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Pradhan N, Anup Belludi S, R S, Hr V, James R. Evaluation and comparison of the efficacy of autologous fibrin glue with 4-0 silk sutures in periodontal flap closure and wound healing - A split mouth randomized controlled trial. J Biomater Appl 2023; 38:412-423. [PMID: 37585785 DOI: 10.1177/08853282231191862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Fibrin glue has shown to be a pioneering remedy to overcome the inconvenience of suturing. Autologous products reduce the risk of contamination and immunological responses compared to commercial fibrin glue. Hence using autologous fibrin glue (AFG) as a tissue sealant in periodontal flap closure would be of added value for a predictable outcome. OBJECTIVE To evaluate and compare the efficacy of AFG with 4-0 silk sutures in periodontal flap closure and healing. MATERIAL AND METHODS Total of 17 patients diagnosed with generalized periodontitis in the age group of 18 to 60 years with probing pocket depth of ≥ 6 mm and clinical attachment level of ≥5 mm in at least two quadrants were categorized into test group (AFG) and control group (4-0 silk sutures). Primary outcome measures [modified gingival index (MGI), early wound index (EHI) and interleukin 1 beta (IL-1ß) and secondary outcome measures (oral hygiene index, plaque index and visual analog scale (VAS) were recorded at baseline, 1, 2, 3 and 4 weeks. RESULTS A statistically significant reduction of IL-1ß value (p =.005); MGI (p = .02); EHI (p = .004), VAS scores (p < .001) and a positive Spearman's correlation (rho = 0.15) was seen between EHI scores & IL-1ß levels in test group at 1week period in comparison to control group. CONCLUSION AFG showed promising results as an alternative to sutures. The use of AFG significantly improved clinical parameters and reduced the levels of pro-inflammatory cytokines making it an effective adhesive with healing properties in the era of suture-less periodontal flap surgery.
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Affiliation(s)
| | | | | | | | - Rani James
- Former Scientist, DiponEd Inelligence Bangalore, India
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2
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Cioba C, Marafon SB, Fortes BGB, Cavalheiro MT, Fabris M, Michel G, Zambon GM, Marcon A, Marinho DR. Autologous fibrin glue versus sutures for conjunctival autograft in primary pterygium: a randomized clinical trial. Int Ophthalmol 2023:10.1007/s10792-023-02635-z. [PMID: 36652022 DOI: 10.1007/s10792-023-02635-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE To describe and compare the autologous fibrin glue and traditional sutures for conjunctival graft attachment in patients undergoing primary pterygium excision surgery. METHOD A randomized clinical trial included patients who underwent pterygium surgery with conjunctival autologous graft (CAG). Using randomization, a single-trained surgeon performed graft fixation with autologous glue or sutures. The glue was prepared immediately before the surgery, using the patient's blood components. After centrifugation, the plasma was collected and enhanced with calcium gluconate. Postoperative assessments were performed on Days 1, 7, 21, 30 and 180. The study evaluated postoperative edema and pain and complications. The mean surgical time was compared. Recurrence of the pterygium was assessed 6 months postoperatively. RESULTS The study evaluated 61 eyes. Thirty-three eyes underwent pterygium surgery using the glue technique, and 28 underwent the traditional suture technique. Fifty-one patients (83.60%) had successful graft adhered to at the end of follow-up. Ten patients (10/33) lost their graft in the glue group, and only 69.70% maintained graft presence in the fourth week versus 100% of the patients in the suture group (p = 0.001). Pain scores were lower in the glue group, and clinical edema was significantly higher. There was no significant difference in graft retraction or the presence of granuloma, necrosis or postoperative infection. CONCLUSION Autologous fibrin glue is an affordable option for CAG fixation in particular contexts where commercial fibrin glue is unavailable, and it could offer advantages compared to sutures. A higher graft loss rate was observed and might be related to topical anesthesia, and improvements to the technique are needed. CLINICALTRIALS gov Identifier: NCT04151017. https://clinicaltrials.gov/ct2/show/NCT04151017?term=20170467&draw=1&rank=1 .
