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Autologous fibrin tissue adhesive for ossicular reconstruction in cats.

Autologous fibrin tissue adhesive is currently the most promising adhesive for otologic use with respect to strength and biocompatibility without the risk of transmissable disease that is of concern with the commercially prepared fibrin adhesive. We set out to evaluate the practicality of preparing autologous fibrin adhesive in cats and to see if the adhesive's duration and strength of bonding was sufficient to allow natural tissue union to occur with various grafting materials. Autologous fibrin adhesive was prepared preoperatively from ten cats using the ammonium sulfate precipitation technique. Twenty otologic procedures were performed in which the incus long process was resected and the defect bridged with one of four grafting materials: autograft ossicular bone, bone pate-fibrin glue, porous hydroxylapatite, and Plastipore-bone pate. All grafts were secured with the autologous adhesive. The cats were sacrificed at 6 and 12 weeks. We found the the autologous adhesive provided adequate duration and strength of support to enable a firm tissue union between all the grafting materials and the adjoining incus and stapes.

Animals

[Autologous fibrin glue--preparation and clinical use].

Fibrin tissue adhesive is a tissue adhesive in which the two components are fibrinogen concentrate and a thrombin solution, respectively. In autologous fibrin tissue adhesive, the fibrinogen is prepared from the patient's own blood in contrast to the fibrin adhesive available commercially where the fibrinogen is prepared from pooled donor plasma. In 42 heart and lung operations, autologous fibrin tissue adhesive prepared by a new method was employed in which the fibrinogen is separated from the patient's own plasma by precipitation with ethanol. Either 44 or 88 ml blood was employed for concentration of the fibrinogen. This resulted in 2.5 ml and 4.9 ml fibrinogen concentrate which was mixed with 0.3 parts of thrombin solution containing calcium and aprotinin (fibrolysis inhibitor) so that the total volumes of tissue adhesive were 3.3 ml and 6.4 ml. Production of autologous fibrin tissue adhesive is uncomplicated and takes less than 90 minutes. A new method of production of autologous tissue adhesive based on ethanol is described. The fibrin tissue adhesive prepared in this manner has a high concentration of fibrinogen and is effective as a haemostatic and as an adhesive in surgical operations and it has the further advantage that it is not associated with the risk of transmission of viral or for immunological reactions.

Blood Specimen Collection

[Clinical analysis of eight cases treated with lateral skull base surgery].

Eight cases were treated by lateral skull base surgery. Three benign tumors (2: paraganglioma, 1: neurinoma) originated from parapharyngeal space and infiltrated into jugular foramen, and five malignant tumors (3: squamous cell carcinoma, 1: adenoid cystic carcinoma, 1: rhabdomyosarcoma) involved the skull base. Preoperative magnetic resonance imaging gives information as to whether tumors invaded to cranial bone or not, and also permits deciding surgical procedures. Surgical management of mandibular bone was performed in five cases for complete tumor resection and sufficient surgical view; hemimandibulectomy was carried out in four malignant cases, who simultaneously underwent radical neck dissection, and one benign case underwent mandiblotomy. Ligation of sigmoid sinus was carried out in four cases (1; benign, 3; malignant) to control bleeding from large vessels. The skull base was reconstructed with myocutaneous flaps which were fixed by fibrin tissue adhesive. No significant surgical complications were not noted. There were no recurrence of benign tumor during 8-13 years follow up period. Malignant tumors, except one (rhabdomyosarcoma), had no local recurrence during follow up period (4 months-2 years). We emphasize that the progress in preoperative assessment, as well as in reconstructive surgical techniques, will assure more adequate indication of lateral skull surgery for malignant tumors.

Adult

Use of tissue adhesive to secure spinal epidural stimulating electrodes: technical note.

Securing spinal cord stimulating electrodes (SCS) within the epidural space is often a challenging task. Complications of the technique include development of cerebrospinal fluid leaks and electrode migration. We report four patients who underwent a limited laminectomy for placement of epidural spinal cord stimulating electrodes to relieve pain and/or spasticity. Suturing electrodes to the dura was not possible, and a tissue adhesive was used. Two-year follow-up shows no migration of the electrodes. Tissue adhesive of "fibrin glue" is a viable alternative for securing epidural SCS electrodes.

Adult

Fibrin glue.

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Adhesiveness

Autologous Fibrin Glue in Pterygium Surgery as an Alternative to Commercial Fibrin Glue.

