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Amirhekmat A, Brown WE, Salinas EY, Hu JC, Athanasiou KA, Wang D. Mechanical Evaluation of Commercially Available Fibrin Sealants for Cartilage Repair. Cartilage 2024; 15:147-155. [PMID: 36974340 DOI: 10.1177/19476035231163273] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Fibrin sealants are routinely used for intra-articular surgical fixation of cartilage fragments and implants. However, the mechanical properties of fibrin sealants in the context of cartilage repair are unknown. The purpose of this study was to characterize the adhesive and frictional properties of fibrin sealants using an ex vivo model. DESIGN Native bovine cartilage-bone composites were assembled with a single application of Tisseel or Vistaseal. Composites were tested in tension and lap shear. In addition, the coefficient of friction (COF) was measured in a native cartilage annulus model alone and with minced cartilage. Finally, the effect of a double application of fibrin sealant was evaluated. RESULTS There were no significant differences in tensile modulus, ultimate tensile strength (UTS), shear modulus, or ultimate shear strength (USS) between the 2 fibrin sealants. Both fibrin sealants demonstrated a UTS and USS of <8 and <30 kPa, respectively. There were no differences in COF between the sealants when tested alone or with minced cartilage. A double application of fibrin sealant did not alter the mechanical properties compared with a single application of fibrin sealant. CONCLUSIONS Fibrin sealant adhesive properties are not affected by the sealant type studied or the number of applications in a bovine cartilage-bone model. Fibrin sealant tribological properties are not affected by sealant type or the addition of minced cartilage. The adhesive properties of Tisseel and Vistaseal were less than those desired for the in vivo fixation of cartilage repair implants. These findings motivate the development of an improved cartilage-specific adhesive for cartilage repair applications.
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Affiliation(s)
- Arya Amirhekmat
- School of Medicine, University of California, Irvine, Irvine, CA, USA
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
| | - Wendy E Brown
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Evelia Y Salinas
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Dean Wang
- School of Medicine, University of California, Irvine, Irvine, CA, USA
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
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Altorfer FCS, Sutter R, Farshad M, Spirig JM, Farshad-Amacker NA. MRI appearance of adjunct surgical material used in spine surgery. Spine J 2022; 22:75-83. [PMID: 34284130 DOI: 10.1016/j.spinee.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Early postoperative MR images are frequently necessary after spine surgery. The appearance of commonly used adjunct hemostatic agents and dural sealants in MR images has not been systematically evaluated. PURPOSE The purpose of this experimental study was to systematically analyze and describe the characteristics of the most commonly applied hemostatic agents and dural sealants in spine surgery on early postoperative MR images. STUDY DESIGN Cadaver Study METHODS: Four commonly applied dural sealants (Duraseal, Bioglue, Tachosil, Tisseel) and five commonly used hemostatic agents (Surgiflo, Bonewax, , Spongostan, Gelfoam, Avitene) were investigated. The experimental setting involved a human cadaver where a standard left-sided laminotomy was performed on nine levels of the thoracolumbar spine, and the materials were separately applied and mixed with fresh blood or water for hemostatic and dural sealants, respectively. The cadaver model was scanned at a 3 Tesla MRI and the imaging findings for all materials were compared to the surrounding tissue and systematically reported. RESULTS All investigated dural sealants and hemostatic agents were distinguishable from the surrounding tissue on MR images with different appearances on the MR sequences. A detailed atlas for the identification of the materials in postoperative spine MRI was established. CONCLUSION Commonly used hemostatic agents and dural sealants can be successfully identified on early postoperative spine MRI. CLINICAL SIGNIFICANCE Knowledge about MRI appearances of commonly used adjunct surgical materials helps in interpretation of postoperative imaging and supports clinical decision making.