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Affiliation(s)
- Christine Cioba
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Samara Bárbara Marafon
- Hospital de Clinicas de Porto Alegre, 2350 Ramiro Barcelos, Porto Alegre, RS, 90035-903, Brazil. .,Oftalmocentro, Porto Alegre, RS, Brazil.
| | | | - Mariana Thomé Cavalheiro
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.,Oftalmocentro, Porto Alegre, RS, Brazil
| | - Marcelo Fabris
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gustavo Michel
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Alexandre Marcon
- Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Diane Ruschel Marinho
- Hospital de Clinicas de Porto Alegre, 2350 Ramiro Barcelos, Porto Alegre, RS, 90035-903, Brazil.,Oftalmocentro, Porto Alegre, RS, Brazil
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Tokumoto H, Akita S, Kubota Y, Mitsukawa N. Utility of autologous fibrin glue in the donor site of free abdominal flap for breast reconstruction: A randomized controlled study. J Plast Reconstr Aesthet Surg 2021; 74:2870-2875. [PMID: 33992561 DOI: 10.1016/j.bjps.2021.03.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 12/28/2020] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Seroma formation at the donor site is a common complication of breast reconstruction using free abdominal flap. In this study, we assessed the benefits of use of autologous fibrin glue (AFG) at the donor site. METHODS This randomized controlled study compared AFG group (n = 61) with commercial fibrin glue (CFG) group (n = 79). Owing to the high volume of AFG (10 mL), AFG group received fibrin glue at both the anastomosis and the donor sites, whereas CFG group received fibrin glue only at the anastomosis site. Operative protocols and the criteria for postoperative drain removal were identical in both groups. Patient characteristics and abdominal discharge were compared between the two groups. RESULTS Since anemia was a contraindication for use of AFG, preoperative Hb in CFG group was significantly lower than that in AFG group; other factors were comparable in the two groups. The mean total abdominal drain volumes on first postoperative day (POD1) and POD2 was (AFG vs. CFG) 130.9 vs. 169.4 mL (P < 0.001) and 131.0 vs. 162.8 mL (P = 0.03), respectively. On POD3, there was no significant difference in this respect (116.2 vs. 128.4 mL, P = 0.19). The mean time for removal of all abdominal drains was significantly lower in AFG group (7.4 vs. 8.4 days; P = 0.01). CONCLUSIONS AFG reduced the discharge at the donor site of free abdominal flap, especially in the early postoperative period. AFG helped to reduce the abdominal drainage period.
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Affiliation(s)
- Hideki Tokumoto
- Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Chiba, Japan.
| | - Shinsuke Akita
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba, Japan
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Dave BP, Sathyanarayana S. Periodontal flap closure using a simplified autologous fibrin glue preparation: A report of two successful cases. J Indian Soc Periodontol 2020; 24:579-582. [PMID: 33424178 PMCID: PMC7781247 DOI: 10.4103/jisp.jisp_630_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/26/2020] [Accepted: 04/26/2020] [Indexed: 11/04/2022] Open
Abstract
Although suturing is an integral part of periodontal flap surgery, it has disadvantages such as difficulty in plaque control, increased postoperative discomfort, and higher infection rate. To overcome these problems, a search for alternatives and possibly a sutureless technique has continued. Fibrin glue is one such biological tissue adhesive, mimicking the final stages of coagulation with several advantages. This report shows the use of an autologous fibrin glue in two cases, prepared using a simplified method. At the end of periodontal flap surgery, the flaps were closed with sutures in two papillae and fibrin glue in other two papillae in both cases. The papillae closed with fibrin glue showed better healing and good stability after flap closure. This simplified preparation of autologous fibrin glue has not been reported till date as found from literature search.
