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Tissue adhesives have certain advantages and should be used only for nephropexy and urethropexy but not for orchiopexy. Because of possible incrustation it should be avoided in the urinary collecting system.
Four tissue adhesives of the butylcyano-acrylate type were tested for breaking strength. The addition of dyes and stabilizers results in an increase in breaking strength. Adhesives coloured with an anthraquinone dye and stabilized with SO2 significantly surpass in breaking strength adhesives that are only coloured or stabilized. Fiomed II (coloured, stabilized with SO2) yields significantly (at P=0.001) better values than Histoacryl blue. Addition of the dye alone seems to exert a better effect on breaking strength than addition of the stabilizer alone. As evidenced by our results, the breaking strength is in the order: 1. Fiomed II (coloured, stabilized with SO2), 2. Histoacryl blue, 3. Fiomed III (coloured, without SO2), 4. Fiomed I (without dye, stabilized with SO2).
This paper summarizes a tissue adhesive system consisting of highly concentrated human fibrinogen and thrombin. The addition of blood-clotting factor XIII stabilizes the adhesive system against fibrinolysis. Although the adhesion system cannot and should not replace surgical suture, it provides valuable assistance in tissue synthesis and in local hemostasis, particularly in cases where conventional suture methods are especially difficult to apply. In addition to good adhesion, an elastic consistency, and good tissue compatibility, the adhesive is completely absorbed and, therefore, preferable to conventional tissue adhesives based on cyanoacrylate. The system has been used successfully in split thickness skin graft application, myringoplasty, repair of dural defects, hemostasis after tonsillectomy, and achieving an airtight seal in tracheoplasty.
A combination of a running P.G.A. subcutaneous suture, reinforced by butyl-cyanoacrylate tissue adhesive for surface bonding of the skin, has enabled us to reduce our rate of fistula formation by about 50 percent in hypospdias repairs by the Denis Browne two-stage or the Horton-Devine one-stage procedure.
A report is given about the clinical experiences, made with a biological adhesive-system, consisting in thrombin, native human fibrinogen and clotting factor XIII. We used this adhesive-system in 28 cases of free skin-grafts, without any other kinds of skin-fixation. The highly adhesive properties, the good tissue compatibility recommend this system for using in free skin grafting. Possibilities for use in other kinds of operations in O.R.L. are discussed.
A technique is described for the construction of A-V fistulae for hemodialysis by performing an end-to-end anastomosis between artery and vein by means of a cyano-acrylate tissue adhesive. The method is quick and easy, provides for good results, and has been free of complications.
The present paper reports the central role of fibrin (and specifically its pre-stage, fibrinogen), thrombin and coagulation factor XIII in wound healing and scar formation. The significance of these three factors had led to the development of a tissue adhesion system on a physiological basis, which can be applied in widely varying areas of surgery. The adhesive allows the exact, flat adaptation of the wound edges and thus promotes flawless scar formation. Two case reports complete the exposition.
A report is given about the Saunders-plasty in a case of Morbus Osler. A 66-year-old female patient had been successfully treated with this method after a ligature of the external carotid artery had to be performed due to heavy bleeding from the teleangiectasia of the bilaterally mucous membrane of the nose. To apply the split thickness skin graft a method of tissue-adhesion, using highly-concentrated human fibrinogen was used. Human fibrinogen, thrombin and blood-clotting factor XIII make an effective physiological tissue glue.
Seromuscular patches were prepared from the gastric wall of 20 experimental dogs and used in the form of autologous or allogenic transplants for the covering of the resection surface of parenchymal organs (liver, spleen, pancreas). The patches were fixed by means of the tissue adhesive Histoacryl-N-Blue; the aim was to achieve haemostasis and to prevent running of the secretion. In the 1 to 90 days follow-up period the patches completely organized and in none of the cases did haemorrhage occur. On the basis of the good experimental results the authors suggest the possibility of the clinical application of autologous patches.
The authors have developed a technique of occluding intracranial aneurysms by the direct injection of a tissue adhesive. Previous work in our laboratory had revealed the unusual intravascular characteristics and physiological properties of isobutyl-2-cyanoacrylate (IBC). These findings had indicated the feasibility of utilizing IBC in the treatment of intracranial aneurysms by its direct injection. We have now treated twenty patients by this method. Eighteen aneurysms were injected during open craniotomy and two were treated by closed stereotactic injection utilizing electronic radiography. Follow-up data, ranging from 1 to 6 years after operation, are available on these patients. Sixteen patients (80% of the series) have had good to excellent results. Our experience and the application of this technique as a potential tool in the treatment of intracranial aneurysms are discussed.
The facial nerve in dogs was exposed, transected, and repaired by either of two methods. Suture and a Silastic sheath was the control method, since a review of the literature suggests it gives the highest rate of success. A tissue adhesive (Histoacryl) was used as the experimental method. In both techniques, the surgical microscope was used. Thirteen nerves were repaired: seven with the adhesive and six with suture and Silastic sheath. Success was judged on two criteria: (1) observation of motion in the muscles that were innervated after electrical stimulation of the nerve proximal to the repair site and (2) evaluation of microanatomical continuity after removal of the repair site and preparation of slides and tissues staining. The two repair methods produced statistically equal results. The "adhesive" method can be performed with greater ease and is less time-consuming. The number of studies required for statistical reliability was determined by means of sequential analysis.
In corneal perforations associated with extensive progressive corneal disease, a technique using tissue adhesive closure of the perforation site and reformation of the anterior chamber before penetrating keratoplasty or conjunctival flap mobilization has been described. Over the past year, six eyes have been successfully treated in this manner. This method allows reformation of the eye under local anesthesia as an emergency procedure without incarceration or injury of the intraocular contents and without pain to the patient. The definitive surgical procedure can then be performed safely under retrobulbar anesthesia.
An account is given of various techniques of blood sampling in the context of certain mustelids, including cardiopuncture, amputation of tail tip, talon cutting, incision of the ear vein, puncture of the jugular or femoral vein, and catheterisation of the abdominal aorta. Reference is made to details of use of all techniques, characteristics, advantages and potential setbacks, and preferable use of some of the tested methods to collect blood from mustela and martes species. Blood collection from the abdominal aorta may be helpful in obtaining no-haemolysis and no-additive plasma for biochemical multi-screening. Biochemical, pharmacological, and toxicological follow-up checks may be feasible under certain conditions following surgical exposure of the external jugular vein. The use of "Fimomed" (n-butylcyano-acrylate), a tissue adhesive, may help to reduce effort in terms of time and material and consequently, rationalise veterinary hygiene action as a whole, provided that the conditions for its application are observed. The skin adhesive is properly applicable to skin lesions of mustelids. A combination of suturing with adhesive should be used to close laparotomy wounds for better mechanical strength of the abdominal wall. Possible applications of "Fimomed" should be tested with other species as well.
A case is reported of uncontrollable hemorrhage from suture lines in a patient having undergone coronary surgery. Ultimately the bleeding was brought under control by the use of isobutyl-cyanoacrylate. A piece of fascia was affixed to the suture line. Tissue adhesive is a valuable tool in difficult hemostatic situations, and should be available where major surgery is performed.
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