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Affiliation(s)
- Franziska C S Altorfer
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Switzerland
| | - José M Spirig
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Switzerland
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Su YY, Lin YS, Yang LY, Pan YB, Huang YT, Weng CH, Wu KY, Wang CJ. Use of human fibrin glue ( Tisseel) versus suture during transvaginal natural orifice ovarian cystectomy of benign and non-endometriotic ovarian tumor: a retrospective comparative study. BMC Surg 2021; 21:49. [PMID: 33478468 PMCID: PMC7818905 DOI: 10.1186/s12893-021-01061-1] [Citation(s) in RCA: 1] [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: 05/31/2020] [Accepted: 01/13/2021] [Indexed: 01/16/2023] Open
Abstract
Background To evaluate the use of a human fibrin glue (Tisseel) for minor bleeding control and approximation of ovarian defect during transvaginal natural orifice ovarian cystectomy (TNOOC) of benign and non-endometriotic ovarian tumors. Methods A total of 125 women with benign and non-endometriotic ovarian tumors who underwent TNOOC between May 2011 and January 2020: 54 with the aid of Tisseel and 71 with traditional suture for hemostasis and approximation of ovarian defect. Surgical outcomes such as length of surgery, operative blood loss, postoperative pain score, and postoperative hospital stay were recorded. Before and immediately (10 days) and at 6 months after the procedure, serum anti-Müllerian hormone (AMH) levels were also determined. Results Complete hemostasis and approximation of ovarian defect were achieved in all cases. No significant difference was noted in the operating time, operative blood loss, postoperative pain scores after 12, 24 and 48 h, length of postoperative stay, and baseline AMH levels between the two groups. The operation did not have a negative effect on the immediate and 6-month postoperative AMH levels in the suture group. However, the decline in the AMH levels was significant immediately after surgery in the Tisseel group, nevertheless, no significant difference was noted in the AMH levels at 6 months (3.3 vs. 1.7 mg/mL; p = 0.042, adjusted p = 0.210). Conclusion The use of Tisseel in TNOOC of benign and non-endometriotic ovarian tumors without suturing the ovarian tissue is clinically safe and feasible.
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Affiliation(s)
- Yu-Ying Su
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Yu-Shan Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Yu-Bin Pan
- Clinical Trial Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Yi-Ting Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Cindy Hsuan Weng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | - Kai-Yun Wu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan.
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4
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Askar M, Gakhar H. Cauda equina syndrome after use of dural sealant in revision lumbar decompression surgery. Br J Neurosurg 2020:1-3. [PMID: 32897107 DOI: 10.1080/02688697.2020.1817855] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We report a case of cauda equina syndrome related to the use of fibrin glue dural sealant "TISSEEL". BACKGROUND Incidental durotomy (ID) is not uncommon in revision spinal surgery. Augmentation of the dural repair after primary closure is gaining popularity. The use of dural sealants is not risk-free. METHOD A 65-year old man who underwent revision lumbar decompression surgery developed postoperative cauda equina syndrome. He had urinary retention, bilateral leg pain and perianal numbness on the third postoperative day. We believe this complication was related to the use of fibrin glue to manage an ID. RESULT After the urgent surgical removal of the fibrin glue patch, the patient fully recovered with no residual neurological deficit. CONCLUSION Cauda equina syndrome development is a potential complication after the use of fibrin glue to augment intraoperative ID. Surgeons should be aware of this potential risk so it can be managed in a timely fashion.
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Affiliation(s)
- Mohamed Askar
- Trauma and Orthopaedics Department, Royal Derby Hospital, Derby, UK.,Orthopaedic Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Harinder Gakhar
- Trauma and Orthopaedics Department, Royal Derby Hospital, Derby, UK
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Roberts JM, Peterson VE, Heran MKS. Percutaneous CT-guided epidural fibrin sealant injection for refractory pediatric post-dural puncture headache. Pediatr Radiol 2020; 50:1156-8. [PMID: 32447413 DOI: 10.1007/s00247-020-04691-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/01/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
Post-dural puncture headache is an uncommon entity in young children and adolescents. Percutaneous epidural blood patching has been classically used to manage refractory post-dural puncture headaches. Injectable fibrin sealant has been shown in a few adult cases to relieve symptoms where blood patching has either failed or was not appropriate. We report a 10-year-old boy who experienced rapid relief of post-dural puncture headache symptoms following percutaneous lumbar epidural fibrin sealant injection under computed tomography guidance. Percutaneous epidural fibrin sealant injection may be an acceptable treatment for post-dural puncture headaches refractory to epidural blood patching, or when an epidural blood patch is otherwise contraindicated. The pediatric interventional radiologist should be aware of this off-label use of fibrin sealant.
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Somani SN, Moshirfar M, Shmunes KM, Ronquillo YC. Comparison and application of commercially available fibrin sealants in ophthalmology. Ocul Surf 2020; 18:418-426. [PMID: 32361085 DOI: 10.1016/j.jtos.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/19/2019] [Revised: 02/03/2020] [Accepted: 04/16/2020] [Indexed: 01/07/2023]
Abstract
Fibrin glues carry many advantages over traditional suture as a tissue adhesive and have been increasingly used in a variety of ophthalmic procedures over the past 15 years. Several fibrin sealants are commercially available worldwide, each of which differs slightly in its composition and mechanism of delivery. The focus of our review is to briefly discuss the reported uses of fibrin in ophthalmic surgery and provide a broad overview of the properties associated with each commercially available fibrin sealant.