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Affiliation(s)
- Bhumit Pradipbhai Dave
- Department of Periodontics, Dayanand Sagar College of Dental Science, Bengaluru, Karnataka, India
| | - Sunil Sathyanarayana
- Department of Periodontics, Dayanand Sagar College of Dental Science, Bengaluru, Karnataka, India
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Nakayama N, Yano H, Egashira Y, Enomoto Y, Ohe N, Kanemura N, Kitagawa J, Iwama T. Efficacy, Reliability, and Safety of Completely Autologous Fibrin Glue in Neurosurgical Procedures: Single-Center Retrospective Large-Number Case Study. World Neurosurg 2017; 109:e819-e828. [PMID: 29107157 DOI: 10.1016/j.wneu.2017.10.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/15/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Commercially available fibrin glue (Com-FG), which is used commonly worldwide, is produced with pooled human plasma from multiple donors. However, it has added bovine aprotinin, which involves the risk of infection, allogenic immunity, and allergic reactions. We evaluate the efficacy, reliability, and safety of completely autologous fibrin glue (CAFG). METHODS From August 2014 to February 2016, prospective data were collected and analyzed from 153 patients. CAFG was prepared with the CryoSeal System using autologous blood and was applied during neurosurgical procedures. Using CAFG-soaked oxidized regenerated cellulose and/or polyglycolic acid sheets, we performed a pinpoint hemostasis, transposed the offending vessels in a microvascular decompression, and covered the dural incision to prevent cerebrospinal fluid leakage. RESULTS The CryoSeal System had generated up to a mean of 4.51 mL (range, 3.0-8.4 mL) of CAFG from 400 mL autologous blood. Com-FG products were not used in our procedures. Only 6 patients required an additional allogeneic blood transfusion. The hemostatic effective rate was 96.1% (147 of 153 patients). Only 1 patient who received transsphenoidal surgery for a pituitary adenoma presented with the complication of delayed postoperative cerebrospinal fluid leakage (0.65%). No patient developed allergic reactions or systemic complications associated with the use of CAFG. CONCLUSIONS CAFG effectively provides hemostatic, adhesive, and safety performance. The timing and three-dimensional shape of CAFG-soaked oxidized regenerated cellulose and/or polyglycolic acid sheets solidification can be controlled with slow fibrin formation. The cost to prepare CAFG is similar compared with Com-FG products, and it can therefore be easily used at most institutions.
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Affiliation(s)
- Noriyuki Nakayama
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
| | - Hirohito Yano
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yusuke Egashira
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yukiko Enomoto
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Naoyuki Ohe
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | | | - Junichi Kitagawa
- Department of Transfusion Medicine, Gifu University, Gifu, Japan
| | - Toru Iwama
- Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu, Japan
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Abd El-Latif N, Abdulrahman M, Helal M, Grawish ME. Regenerative capacity of allogenic gingival margin- derived stem cells with fibrin glue on albino rats' partially dissected submandibular salivary glands. Arch Oral Biol 2017; 82:302-309. [PMID: 28688332 DOI: 10.1016/j.archoralbio.2017.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the possible regenerative effect of allogenic gingival margin-derived stem cells (GMSCs) with or without autologous fibrin glue on partially dissected submandibular salivary glands of albino rats. METHODS Forty rats were randomly divided into four equal groups. Group I, where no operation was performed, was considered the negative control. Group II rats were considered the positive control and were subjected to a rectangular cut on the outer surface of the center right of the submandibular salivary gland and received no other treatment. Groups III and IV rats were handled as those in group II, but the cut areas of group III were filled with fibrin glue and the cut borders of group IV were injected with 1×105cell/ml GMSCs and then glued with fibrin glue. Five animals from each group were euthanized at the end of the first postoperative week, while the remaining animals were euthanized at the end of the second postoperative week, i.e., end of the experiment. RESULTS Regeneration of ductal, acinar, and myoepithelial cells was better in group IV. A two-way ANOVA for proliferating cell nuclear antigen and α-smooth muscle actin revealed an overall significant difference between the different groups (P<0.05). In addition, an LSD post hoc test for multiple comparisons revealed a significant difference between each two groups. An independent sample t-test revealed significant differences between time periods for groups II, III, and IV, but there were no significant differences between the time periods for group I. CONCLUSION Injecting GMSCs at the cut borders and gluing the cut area with autologous fibrin glue ameliorates the regeneration of partially dissected submandibular salivary gland better than using fibrin glue alone.
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Affiliation(s)
- Noura Abd El-Latif
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Egypt
| | - Mohamed Abdulrahman
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Egypt
| | - Mohamad Helal
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Egypt
| | - Mohammed E Grawish
- Department of Oral Biology, Faculty of Dentistry, Mansoura University, Egypt; Department of Oral Biology, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Gamasa, Mansoura, Egypt.
