Microneural anastomosis with fibrin glue: an experimental study.
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An experimental study was designed to compare the histological analysis of nerve anastomosis with 10-0 microsurgical sutures and fibrin adhesive. Wistar albino rats' sciatic nerves were transected and repaired either with fibrin adhesive-Beriplast P (M/s Centeon-Cadila Health Care) or with 10-0 monofilament microsutures. Histological assessment was performed at 10, 20, 30, 60 and 90 days after surgery. Functional recovery of the sciatic nerves started at two months and was near normal by three months. Separation of the stumps did not occur in any of the glued nerves. Histological evaluation showed no appreciable difference in the outcome of nerve regeneration after microsurgical repair using sutures or fibrin tissue adhesive. However, inflammation and granuloma formation were appreciated at the suture site, which presented a focal hindrance to myelin and axonal regeneration. Fibrin glueing is attractive for clinical purposes, since it is simpler and less time consuming than suturing. (+info)
A randomised, controlled trial comparing a tissue adhesive (2-octylcyanoacrylate) with adhesive strips (Steristrips) for paediatric laceration repair.
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OBJECTIVE: To compare the tissue adhesive 2-octylcyanoacrylate (Dermabond) with adhesive strips, Steristrips in paediatric laceration repair. METHOD: Children with suitable lacerations were randomly allocated for wound closure with either a tissue adhesive or adhesive strips. Thirty children were treated in each group. Linear Visual Analogue Scores were used to judge parents' and nurses' opinions of the application of each treatment. A similar scoring system was used to judge the cosmetic outcome as viewed by parents and a plastic surgeon. Complications and trial failures were noted. RESULTS: Complete data were available for 44 of the children. Parents viewed the treatments as equally acceptable. In contrast those performing the procedure judged the tissue adhesive more difficult to apply. Scores of cosmetic outcome by both parents and the plastic surgeon showed no significant difference in the treatment method used. There were four children in the tissue adhesive group and one from the adhesive strip group in whom the wounds were unable to be closed. CONCLUSION: Both tissue adhesives and adhesive strips are excellent "no needle" alternatives for the closure of suitable paediatric lacerations. This study suggests that the techniques are similar in efficacy, parental acceptability, and cosmetic outcome. The choice as to which is used may come down to economics and operator preference. (+info)
Does fibrin glue reduce complications after femoral artery surgery? A randomised trial.
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OBJECTIVES: to determine whether application of fibrin glue before closure of inguinal wounds reduces the incidence of lymphatic complications. DESIGN: we a prospective randomised trial. MATERIALS AND METHODS: 224 consecutive patients were enrolled. The wounds were randomly assigned to standard closure (group A, n = 134) or closure with application of fibrin glue (group B, n = 132). The incidence of local lymphatic and non-lymphatic complications, the amount of lymphatic fluid collected, and the time to drain removal were compared in the groups. RESULTS: the incidence of lymphatic complications was 19% in group A and 10% in group B (p = 0.027). The average drain output and the time to drain removal did not differ in the two groups. The total incidence of non-lymphatic local complications was 10% and did not differ in the two groups. CONCLUSIONS: fibrin glue application is associated with a significant reduction in lymphatic complications. (+info)
Surgical treatment of left ventricular free wall rupture after myocardial infarction: case series.
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AIM: To analyze the results of surgical treatment of left ventricular free wall rupture after acute myocardial infarct in a case series. METHOD: From 1984 to 2001, 25 patients (10 women and 15 men) were surgically treated in our Center for left ventricular free wall rupture after acute myocardial infarction. Their mean age was 62 years (range, 42-80). Cardiac symptoms (chest pain and/or dyspnea) prior to admission were recorded in 4 patients. One patient had acute myocardial infarction of the anterolateral wall, 6 patients of the lateral wall, 13 patients of the anterior wall, 4 patients of the inferior wall, and one patient had a right ventricle infarction. Thrombolytic therapy was administered in 10 patients, according to the criteria of the American Heart Association and Spanish Society of Cardiology criteria. In all patients, the final diagnosis was established echocardiographically before the surgery. RESULTS: All patients underwent surgical intervention on an emergency basis. Extracorporeal circulation was used in the first 9 cases, whereas the next 16 patients had off-pump surgery. Two patients had heart arrest during off-pump surgery, which required extracorporeal circulation support. One patient was found false positive for rupture only at surgery. In the first 4 cases, we performed a direct suture after excising necrotic tissue, in the next 15 cases we sutured a patch over the infarction zone, and in the last 5 patients we used Teflon patch fixed with fibrin glue and polypropylene and stitched to the epicardium with a continuous suture. Out of 24 patients, 8 died: one in the surgical room from uncontrollable bleeding and another 7 between 30 and 90 days after the surgery in the intensive care unit. All of them underwent surgery with extracorporeal circulation. There were no deaths among the patients undergoing off-pump surgery. Three out of 4 patients in whom direct suture and necrotic tissue excision was performed died in the hospital. Five out of 19 patients in whom patch correction with direct suture was done died in the hospital. CONCLUSION: The left ventricle free wall rupture, as a complication of acute myocardial infarction, can be diagnosed early and treated on time. Rapid diagnosis and emergency surgery are crucial for successful treatment of patients with impending heart rupture. Off-pump surgery and patch with glue technique seem to yield best results. (+info)
New surgical technique of left ventricular free wall rupture: double patch sealing method.