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Affiliation(s)
- Shaan N Somani
- Northwestern Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA
| | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA; Utah Lions Eye Bank, Murray, UT, USA; HDR Research Center, Hoopes Vision, Draper, UT, USA.
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Galan D, Monuszko K, Sankey EW, Zakare-Fagbamila R, Yang Z, Niedzwiecki D, Gottfried O, Bagley CA, Krucoff MO. Fibrin glue as an adjuvant dural sealant reduces the rate of perioperative complications in posterior fossa decompression with duraplasty: A single center experience in 165 adult Chiari I patients. J Clin Neurosci 2019; 68:80-85. [PMID: 31327584 DOI: 10.1016/j.jocn.2019.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Diego Galan
- Duke University School of Medicine, United States
| | | | - Eric W Sankey
- Department of Neurosurgery, Duke University Medical Center, United States.
| | | | - Zidanyue Yang
- Department of Biostatistics and Bioinformatics, Duke University, United States
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University, United States
| | | | - Carlos A Bagley
- Department of Neurosurgery, University of Texas Southwestern Medical Center, United States
| | - Max O Krucoff
- Department of Neurosurgery, Duke University Medical Center, United States
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Sdralis E, Tzaferai A, Davakis S, Syllaios A, Kordzadeh A, Lorenzi B, Charalabopoulos A. Reinforcement of intrathoracic oesophago-gastric anastomosis with fibrin sealant ( Tisseel®) in oesophagectomy for cancer: A prospective comparative study. Am J Surg 2019; 219:123-128. [PMID: 31235074 DOI: 10.1016/j.amjsurg.2019.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/15/2019] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Fibrin sealant (Tisseel) is a human protein and thrombin soluble fibrinogen that has been indicated for reinforcement of gastro-intestinal anastomoses to prevent leakage. The objective of this study is to examine the impact of fibrin sealant regarding anastomotic leak, following Ivor-Lewis procedure. METHODS This is a prospective comparative study on 2-stage oesophagectomy for cancer of the distal oesophagus or oesophagogastric junction. N = 57 individuals were randomly subjected; n = 22 patients to Tisseel in combination to surgical anastomosis versus n = 35 patients to surgical anastomosis alone. The test of probability was assessed through Chi-Square, independent samples paired T-Test and Log-Rank analysis. RESULTS Of the 57 cases included, 56 underwent hybrid and 1 open oesophagectomy. In the Tisseel group, n = 5(22.7%) developed anastomotic leak comparing to n = 3(8.6%) of the control group. No statistically significant difference in leak rate was shown between the two groups; the test of probability was rejected. CONCLUSIONS Our results are not supportive of Tisseel tissue sealing property on the intrathoracic oesophago-gastric anastomosis and fibrin sealant's use cannot be justified.
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Affiliation(s)
- Elias Sdralis
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex, UK
| | - Anna Tzaferai
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex, UK
| | - Spyridon Davakis
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex, UK; First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Athanasios Syllaios
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex, UK; First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ali Kordzadeh
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex, UK
| | - Bruno Lorenzi
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex, UK
| | - Alexandros Charalabopoulos
- Regional Oesophago-Gastric Cancer Centre, Department of Upper Gastrointestinal Surgery, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex, UK; First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
The application of laparoscopic surgery via the vagina has been introduced at the beginning of this millennium. Here, we report a case of transvaginal extraction of a laparoscopic hepatectomy specimen. An exophytic liver mass originated from segment VI in a 24-year-old female was excised with laparoscopic technique using four trocars (0.5–1.2 cm sizes). The specimen (11 × 8.5 cm) was removed transvaginally instead of an abdominal incision. To the best of our knowledge, only six similar cases have been previously reported, with a patient age range of 32–74 years. Our case, due to younger age, had high cosmetic expectations. Specific to this case, we aimed a better aesthetic outcomes and better convalescence period and, we achieved these objectives. We believe that patient selection and experience on natural orifice specimen extraction were the keys to the success of the operation. We shared this technique with a video presentation.