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Kouketsu A, Nogami S, Fujiwara M, Mori S, Yamauchi K, Hashimoto W, Miyashita H, Kurihara J, Kawai T, Higuchi K, Takahashi T. Clinical evaluations of autologous fibrin glue and polyglycolic acid sheets as oral surgical wound coverings after partial glossectomy. J Craniomaxillofac Surg 2016; 44:964-8. [PMID: 27341770 DOI: 10.1016/j.jcms.2016.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/18/2016] [Accepted: 05/31/2016] [Indexed: 11/24/2022] Open
Abstract
Polyglycolic acid (PGA) sheets and commercial fibrin glue are commonly used to cover open wound surfaces in oral surgery. Compared to commercial fibrin glue composed of pooled allogeneic blood, autologous fibrin glue is less expensive and poses lower risks of viral infection and allergic reaction. Here, we evaluated postoperative pain, scar contracture, ingestion, tongue dyskinesia, and postoperative bleeding in 24 patients who underwent partial glossectomy plus the application of a PGA sheet and an autologous fibrin glue covering (autologous group) versus 11 patients in whom a PGA sheet and commercial fibrin glue were used (allogeneic group). The evaluated clinical measures were nearly identical in both groups. Remarkable wound surface granulation was recognized in two cases in the autologous group. No complications were observed in either group, including viral infection or allergic reaction. Abnormal postoperative bleeding in the wound region was observed in one case in the allogeneic group. Coagulation and adhesion of the autologous fibrin glue were equivalent to those of conventional therapy with a PGA sheet and commercial fibrin glue. Thus, our results show that covering wounds with autologous fibrin glue and PGA sheets may help avoid the risks of viral infection and allergic reaction in partial glossectomy cases.
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Affiliation(s)
- Atsumu Kouketsu
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
| | - Shinnosuke Nogami
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Minami Fujiwara
- Division of Blood Transfusion and Cell Processing, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Shiro Mori
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Kensuke Yamauchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Wataru Hashimoto
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Hitoshi Miyashita
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Jun Kurihara
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Tadashi Kawai
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Keisuke Higuchi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
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Graziano F, Maugeri R, Basile L, Meccio F, Iacopino DG. Aulogous fibrin sealant (Vivostat(®)) in the neurosurgical practice: Part II: Vertebro-spinal procedures. Surg Neurol Int 2016; 7:S77-82. [PMID: 26904371 PMCID: PMC4743263 DOI: 10.4103/2152-7806.174894] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/17/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Epidural hematomas, cerebrospinal fluid fistula, and spinal infections are challenging postoperative complications following vertebro-spinal procedures. We report our preliminary results using autologous fibrin sealant as both fibrin glue and a hemostatic during these operations. METHODS Prospectively, between January 2013 and March 2015, 68 patients received an autologous fibrin sealant prepared with the Vivostat(®) system applied epidurally to provide hemostasis and to seal the dura. The surgical technique, time to bleeding control, and associated complications were recorded. RESULTS Spinal procedures were performed in 68 patients utilizing autologous fibrin glue/Vivostat(®) to provide rapid hemostasis and/or to seal the dura. Only 2 patients developed postoperative dural fistulas while none exhibited hemorrhages, allergic reactions, systemic complications, or infections. CONCLUSIONS In this preliminary study, the application of autologous fibrin sealant with Vivostat(®) resulted in rapid hemostasis and/or acted as an effective dural sealant. Although this product appears to be safe and effective, further investigations are warranted.
