established Although wide variations exist among sinus surgeons, the goals are adequate hemostasis, rapid healing, and patient comfort. Preliminary studies indicated that FloSeal (FS), a novel absorbable hemostatic paste used as a nasal pack, was associated with minimal postoperative discomfort and effective hemostasis. This study was designed to evaluate the effects of this agent on mucosal healing in ESS. METHODS: Twenty consecutive patients underwent bilateral ESS. For each patient, one ethmoid cavity was randomized to receive FS and the other received thrombin-soaked gelatin foam. The extent of granulation tissue and adhesion formation was evaluated at 6-8 weeks after surgery. RESULTS: No significant differences were observed between the FS and the thrombin-soaked gelatin foam groups with respect to the preoperative Lund-Mackay score, extent of surgery performed, or need for additional nasal packing. However, the FS group showed clear trends toward increased granulation tissue (p = 0.007) and adhesion (p = 0.006) formation. CONCLUSION: Absorbable hemostatic agents are associated with a high degree of patient comfort and provide hemostasis comparable with traditional techniques. Different materials may induce differential patterns of mucosal healing, potentially affecting the ultimate result of ESS.

Endoscopy↗

PubMed1991

Application of INSTAT hemostat in the control of gingival hemorrhage in the patient with thrombocytopenia. A case report.

Gingival bleeding in the patient with thrombocytopenia can be a difficult management problem. Primary therapy with platelet transfusions may not be sufficient to control the hemorrhage and adjunctive local therapy may be required. Currently, few local management techniques can effectively control this problem. INSTAT collagen absorbable hemostat can be used as a local adjunct with platelet transfusions and has certain application advantages over topical thrombin and microfibrillar collagen. Two successful techniques of INSTAT application to control gingival hemorrhage in a patient with severe thrombocytopenia in leukemic relapse are described.

Aged↗

PubMed1990

[Surgical interventions in severe experimental injuries of the liver].

The authors generalize experience in experimental study of some surgical interventions in severe injuries to the liver. A total of 104 operations were carried out on 52 animals. The efficacy of gauze tamponade with the use of absorbable hemostatics is determined. The methods for applying a vascular suture in injury to the efferent hepatic veins was studied on 12 human cadavers and 10 dogs. It is concluded that gauze +hepatic tamponade is expedient, mainly in coagulopathy in which subsequent relaparotomy is necessary (optimal terms 1-3 days) and the accomplishment of final hemostasis.

Animals↗

PubMed2000

Sellar reconstruction with resorbable vicryl patches, gelatin foam, and fibrin glue in transsphenoidal surgery: a 10-year experience with 376 patients.

OBJECT: Closure of the sella turcica after transsphenoidal surgery is mainly accomplished with autologous muscle fascia and fat or muscle; this requires a second surgical incision. The authors review the results of using resorbable vicryl patches, gelatin foam, and fibrin glue for sellar reconstruction. METHODS: A review was conducted of 376 consecutive patients who underwent surgery for pituitary adenomas, cysts, or subdiaphragmatic craniopharyngiomas in the sella turcica that the senior author (R.W.S.) had performed or directly supervised over the last 10 years. The sellar reconstruction was performed with a commercially available, synthetic absorbable patch composed of polyglactin 910/poly-p-dioxanone, gelatin foam, and fibrin glue. The patch is essentially resorbed in 2 to 3 months and replaced by fibrous collagen tissue. There were 117 small, 112 medium-sized, and 147 large lesions. The overall nonendocrine postoperative morbidity rate was 2.8%, and included visual deterioration, meningitis, secondary epistaxis, nasal septum complication, and cerebrospinal fluid (CSF) leakage. Two patients with macroadenomas needed reoperation for persistent CSF leakage, which comprised 0.5% of the whole series or 0.8% of the 259 patients with medium-sized or large lesions. There was no mortality and no morbidity related to the implanted material, and in particular no delayed empty sella syndrome. CONCLUSIONS: Closure of the sella turcica with a synthetic absorbable vicryl patch, gelatin foam, and fibrin glue after transsphenoidal surgery is safe and very effective in preventing postoperative CSF fistulas. The use of this technique obviates the need for a second surgical incision and shortens the operating time. Because of the progressive resorption of the substitute material, the interpretation of postoperative magnetic resonance studies was not significantly hindered.

Adenoma↗

PubMed2005

Feasibility study for robotic radical prostatectomy cautery-free neurovascular bundle preservation.