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Affiliation(s)
- Veysel Ersan
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Aydin Aktas
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Ersin Gundogan
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Uygar Teomete
- Department of Radiology, Miami University, Coral Gables, FL, USA
| | - Fatih Sumer
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Servet Karagul
- Department of Surgery, Inonu University School of Medicine, Malatya, Turkey
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10
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Abstract
Background: Tisseel (Baxter International Inc., Westlake Village, CA, USA), a fibrin sealant, was originally devised to strengthen repairs of spinal cerebrospinal fluid (CSF) fistulas. Here, we evaluated how Tisseel correlated with hemostasis (e.g., defined as reduced postoperative drainage, time to drain removal, length of stay (LOS), and postoperative transfusion requirements) in 58 patients undergoing 2–3 vs. 79 patients having 4–6 level lumbar laminectomies. Methods: We assessed how Tisseel correlated with hemostasis in 58 patients undergoing 2–3 level laminectomies/stenosis (with 48 herniated discs and 20 synovial cysts, 1 degenerative spondylolisthesis) vs. 79 having 4–6 level laminectomies/stenosis (with 39 lumbar discs, 45 synovial cysts, and 26 degenerative spondylolisthesis). Results: Following 2–3 level laminectomies, the average drainage on postoperative day 1 was 87.26 cc, and on day 2 was 59.62 cc; most drains were removed and the majority of patients were discharged on postoperative day 2, requiring no transfusions. After 4–6 level decompressions, greater postoperative drainage was observed on postoperative days 1 (e.g., 156.63 cc), and 2 (115.8 cc), and many were continued for 3 (85.7 cc; 44 patients), and 4 postoperative days (93.6: 6 patients) respectively. Drains were typically removed and patients were discharged on postoperative days 3 and 4, with just 6 requiring transfusions. Notably, there were four CSF fistulas for patients undergoing 4–6 level laminectomies; one had a large disc hernation in conjunction with postoperative scare, while three had massive calcified synovial cysts extending to/through the dura. Conclusions: Utilizing Tisseel as a hemostatic allowed us to quantitate hemostasis (the average postoperative drainage, time to drain removal, LOS, and postoperative transfusion requirements) for those undergoing 2–3 level laminectomies vs. 4–6 level procedures with large subsets also exhibiting herniated discs, synovial cysts, and degenerative spondylolisthesis.
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Affiliation(s)
- Nancy E Epstein
- Professor of Clinical Neurosurgery, Schoold of Medicine, State University of New York at Stony Brook and Chief of Neurosurgical Spine and Education, NYU Winthrop Hospital, NYU Winthrop NeuroScience, NY, USA
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Cravens MG, Behn AW, Dragoo JL. Comparison of mechanical compressive properties of commercial and autologous fibrin glues for tissue engineering applications. Clin Biomech (Bristol, Avon) 2017; 49:34-39. [PMID: 28863319 DOI: 10.1016/j.clinbiomech.2017.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/17/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fibrin glues are widely used in orthopedic surgery as adhesives and hemostatic agents. We evaluated the compressive properties of selected fibrin glues in order to identify which are appropriate for tissue regeneration applications subject to compression. METHODS Uniaxial unconfined compression tests were performed on fibrin gels prepared from commercial and autologous products: (1) Evicel (Ethicon), (2) Tisseel (Baxter), (3) Angel (Arthrex), and (4) ProPlaz (Biorich). Cyclic loads were applied from 0 to 30% strain for 100cycles at 0.5Hz. Following cyclic testing, specimens were subjected to ramp displacement of 1% strain per second to 80% strain. FINDINGS Throughout cyclic loading, Evicel and Tisseel deformed (shortened) less than Angel at all but one time point, and deformed less than ProPlaz at cycles 10 and 20. The dynamic moduli, peak stress, and strain energy were significantly greater in Tisseel than all other groups. Evicel displayed significantly greater dynamic moduli, peak stress, and strain energy than Angel and ProPlaz. Following cyclic testing, Tisseel and Evicel were significantly less deformed than Angel. No specimens exhibited gross failure during ramp loading to 80% strain. Ramp loading trends mirrored those of cyclic loading. INTERPRETATION The tested commercial glues were significantly more resistant to compression than the autologous products. The compressive properties of Tisseel were approximately twice those of Evicel. All preparations displayed moduli multiple orders of magnitude less than that of native articular cartilage. We conclude that in knee surgeries requiring fibrin glue to undergo compression of daily activity, commercial products are preferable to autologous preparations from platelet-poor plasma, though both will deform significantly.