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Affiliation(s)
- Francesca Graziano
- Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, University Hospital, Paolo Giaccone, Palermo, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, University Hospital, Paolo Giaccone, Palermo, Italy
| | - Luigi Basile
- Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, University Hospital, Paolo Giaccone, Palermo, Italy
| | - Favia Meccio
- Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, University Hospital, Paolo Giaccone, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, University Hospital, Paolo Giaccone, Palermo, Italy
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9
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Graziano F, Certo F, Basile L, Maugeri R, Grasso G, Meccio F, Ganau M, Iacopino DG. Autologous fibrin sealant (Vivostat(®)) in the neurosurgical practice: Part I: Intracranial surgical procedure. Surg Neurol Int 2015; 6:77. [PMID: 25984391 PMCID: PMC4429333 DOI: 10.4103/2152-7806.156871] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/08/2015] [Indexed: 12/17/2022] Open
Abstract
Background: Hemorrhages, cerebrospinal fluid (CSF) fistula and infections are the most challenging postoperative complications in Neurosurgery. In this study, we report our preliminary results using a fully autologous fibrin sealant agent, the Vivostat® system, in achieving hemostasis and CSF leakage repair during cranio-cerebral procedures. Methods: From January 2012 to March 2014, 77 patients were studied prospectively and data were collected and analyzed. Autologous fibrin sealant, taken from patient's blood, was prepared with the Vivostat® system and applied on the resection bed or above the dura mater to achieve hemostasis and dural sealing. The surgical technique, time to bleeding control and associated complications were recorded. Results: A total of 79 neurosurgical procedures have been performed on 77 patients. In the majority of cases (98%) the same autologous fibrin glue provided rapid hemostasis and dural sealing. No patient developed allergic reactions or systemic complications in association with its application. There were no cases of cerebral hematoma, swelling, infection, or epileptic seizures after surgery whether in the immediate or in late period follow-up. Conclusions: In this preliminary study, the easy and direct application of autologous fibrin sealant agent helped in controlling cerebral bleeding and in providing prompt and efficient dural sealing with resolution of CSF leaks. Although the use of autologous fibrin glue seems to be safe, easy, and effective, further investigations are strongly recommended to quantify real advantages and potential limitations.
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Affiliation(s)
- Francesca Graziano
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, University of Palermo, Italy
| | | | - Luigi Basile
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, University of Palermo, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, University of Palermo, Italy
| | - Giovanni Grasso
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, University of Palermo, Italy
| | - Flavia Meccio
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, University of Palermo, Italy
| | - Mario Ganau
- Harvard Medical School, Cambridge, MA, USA and Department of Biomedical Engineering, University of Cagiari, Italy
| | - Domenico G Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, University of Palermo, Italy
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10
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Okuda T, Fujita M, Yoshioka H, Tasaki T, Kato A. Novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue for complete resection. Surg Neurol Int 2014; 5:100. [PMID: 25101195 PMCID: PMC4123252 DOI: 10.4103/2152-7806.135304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/02/2014] [Indexed: 11/17/2022] Open
Abstract
Background: An outstanding issue regarding the surgical treatment of cyst-type metastatic brain tumors is the incomplete resection of cyst walls. Herein we propose a novel surgical technique that can overcome this issue. During a surgical procedure for cystic tumors, autologous fibrin glue is to be injected into the tumor cysts, which solidifies the cyst lumens and cyst walls en bloc with reducing the tumor size. As a result, tumor masses and cyst walls can be removed completely in an en bloc fashion in all cases. Methods: The illustrative case presented in this report is a patient with metastatic brain tumors in the frontal lobe. When we reached the tumor wall surgically, we first suctioned out the cyst content and subsequently injected autologous fibrin glue into the cyst lumen. The autologous fibrin glue solidified the tumor en bloc, and we resected the tumor mass and the cyst walls in an en bloc fashion. Results: We have applied this technique to four cases with cyst-type metastatic brain tumors. This approach made it possible to perform ideal en bloc resection in all cases. There were no adverse events due to the autologous fibrin glue. Conclusion: We developed a novel surgical technique to solidify cyst-type metastatic brain tumors using autologous fibrin glue, which allows en bloc resection of tumor masses and cyst walls quite safely using inexpensive materials. Given these advantages, it appears a promising surgical strategy for cyst-type metastatic brain tumors.
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Affiliation(s)
- Takeshi Okuda
- Department of Neurosurgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Mitsugu Fujita
- Department of Microbiology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Hiromasa Yoshioka
- Department of Neurosurgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Takayuki Tasaki
- Department of Neurosurgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Amami Kato
- Department of Neurosurgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
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