INTRODUCTION: Efforts continue to develop techniques that maintain the neurovascular bundles and minimize trauma for robotic laparoscopic radical prostatectomy. We evaluated the feasibility of preserving the nerve bundles without cautery or surgical clips. TECHNICAL CONSIDERATIONS: The seminal vesicles were dissected using scissors and bipolar cautery. After the rectum was mobilized, the vascular pedicles (VPs) were delineated. Laparoscopic bulldog clamps (30 mm) were placed at least 1 cm from the prostate. Using scissors, the VPs were divided right at the prostate. The neurovascular bundle was gently dissected off the prostatic capsule. After mobilizing the bundle, FloSeal was applied along its entire length. The FloSeal was then covered with a dry 1 x 4-cm sheet of Gelfoam. Once the prostate was removed, the bulldog clamps were sequentially withdrawn. The VPs were observed, and, if pulsatile bleeding was encountered, a 3-0 figure-of-eight suture was precisely placed for hemostasis. When hemostasis was complete, the anastomosis was performed. RESULTS: In 17 men, temporary vascular occlusion was applied to 27 VPs and FloSeal and Gelfoam was applied each time. In 4 cases (15%), hemostasis was inadequate because of continued arterial bleeding that was easily controlled with a superficial figure-of-eight ligature of 3.0 absorbable suture. The average estimated blood loss was 91 mL (range 75 to 150). CONCLUSIONS: Cautery-free, clip-free, nerve-sparing robotic laparoscopic radical prostatectomy is feasible using a combination of temporary occlusion of the thick posterior prostatic pedicles with bulldog clamps followed by application of FloSeal. The effect on potency needs further follow-up.

Adult↗

PubMed1981

Gelfoam paste in experimental laminectomy and cranial trephination: hemostasis and bone healing.

The hemostatic properties and effect on osteogenesis of gelatin foam paste and bone wax were compared on surgical bone lesions in experimental animals. Thirty rabbits each received four trephine craniotomies and four lumbar laminectomies. Alternate bone incisions in each animal were treated with either gelatin foam paste or bone wax. Blood loss was measured by absorbing the blood into dry surgical cottonoids weighed before and after use. Bone healing sites of three rabbits were examined histologically to assess the effect of each agent on osteogenesis. The trephination sites of eight rabbits were subjected to fracture force testing at 6 weeks postoperatively to compare the effect ot the two agents on bone healing. No significant difference was found between gelatin foam paste and bone wax in either effectiveness of hemostasis or effect on osteogenesis.

Animals↗

PubMed2005

In situ osteogenesis: regeneration of 10-cm mandibular defect in porcine model using recombinant human bone morphogenetic protein-2 (rhBMP-2) and Helistat absorbable collagen sponge.

Traditional bone grafting relies upon the incorporation of a bone-cell bearing structure into a recipient site. The graft serves as a scaffold that is eventually replaced and remodeled. This process is known as osteoconduction. Recombinant human bone morphogenetic protein-2 (rhBMP-2) is commercially available as an acellular implant in which the protein is bound to an absorbable collagen sponge (ACS). The rhBMP-2/ACS implant converts undifferentiated mesenchymal stem cells into osteoblasts and promotes an intense local neovascular response. This process, known as osteoinduction, produces bone via membranous, chondroid, or endochondral ossification. The type of bone synthesis depends upon the mesenchymal substrate and the local cellular environment. Using this simple technique, bone defects can be resynthesized with good outcomes and a significant reduction in donor site morbidity. Repair of a critical-sized mandibular resection defect with ISO is described. Basic science concepts of rhBMP-2, relevant histopathologic findings, and clinical application are described.

Animals↗

PubMed2002

Effect of KTP laser on implants used in middle-ear surgery.

The present study is intended to explore the effects of the KTP laser on various types of implant, used in middle-ear surgery. A laboratory study was undertaken to evaluate the interaction between the KTP laser (KTP-532 Orion Laser, Laserscope, UK) and individual middle-ear implants. A variety of middle-ear implants were used: a silicone sheet, Teflon, hydroxylapatite, ionomeric cement, gold and titanium prostheses as well as gelfoam. Following exposure to the laser, these implants were studied by direct inspection using an operating microscope. The KTP laser induced no detectable alteration in any of the implants when they were clean and dry. However, in the presence of fresh blood, under the influence of the energy of the absorbed laser, the silicone burnt and melted and the Teflon piston was vaporized. Likewise, a few tiny holes appeared on the surface of the ionomeric implant and then the prosthesis deformed. The hydroxylapatite implant broke into two pieces. However, no detectable alteration could be observed on gold or titanium pistons, even in the presence of blood. The authors conclude, that in the presence of blood, interaction between the KTP laser and both silicone and hydroxylapatite implants needs to be avoided. Teflon prostheses can be cautiously vaporized. Gold and titanium prostheses were unaffected by laser even in the presence of blood.

Blood↗

PubMed2006

Controlling bone morphogenetic protein diffusion and bone morphogenetic protein-stimulated bone growth using fibrin glue.