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Affiliation(s)
- Matthew G Cravens
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony W Behn
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason L Dragoo
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Kılıç B, Erşen E, Demirkaya A, Kara HV, Alizade N, İşcan M, Kaynak K, Turna A. A prospective randomized trial comparing homologous and autologous fibrin sealants for the control of alveolar air leak. J Thorac Dis 2017; 9:2915-2922. [PMID: 29221263 DOI: 10.21037/jtd.2017.08.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Postoperative air leak is a common complication seen after pulmonary resection. It is a significant reason of morbidity and also leads to greater hospital cost owing to prolonged length of stay. The purpose of this study is to compare homologous sealant with autologous one to prevent air leak following pulmonary resection. Methods A total of 57 patients aged between 20 and 79 (mean age: 54.36) who underwent pulmonary resection other than pneumonectomy (lobar or sublobar resections) were analyzed. There were 47 males (83%) and 10 females (17%). Patients who intraoperatively had air leaks were randomized to receive homologous (Tisseel; n=28) or autologous (Vivostat; n=29) fibrin sealant. Differences among groups in terms of air leak, prolonged air leak, hospital stay, amount of air leak were analyzed. Results Indications for surgery were primary lung cancer in 42 patients (71.9%), secondary malignancy in 5 patients (8.8%), and benign disease in 10 patients (17.5%). Lobectomy was performed in 40 patients (70.2%), whereas 17 patients (29.8%) had wedge resection. Thirteen (46.4%) patients developed complications in patients receiving homologous sealant while 11 (38.0%) patients had complication in autologous sealant group (P=0.711). Median duration of air leak was 3 days in two groups. Time to intercostal drain removal was 3.39 and 3.38 days in homologous and autologous sealant group respectively (P=0.978). Mean hospital stay was 5.5 days in patients receiving homologous sealant whereas it was 5.0 days in patients who had autologous agent (P=0.140). There were no significant differences between groups in terms of measured maximum air leak (P=0.823) and mean air leak (P=0.186). There was no significant difference in the incidence of complications between two groups (P=0.711). Conclusions Autologous and heterologous fibrin sealants are safe and acts similarly in terms of air leak and hospital stay in patients who had resectional surgery.
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Affiliation(s)
- Burcu Kılıç
- Department of Thoracic Surgery, Cerrahpasa School of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Ezel Erşen
- Department of Thoracic Surgery, Cerrahpasa School of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Ahmet Demirkaya
- School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey
| | - H Volkan Kara
- Department of Thoracic Surgery, Cerrahpasa School of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Nurlan Alizade
- Department of Thoracic Surgery, Cerrahpasa School of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Mehlika İşcan
- Department of Thoracic Surgery, Cerrahpasa School of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Kamil Kaynak
- Department of Thoracic Surgery, Cerrahpasa School of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Akif Turna
- Department of Thoracic Surgery, Cerrahpasa School of Medicine, Istanbul University, Fatih, Istanbul, Turkey
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13
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Pereira EAC, Grandidge CA, Nowak VA, Cudlip SA. Cerebrospinal fluid leaks after transsphenoidal surgery - Effect of a polyethylene glycol hydrogel dural sealant. J Clin Neurosci 2017; 44:6-10. [PMID: 28676314 DOI: 10.1016/j.jocn.2017.06.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 12/07/2016] [Revised: 05/04/2017] [Accepted: 06/08/2017] [Indexed: 11/30/2022]
Abstract
To investigate cerebrospinal fluid (CSF) leak rates after mainly endoscopic endonasal transsphenoidal surgery with and without polyethylene glycol hydrogel dural sealant (DuraSeal®), we prospectively collected data from a single-centre consecutive case series over four years from January 2007 to December 2010 inclusive. 250 patients were identified (135 male, 115 female; median age 52years, range 14-83). 180 patients received DuraSeal® (72%). 85 (34%) had intra-operative dural breach and 13 (5.2%) developed post-operative CSF leaks (3 without intra-operative dural breach) requiring lumbar drainage or formal repair. Of this group 5/251 (2.0%) patients required a formal repair. Post-operative CSF leak was seen in 5/189 (2.7%) of patients with pituitary adenoma, of which 2/5 (40%) were in cases undergoing revision surgery. 5/13 (38.4%) patients who developed a CSF leak presented with either Rathke's cleft cyst or craniopharyngioma. 3/71 patients not receiving DuraSeal® leaked (4.2%) and 10/180 patients receiving DuraSeal® leaked (5.6%). 11/234 patients without Tisseel (4.7%) and 2/16 receiving Tisseel (12.5%) leaked. 54 patients (22%) received intra-operative lumbar drains, one of whom developed subsequent CSF leak (1.9%), in contrast to 12/197 (6.1%) of patients without intra-operative lumbar drains who later developed CSF leak. The rate of post-operative CSF leak requiring re-exploration and nasoseptal flap repair was low (2.0%) in this mainly endoscopic case series without statistically significant benefit from either DuraSeal® or Tisseel. Intra-operative and post-operative lumbar drainage appears beneficial in patients at higher risk of post-operative CSF leak.