PURPOSE: The aim of this study was to evaluate the efficacy and safety of autologous fibrin glue in pterygium surgery, comparing it with commercial fibrin glue in terms of postoperative complications, graft stability, and recurrence rate. METHODS: A prospective, randomized, double-blind study was conducted, involving 42 patients with primary pterygium who underwent autologous conjunctival-limbal transplantation. The graft was fixed using autologous fibrin glue (Group 1, G1) or commercial fibrin glue (Group 2, G2). All patients underwent surgery performed by the same surgeon and were reevaluated on postoperative days 7, 30, 90, and 180 by an independent observer, assessing clinical parameters in the preoperative, intraoperative, and postoperative periods. RESULTS: No cases of severe adverse events were reported. Complete graft dehiscence occurred in 1 patient from G1. The G2 group had more cases of subconjunctival hemorrhage ( P = 0.0355). Pyogenic granuloma was observed in 1 patient from G2 and 2 patients from G1. There was no significant difference in recurrence rates between the groups (15% in G1 vs. 5% in G2; P = 0.2918). In both groups, graft dimensions tended to decrease slightly in the early postoperative period, followed by stabilization. CONCLUSIONS: Autologous fibrin glue demonstrated efficacy and safety comparable to commercial fibrin glue, making it a viable alternative to conjunctival graft fixation in primary pterygium surgery.

Humans

Mechanical properties of fibrin adhesives for blood vessel anastomosis.

Various methods have been used for anastomosing, or attaching, two ends of a severed blood vessel together. The most common method, suturing, is tedious, can be time-consuming, and requires special training in microvascular surgery. Other methods, such as mechanical devices and lasers, have some problems as well. The use of fibrin adhesives for blood vessel anastomosis might eliminate some of the current problems by allowing a quicker, simpler, and more reliable method of attachment. Although mechanical studies have been conducted to determine fibrin glue properties in shear, tensile, and burst tests; most of these studies have used skin or intestinal tissue. Therefore, to evaluate the feasibility of using fibrin glue as an adhesive for blood vessel anastomosis, the mechanical properties of blood vessels joined with fibrin glue were examined using tensile and burst tests. High and low fibrinogen concentrations were tested after 5- or 45-min time periods. In addition, three clinical methods of attachment were compared: end-to-end anastomosis, vessel overlapping, and suturing. In this study, because the adhesive strength was not found to increase significantly after 5 min, setting times for fibrin glue may be short enough to make it a clinical option when compared to suturing. In addition, the higher fibrinogen concentration did not result in a significantly higher adhesive strength, indicating that the lower concentration fibrin adhesives may be of comparable strength to the higher concentrations for clinical applications.

Anastomosis, Surgical

[Gluing of sterile abdominal benign cyst walls with tissue adhesives (Tissucol) (preliminary report)].

The authors, endeavouring to stick the walls of percutaneously emptied cysts together had applied the two-component Tissucol fibrin glue in the treatment of abdominal and thoracic cysts. Their ten cases, however, may be considered only as preliminary experiences. It seems that the method can be recommended for an attempt to cease these formations in a fast and simple way. Nevertheless, this method must not be the subject of treatment in infected and malignant fluid collections, but seems successful in pancreatic pseudocysts, in spite of their higher proteolytic activity.

Abdomen

Alveolar ridge augmentation with hydroxylapatite using fibrin sealant for fixation. Part II: Clinical application.

The use of fibrin as a resorbable biological adhesive permits moulding of HA granules into individually shaped implants. The binder prevents dislocation of granules during delivery, and the moulded implants securely retain their shape until fibrous tissue ingrowth is complete. Three years of clinical experience have shown that, mouldable fibrin-bound HA has so far proved suitable as a bone substitute in preprosthetic as well as in plastic and reconstructive surgery.

Aged

[Fibrin glue and wound healing].