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We experienced two cases of left ventricular free wall rupture (LVFWR) following acute myocardial infarction (AMI). Case 1, with the blowout type of LVFWR was initially closed by direct suture, followed by hemostasis using a double patch sealing method (DPS) by which the tear was doubly sealed with large and small bovine pericardium patches to which GRF glue was applied. Case 2 with the oozing type of LVFWR was treated only using DPS. Complete hemostasis was achieved in both cases, and aneurysmal dilatation or constrictive heart failure were not detected by postoperative left ventriculography. Therefore, DPS may be useful for treating LVFWR following AMI. (+info)
Fibrin glue for persistent pneumothorax in neonates.
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Fibrin glue was used to treat significant pneumothoraces persisting for an average of 10 days in eight newborns. Six of the eight infants had reduction or resolution of persistent air leak within 24 hours of therapy. Two infants received a second course of therapy for recurrences. Complications encountered were bradycardia requiring manual ventilation (N=2), significant hypercalcemia (N=2), diaphragmatic paralysis (N=2), pneumothorax (PTX) on the contralateral side (N=1), and localized tissue necrosis (N=1). Fibrin glue is an effective treatment for intractable PTX but has significant risks. (+info)
Treatment of a primary type IA endoleak with a liquid embolic system under conditions of aortic occlusion.
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We present the case of a primary type IA endoleak after deployment of a bifurcated Ancure endograft (Guidant Endovascular Solutions, Menlo Park, Calif) to treat a 9-cm abdominal aortic aneurysm with a short angulated neck. The endoleak was treated unsuccessfully with repeat balloon angioplasty, placement of a Palmaz aortic stent (Cordis Endovascular, Miami, Fla), and deployment of an AneuRx aortic extender cuff (Medtronic AneuRx, Santa Rosa, Calif). The endoleak then was sealed with injection of n-butyl cyanoacrylate into the aneurysm sac at the site of the leak with occlusion of aortic flow. We suggest the use of this liquid embolic agent be considered as an adjunct to control primary type IA endoleaks when other forms of therapy have failed. (+info)
R136K fibroblast growth factor-1 mutant induces heparin-independent migration of endothelial cells through fibrin glue.
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OBJECTIVES: R136K is a mutation of fibroblast growth factor-1 (FGF-1) in which arginine replaces lysine at the primary thrombin cleavage site. This may be important in vivo in inducing endothelial cell (EC) migration and coverage of arterial injury sites by allowing R136K to be used in a fibrin glue delivery system, without thrombin-induced degradation, in the absence of heparin. The objectives of this study were to determine whether R136K, with and without heparin, can induce migration of EC and smooth muscle cells (SMC) through fibrin glue, and to compare these results with those of wild-type FGF-1; and to determine the resistance of R136K to thrombin-induced degradation versus FGF-1. METHODS: The dose-response migration through fibrin glue induced by wild-type FGF-1 and the R136K mutant in the presence and absence of heparin was tested with EC and SMC. Migration was tested with 50, 100, and 200 ng/mL of both FGF-1 and R136K, either with or without 5 U/mL of heparin. Migration of EC was also assessed after growth inhibition with mitomycin C. A novel modified Boyden chamber-type migration assay using fibrin glue on the upper surface of the chamber filter was used to test migration. The fluorescent marker calcein was used to identify those cells that had migrated through the fibrin glue and were embedded in the filter. Molecular degradation by thrombin was assessed with sodium dodecylsulfate polyacrylamide gel electrophoresis. RESULTS: For EC, R136K in the absence of heparin induced significantly more migration than did FGF-1 at 50 (P <.002), 100 (P <.0001), and 200 (P <.0001) ng/mL. In the presence of heparin, a chemotactic response of EC to cytokine was seen at all doses, with no significant difference between FGF-1 and R136K. A dose-dependent difference was noted in this group between the 100 and 200 ng/mL concentrations of cytokine (for FGF-1, P <.0001; for R136K, P <.0001). SMC showed no difference in migration with FGF-1, R136K, or negative control at any dose in the presence or absence of heparin. Gel electrophoresis demonstrated that R136K was more resistant to thrombin degradation than was FGF-1. CONCLUSION: Site-directed mutagenesis of FGF-1 to R136K enables induction of heparin-independent migration of EC through fibrin glue at an optimal concentration of 100 ng/mL. Neither FGF-1 nor R136K elicits SMC migration through fibrin glue. The ability of R136K to induce EC migration through fibrin glue in the absence of heparin may prove useful in vivo by inducing EC migration and coverage of arterial injury sites, thus potentially reducing thrombogenicity and intimal hyperplasia. (+info)