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Affiliation(s)
- Erlick A C Pereira
- Academic Neurosurgery Unit, St George's, University of London, London, UK.
| | - Carly A Grandidge
- Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Victoria A Nowak
- Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Simon A Cudlip
- Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
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Cobb R, Muscat K, Cascarini L, Fry A. Fibrin sealant ( Tisseel™) for mesh fixation in repair of the deep circumflex iliac artery (DCIA) free flap donor site. Br J Oral Maxillofac Surg 2017; 55:748-749. [PMID: 28576300 DOI: 10.1016/j.bjoms.2017.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Affiliation(s)
- R Cobb
- Department of Head & Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT.
| | - K Muscat
- Department of Head & Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT
| | - L Cascarini
- Department of Head & Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT
| | - A Fry
- Department of Head & Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT
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Yamamoto KT, DeJoseph LM. Efficacy and Safety of Artiss Fibrin Tissue Sealant Use in Rhytidectomy: A Review of 120 Cases. Surg J (N Y) 2017; 3:e69-e74. [PMID: 28825024 PMCID: PMC5553512 DOI: 10.1055/s-0037-1599237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/04/2016] [Accepted: 01/18/2017] [Indexed: 12/02/2022] Open
Abstract
Hematoma formation has persisted as the most common complication in rhytidectomy. The objective of this study is to determine the efficacy and safety of Artiss (Baxter) for use in rhytidectomies. In addition, we determine the use of fibrin tissue sealants by facial plastic surgeons. In this retrospective chart review, 120 patients in a single private practice were identified who underwent a rhytidectomy from August 2013 to January 2015 by a single facial plastic surgeon. The last 60 rhytidectomies performed with Tisseel (Baxter) were compared with the first 60 rhytidectomies performed with Artiss. All perioperative or postoperative complications were identified and recorded, focusing on the incidence of hematoma. In addition, a six-question survey was created and sent to all members of the American Academy of Facial Plastic and Reconstructive Surgery. Results of the survey were recorded and analyzed for trends or patterns in the data. In total, 120 patients were assessed. In the Tisseel group, two complications of fluid collection requiring needle aspiration were recorded. No other complications were found. In the Artiss group, 10 complications were recorded, including 9 fluid collections requiring needle aspiration and 1 hematoma. In total, 179 members of the American Academy of Facial Plastic and Reconstructive Surgery completed the six-question survey. Of all respondents, 61 (34%) use tissue sealants for rhytidectomies, whereas 118 (66%) do not. Artiss is efficacious and safe for use in rhytidectomies. Its use obviates the need for surgical drains, and complications are minimal and similar in rate to the use of Tisseel.
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Affiliation(s)
- Kyle T Yamamoto
- Premier Image Cosmetic and Laser Surgery, Atlanta, Georgia.,Sierra Nevada Cosmetic and Laser Surgery, Reno, Nevada
| | - Louis M DeJoseph
- Premier Image Cosmetic and Laser Surgery, Atlanta, Georgia.,Sierra Nevada Cosmetic and Laser Surgery, Reno, Nevada
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Li CC, Yeh HC, Lee HY, Li WM, Ke HL, Hsu AH, Lee MH, Tsai CC, Chueh KS, Huang CN, Chou YH, Li CF, Wu WJ. Laparoscopic partial nephrectomy without intracorporeal suturing. Surg Endosc 2016; 30:1585-91. [PMID: 26162423 DOI: 10.1007/s00464-015-4382-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/26/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Partial nephrectomy has gained wider acceptance as a surgical technique in treating small renal tumors. Laparoscopic partial nephrectomy (LPN) still remains a technically demanding surgery to this day. We present our technique of laparoscopic partial nephrectomy, one that is performed without intracorporeal suturing. METHODS We performed LPN on 31 patients with localized renal parenchymal tumor (stage T1). The procedures were done from September 2009 to March 2015 at the Kaohsiung Medical University Hospital and the Kaohsiung Municipal Ta-Tung Hospital. Our technique involves the covering of renal defect layer by layer with FloSeal, Tisseel and a fat pad after monopolar coagulation. RESULTS Thirty-one patients were included in this study. Mean patient age was 53 years old (range 39-70). Mean tumor size was 2.9 cm (range 1.8-6.3). Mean RENAL nephrometry score was 5.3 (range 4-7). The average operation time was 188 min (range 120-290), and the average warm ischemic time was 19.0 min (range 9-26). Mean estimated blood loss was 171 ml (range 10-650), with no postoperative bleeding among the total 31 patients. No recurrent tumors were identified at a mean follow-up of 29 months postoperatively. The mean change in eGFR was 6.5 (ml/min/m2). CONCLUSION Laparoscopic partial nephrectomy is a feasible surgical method for most patients with stage 1 tumor. Our technique has shown to reduce warm ischemic time significantly and provide patients with excellent functional outcomes without affecting oncological results. With this technique, surgeons can perform LPN with more efficiency and with fewer complications.