Bioadhesive systems used in medicine must meet certain prerequisites on which their application depends. A very important relationship is that of glue and tissue, irritability, the influence on regeneration of tissue cells and histotoxicity. The authors evaluated in an experimental study the necroptic appearance of the peritoneal cavity, the microscopic character of the scar and histological appearance of tissue after treatment of an induced hepatic and lienal rupture in 28 rabbits and 28 baby pigs, using fibrin tissue glue. The typical properties of the adhesive fibrin system ensue from its physiological properties. Filling the wound enhances natural biological processes of healing. The tissue reaction to the applied tissue fibrin coagulum is favourable. The treated parenchymatous organs, liver and spleen, healed by a smooth scar. The number of adhesions in the peritoneal cavity in all thus treated experimental animals after treatment of the spleen was similar. Fewer adhesions were observed when using glue for repairing liver injuries in rabbits. The macroscopic appearance of the scar was similar, the scar was less visible in the liver parenchyma. The histological appearance was similar. The glue did not damage the tissue surrounding the parenchyma and did not act as a foreign body. The assessed results confirm the harmlessness of the fibrin glue, tissue tolerance and satisfactory healing with out a reaction to alien material. After healing the fibrin glue replaced by natural fibrous tissue.

Animals

[Innovative elastomeric bio-adhesive (pup-201) synthesized by urethane-prepolymer].

Properties of PUP-201 for the application to vital organs were estimated. Basic properties of PUP-201 were compared with two kinds of commercial fibrin and synthetic adhesives. Its initial and wet adhesive strength was 40 and 150 times stronger than those of fibrin adhesives respectively. Its curing time was 50 seconds, and elongating rate was 150% nearly as same as that of the intestine. This adhesive had not antimicrobial activities. The strength of adhesive bonded pig skin in shear by tension loading by way of JIS K6850 recorded 2.0-2.7kg/cm2 five minutes after, and 2.0-2.8kg/cm2 after 24 hours. The results of the same test in small intestine defined 0.4-1.0kg/cm2 in sero-sero attachment. There was no toxicity on the pig skin. Practical examinations for application to hemostasis on the section of dog liver and sealing of the lung section were performed successfully. PUP-201 was demonstrated excellently useful material for the adhesive, hemostasis and sealant of vital tissue.

Animals

Effects of fibrin glue on hemostasis.

In order to decrease complications following incomplete hemostasis, we tried to make a safe, efficient and highly concentrated fibrin glue by thawing single-donor fresh frozen plasma. Using a unique animal model, in which arterial bleeding was created, fibrin glue and some related hemostatic agents were tested to evaluate their hemostatic effectiveness. The results demonstrated that: 1) the concomitant use of cryoprecipitate-thrombin tissue glue with adjuvant (aprotinin or calcium chloride) had a better hemostatic effect than the use of cryoprecipitate-thrombin tissue glue alone (p < 0.05); 2) impregnation of fibrin glue with a suitable vehicle was advisable to accelerate the coagulation plug formation and to enhance the mechanical strength of the adhesive plug; 3) Gelform, used as a vehicle to hold the fibrin glue, had a more efficient hemostatic effect than gauze, collagen fleece and Surgicel (p < 0.05); 4) systemic heparinization attenuated the effectiveness of the hemostatic agents and aggravated the bleeding problem, but a low hematocrit level did not; 5) fibrin glue had its own limitations, especially under systemic heparinization, on hemostatic effectiveness in a high-pressure system. Understanding the characteristics of fibrin glue, as mentioned above, definitely improved the hemostatic effectiveness of the glue, especially after failure of the usual methods of controlling bleeding.

Animals

[Therapy of splenic injuries by freezing and fibrin gluing. Animal experiment study].

The goal of this investigation was to improve the reliability of intraoperative and postoperative hemostasis and to observe the healing process after using a combined technique of tissue freezing followed by the application of collagen fleece and fibrin glue for the treatment of splenic ruptures. Grade II lesions were inflicted on the spleens of 15 swine. The bleeding wounds were frozen for 1 min at -60 degrees C using a cryosurgical device. Immediately afterwards the frozen lesions were covered with fibrin glue and collagen fleece and kept under slight compression. In every case complete hemostasis was achieved intraoperatively. The spleens of three animals each time were collected for gross and microscopic examination after 2 days and 1, 2, 5, and 6 weeks. A visceroperitoneal adhesion was observed in only one spleen, U-shaped viscerovisceral adhesions in five spleens. Superficial coagulation necroses could be detected microscopically only after 2 days and 1 week. Organization of the wounds, indicated by granulation tissue which contained siderophages, started in the 2nd week. There was distinct formation of collagen fibers after 5 and 6 weeks; only a residue of the collagen fleece was visible and the surplus fibrin glue was encapsulated. With this combined technique complete and safe hemostasis and a good subsequent healing process was achieved.

Animals