STUDY DESIGN: An in vitro and in vivo study. OBJECTIVE: To evaluate the ability of fibrin glue to limit diffusion of recombinant human bone morphogenetic protein (rhBMP)-2 and its ability to protect spinal nerves from rhBMP-2 stimulated bone growth. SUMMARY OF BACKGROUND DATA: Studies have shown bone morphogenetic protein (rhBMP-2) stimulated bone growth can encroach on the spinal canal and nerves, causing neural compression. More recently, rhBMP-2 use in the cervical spine has been associated with life-threatening swelling. Fibrin glue has been used as a biologic carrier but has not been evaluated for its ability to limit rhBMP-2. METHODS: In phase 1 of the study, rhBMP-2 soaked absorbable collagen sponges (ACS) were encapsulated in fibrin glue and immediately incubated in physiologic lactated ringers solution at 38 degrees C. Samples of solution were tested for rhBMP-2 concentration. In phase 2 of the study, rats were surgically treated with laminectomy and placement of rhBMP-2/ACS versus laminectomy and placement of fibrin glue before placement of rhBMP-2/ACS. After 8 weeks, animals were euthanized and imaged using micro-computerized tomography. RESULTS: The diffusion study showed a significant limitation in rhBMP-2 diffusion when encapsulated in fibrin glue. The laminectomy study revealed blockage of bone formation by fibrin glue and protection of the spinal canal. CONCLUSIONS: Fibrin glue can limit the diffusion of rhBMP-2, and, thus, it can be used to help protect the spinal canal and nerve roots from rhBMP-2 stimulated bone growth.

Animals↗

PubMed2001

Maxillary sinus floor augmentation in rabbits: a comparative histologic-histomorphometric study between rhBMP-2 and autogenous bone.

The present study was designed to compare recombinant human bone morphogenetic protein-2 (rhBMP-2) impregnated on an absorbable collagen sponge (ACS) with particulate cancellous bone and marrow (PCBM) harvested from the iliac crest in an animal model of maxillary sinus floor augmentation. Bilateral sinus floor augmentation procedures were performed in 30 adult Japanese white rabbits. rhBMP-2/ACS or PCBM was grafted to each maxillary sinus. Animals were sacrificed at 2, 4, or 8 weeks after grafting, and bone formation in response to each implant was evaluated histologically and histometrically. Histometric results compared by analysis of variance revealed no statistically significant difference in the bone volume at augmented areas between the two types of implant (P > 0.05). Histologic evaluation documented that the trabeculae with a lamellar structure were embedded in fatty marrow at 8 weeks in both implant sites. These results suggest that sinus floor augmentation with rhBMP-2/ACS or PCBM induces comparable histologic and histometric evidence of bone formation in rabbits.

Alveolar Ridge Augmentation↗

PubMed2004

Effect of recombinant human bone morphogenetic protein-2 on the osseointegration of dental implants: a biomechanics study.

BACKGROUND: Bone augmentation procedures in combination with dental implants enhance osseointegration in areas that demonstrate localized bone deficit. Clinical confirmation of a biomechanically stable interface is essential for functional implant loading. PURPOSE: The aim of this study was to evaluate biomechanically the effect of recombinant human bone morphogenetic protein (rhBMP)-2 on implant osseointegration and correlate it with periotest and radiographic measurements. MATERIALS AND METHODS: Hollow cylinder implants were filled with absorbable collagen sponge soaked with rhBMP-2 or left empty and implanted in dog mandibles. The animals were followed for 4, 8, and 12 weeks, periotest assessment was performed at the end of each time interval, and specimens were collected for pullout biomechanical testing and radiographic evaluation of bone-implant contact levels. RESULTS: Periotest assessment did not provide evidence of statistically significant differences between the two groups and correlated well with the radiographic bone-implant contact levels. The pullout test revealed a higher correlation between force/displacement and displacement/energy for the experimental group, suggesting that the addition of rhBMP-2 did influence the rate of osseointegration. CONCLUSION: The results from the pullout test support the potential role of rhBMP-2 in clinical applications by promoting a biomechanically mature interface at 12 weeks. However, radiographic and periotest assessment of the bone-implant interface did not provide evidence of the differences observed with biomechanical testing.

Animals↗

PubMed2005

Reconstruction of the sellar floor following transsphenoidal surgery using gelatin foam and fibrin glue.

OBJECTIVE: To introduce a new principle of sellar reconstruction and to evaluate the effectiveness of absorbable gelatin foam and fibrin glue for sellar reconstruction. METHODS: A total of 176 consecutive patients who underwent surgery for pituitary adenomas, cysts, chordomas, or subdiaphragmatic craniopharyngiomas in the sella turcica between January 2001 and April 2003 at Peking Union Medical College Hospital were enrolled. Different techniques of sellar closure and indications for each specific condition were retrospectively reviewed. RESULTS: Seventy-seven (43.7%) patients developed a visible cerebrospinal fluid (CSF) leakage during surgery. Intra-operative CSF leakage were repaired simply with gelatin foam and fibrin glue in 62 (35.2%) patients, and with autologous fat graft and sellar floor reconstruction in 15 (8.5%) patients. Postoperative CSF rhinorrhea occurred only in 1 case. There were no visual deterioration, allergic rhinitis, meningitis, pneumocranium, granulomas, or other complications associated with the reconstruction procedure. CONCLUSION: The procedure of using gelatin foam and fibrin glue and principle of cranial base reconstruction is safe and effective in preventing postoperative complications following transsphenoidal surgery.

Adenoma↗