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Epstein NE. Hemostasis and other benefits of fibrin sealants/glues in spine surgery beyond cerebrospinal fluid leak repairs. Surg Neurol Int 2014; 5:S304-14. [PMID: 25289150 PMCID: PMC4173211 DOI: 10.4103/2152-7806.139615] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 02/04/2014] [Accepted: 03/17/2014] [Indexed: 11/22/2022] Open
Abstract
Background: Fibrin sealants (FS)/glues (FG) are primarily utilized in spinal surgery to either strengthen repairs of elective (e.g., intradural tumors/pathology) or traumatic cerebrospinal fluid (CSF) fistulas. Here, additional roles/benefits of FS/FG in spine surgery are explored; these include increased hemostasis, reduction of scar, reduction of the risk of infection if impregnated with antibiotics, and its application to restrict diffusion and limit some of the major complications attributed to the controversial “off-label” use of bone morphogeneitc protein (rhBMP-2/INFUSE). Methods: We reviewed multiple studies, focusing not just on the utility of FS/FG in the treatment of CSF fistulas, but on its other applications. Results: FS/FG have been primarily used to supplement elective/traumatic dural closure in spinal surgery. However, FS/FG also contribute to; hemostasis, reducing intraoperative/postoperative bleeding/transfusion requirements, length of stay (LOS)/costs, reduced postoperative scar/radiculitis, and infection when impregnated with antibiotics. Nevertheless, one should seriously question whether FS/FG should be applied to prevent diffusion and limit major complications attributed to the “off-label” use of BMP/INFUSE (e.g., limit/prevent heterotopic ossification, dysphagia/respiratory decompensation, and new neurological deficits). Conclusions: FS/FG successfully supplement watertight dural closure following elective (e.g., intradural tumor) or traumatic CSF fistulas occurring during spinal surgery. Additional benefits include: intraoperative hemostasis with reduced postoperative drainage, reduced transfusion requirements, reduced LOS, cost, scar, and prophylaxis against infection (e.g., impregnated with antibiotics). However, one should seriously question whether FS/FG should be used to contain the diffusion of BMP/INFUSE and limit its complications when utilized “off-label”.
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Affiliation(s)
- Nancy E Epstein
- Chief of Neurosurgical Spine, Education, and Research Winthrop University Hospital, Mineola, N.Y., USA, 11501
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Epstein NE. Tisseel utilized as hemostatic in spine surgery impacts time to drain removal and length of stay. Surg Neurol Int 2014; 5:S354-61. [PMID: 25289160 PMCID: PMC4173204 DOI: 10.4103/2152-7806.139668] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 06/05/2014] [Accepted: 06/12/2014] [Indexed: 11/08/2022] Open
Abstract
Background: Although fibrin sealants (FSs) and fibrin glues (FGs) are predominantly utilized to strengthen repairs of cerebrospinal fluid (CSF) fistulas (deliberate/traumatic) during spinal surgery, they are also increasingly utilized to achieve hemostasis. Here, we investigated whether adding Tisseel (Baxter International Inc., Westlake Village, CA, USA), utilized to address increased bleeding during multilevel lumbar laminectomies with non-instrumented fusions, would reduce or equalize the time to drain removal and length of stay (LOS) without contributing to infections or prolonging time to fusion. Methods: Prospectively, 39 patients underwent multilevel laminectomies and 1-2 level non-instrumented (in situ) fusions to address stenosis/olisthesis; 22 who demonstrated increased intraoperative bleeding received Tisseel, while 17 without such bleeding did not. Results: The 22 receiving versus 17 not receiving Tisseel, with similar clinical parameters, underwent comparable average multilevel laminectomies (4.36 and 4.25) and 1-2 level fusions (1.4 vs. 1.29 levels). As anticipated, for those receiving Tisseel, the average intraoperative estimated blood loss (EBL), total postoperative blood loss, and total perioperative transfusion requirements [red blood cells (RBC), fresh frozen plasma (FFP), platelets] were higher. However, Tisseel had the added benefit of equalizing the time to postoperative drain removal [e.g. 3.41 days (with) vs. 3.38 days (without)] and LOS [e.g. 5.86 days (with) vs. 5.82 days (without)] without increasing the infection rates (e.g. one superficial infection per group) or average times to fusion (e.g. 5.9 vs. 5.5 months). Conclusions: Adding Tisseel for increased bleeding during multilevel laminectomies/in situ fusions contributed to hemostasis by equalizing the average times to drain removal/LOS compared to patients without increased bleeding and not requiring Tisseel.
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Affiliation(s)
- Nancy E Epstein
- Chief of Neurosurgical Spine and Education, Winthrop University Hospital, Mineola, NY, USA
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Dwyer JF, McCoy JA, Yang Z, Husser M, Redl H, Murphy MA, Wolfsegger M, DiOrio JP, Goppelt A, Donovan S. Thrombin based gelatin matrix and fibrin sealant mediated clot formation in the presence of clopidogrel. Thromb J 2014; 12:10. [PMID: 24891841 PMCID: PMC4041347 DOI: 10.1186/1477-9560-12-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/12/2013] [Accepted: 04/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Platelet inhibitors are commonly used to reduce the risk of atherothrombotic events. The aim of this study was to determine the impact of platelet inhibitors, specifically clopidogrel and aspirin, on clot kinetics, strength, and/or structure during the use of thrombin based gelatin matrices and fibrin sealants. METHODS Blood was collected and heparinized from donors on clopidogrel (and aspirin) and age matched control donors. Blood component analysis, whole blood platelet aggregometry, and activated clotting time (ACT) were used to monitor compliance to therapy and identify any differences between donor groups. Clot kinetics and strength were analyzed using thrombelastography (TEG). Field Emission Scanning Electron Microscopy (FESEM) was used to analyze clot structure. RESULTS Blood component profiles were similar for both donor groups. Aggregometry indicated that aggregation response to adenosine diphosphate (ADP) for clopidogrel donors was 12% of that for the controls (p = 0.0021), an expected result of clopidogrel induced platelet inhibition. However, blood from both donor groups had an elevated thrombin induced aggregation response. Heparinization of donor blood resulted in similarly elevated ACTs for both donor groups. TEG results indicated similar clot kinetics and strength between clopidogrel and control donor groups for blood alone and when clotting was induced using thrombin based gelatin matrices and fibrin sealants. FESEM images supported TEG findings in that similar morphologies were observed in ex vivo formed clots from both donor groups when thrombin based gelatin matrices and fibrin sealants were used. CONCLUSION These results suggest that platelet inhibitors do not negatively impact clot kinetics, strength, and structure when clotting is initiated with thrombin based gelatin matrices and fibrin sealants.
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Affiliation(s)
| | - Jill A McCoy
- Baxter Healthcare Corporation, Deerfield, IL, USA
| | - Ziping Yang
- Baxter Healthcare Corporation, Deerfield, IL, USA
| | | | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | | | | | | | - Andreas Goppelt
- Baxter Innovations GmbH, Wagramerstrasse 17-19, 1220 Wien, Austria
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Al-Qahtani K. Initial experience with hemostatic fibrin glue as adjuvant during drainless parotidectomy. Saudi Dent J 2010; 23:67-71. [PMID: 23960501 DOI: 10.1016/j.sdentj.2010.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 08/18/2010] [Revised: 11/05/2010] [Accepted: 11/15/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the use of Hemostatic Fibrin Glue in parotidectomy without the use of surgical drains. STUDY DESIGN Prospective cohort study of 10 patients undergoing parotidectomy. Surgery as a one day admission without the use of surgical drains was planned. The complication and duration of the hospital stay were obtained. METHODS Parotidectomy was undertaken by one surgeon. Prior to wound closure, the skin flap and wound bed were approximated using Tisseel tissue sealant. Data regarding the incidence of any complication and the duration of the hospital stay were obtained. Patients were followed to assess surgical outcome and document any complications. The mean follow-up period was 8 months (range 4-12 months). RESULTS There were no major surgical complications. Two patients had facial nerve weakness due to adherence of the tumour in the facial nerve, in there was which complete recovery after few months. All patients were discharged the next day. None of the patients felt that the discharge had been premature. CONCLUSIONS Parotidectomy can be undertaken safely without the need for surgical drains, therefore, allowing the patients to leave the hospital on the first postoperative day.
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Affiliation(s)
- Khalid Al-Qahtani
- King Saud University, ORL & Head and Neck Surgery, King Abdulaziz Street, Riydah 0533301118, Saudi Arabia
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