Morphology of the early hemostasis in human skin wounds: influence of acetylsalicylic acid.

The in vivo formation of hemostatic plugs was studied in humans in skin wounds made using the template bleeding procedure of Mielke (34). The wounds were excised by punch biopsy 10 seconds, 30 seconds, 2 minutes, and 3 minutes after they were made. The wounds were V-shaped and approximately 0.4 mm. deep. Within 30 seconds small hemostatic plugs were observed at the end of transected vessels. The plugs grew in size in the subsequent minutes and became impermeable. The platelets degranulated and formed pseudopods which became strongly interdigitated. The platelets at the periphery of the plugs showed discontinuities of the membranes. Cytoplasmic matrix and cell organelles had disappeared in many of these peripheral cells. Small fibrin fibers were already found at 30 seconds, mostly along the margins of the wounds and also at the periphery of the hemostatic plugs. Fibrin was absent from the center of the plugs and from the lumen of transected vessels. When part of a plug was extending into the vessel lumen, the platelets inside the vessel were less degranulated and less interdigitated than the rest of the plug. The effect of acetysalicylic acid (ASA) was studied in wounds before and 2.5 hours after ingestion of 2 gm. of ASA. Wounds were excised by punch biopsy 3 or 10 minutes after they had been made. Platelets in ASA were less degranulated, had fewer pseudopods, and showed less interdigitation than platelets in control plugs. Ballooning and fibrin deposition were similar in control and ASA plugs. Pronounced differences between control and ASA plugs were observed in a subject who exhibited a considerably prolonged bleeding time after ASA. The ASA plugs were very large; many plugs had fused and in addition numerous small platelet clumps, most likely fragments from the plugs, were found in the superficial scab of the wound. It is postulated that ASA plugs are less stable due to decreased interdigitation. This allows more disruption of the plugs and rebleeding. Consequently, more platelets are needed and longer time is required for hemostasis to occur.     

Platelet plug formation in an extracorporeal unit.

Platelet plugs were formed in an extracorporeal unit from flowing venous blood and studied by electron microscopy. The unit consisted of a stainless steel needle threaded into a section of silicone rubber tubing that was constricted to form a slit-like stenosis equivalent in cross-sectional area to an arteriole 100 mu in diameter. Blood was allowed to flow at a steady pressure from an antecubital vein through a collection line and the attached unit until bleeding was stopped by the formation of a platelet plug at the stenosis. Electron microscopy of the plugs showed closely packed aggregated platelets. No fibrin was detected. The formation of a stable plug in the absence of fibrin was considered a measure of the capacity of platelets in hemostasis and thrombosis to aggregate and resist the force of the blood current.     

Thrombogenesis of the Rabbit Arterial Plaque: An Electron Microscopic Study

Rabbit arteries, de-endothelialized with an intravascular balloon catheter and allowed to heal for 4 weeks, showed intimal changes that were similar to the preatherosclerotic fibromusculoelastic plaques of man. Reinjury of the healed vessels by balloon catheter produced marked quantitative and qualitative alterations of hemostasis, as compared to that in previously uninjured vessels. The most apparent modification of thrombogenesis 10 minutes after injury to the plaque was a large increase in the size of the thrombotic deposits. Features of this exaggerated response were the major participation of fibrin in thrombus formation and greater platelet accumulation. Some platelets and fibrin strands appeared to penetrate into and beneath the neointima. By 3 hours, these deposits had diminished in size, although the hemostatic mass remained larger in the doubly injured vessels.     

Morphology of menstrual hemostasis in essential menorrhagia

We performed a morphologic and morphometric study with light and electron microscopy on early menstrual hemostasis in five menorrhagic uteri and one control uterus, related the data to measured menstrual blood loss and compared the data with our previous study on normal menstruation. Menstrual blood loss ranged from 39 to 234 ml. Menorrhagic uteri contained large hemostatic plugs, protruding with a large part into the extravascular space. These plugs often consisted of loosely packed, poorly degranulated platelets with few fibrin fibers. Recanalized plugs, consisting of fibrin fibers and platelet remnants at the periphery of the vessel, were also observed in menorrhagic uteri. Using morphometry, we demonstrated a positive correlation between menstrual blood loss and the number of occlusive and nonocclusive hemostatic plugs, but not with other aspects of hemostatic plug formation such as the vessel area occluded by the plug, plug transformation, or intra- or extravascular localization of the plug. Vasodilation or endometrial height were not correlated with the amount of menstrual blood loss. These data suggest that essential menorrhagia is associated with fragile hemostatic plugs or with more extensive vessel damage.     

Comparative evaluation of absorbable hemostats: advantages of fibrin-based sheets

Bioactive hemostats and wound dressings consist of either inherently active materials or act as delivery vehicles which contain such materials. Fibrin is a natural hemostat and scaffold, guiding the direction of wound contraction and closure. In order to improve the ease of application of liquid fibrin glue, we have made a freeze-dried form of polymerized fibrin that supports hemostasis and wound healing. The bleeding from the middle ear artery of rabbits was found to be arrested instantaneously on application of fibrin sheets, even when the animal was heparinized systemically. As the fibrin sheet was found to be fragile, gelatin was incorporated to the sheet and thus the mechanical stability was improved without compromising the hemostatic effect. The efficacy of the fabricated fibrin and fibrin-gelatin sheets to seal traumatized rat liver was compared with commercially available hemostats, Abgel (cross-linked gelatin) and Surgicel (cross-linked cellulose). Tissue compatibility of all the hemostats was studied by analyzing the liver tissue 15 days after application. While the hemostatic effect was best with fibrin and fibrin-gelatin sheets, both Surgicel and Abgel were not capable of arresting the bleeding quickly. Gross analysis of tissue on the 15th day of application, visibly, Abgel was not only degraded but resulted in severe adhesions of internal organs and histologically capsule formation around the implant was evident. Though Surgicel was also seen as cream soft material on the site of application that joined two pieces of liver, there was no adhesion of other internal organs and histologically, immune reaction and foreign-body-type giant cells were present in large amounts. Fibrin was not found grossly on application site whereas fibrin-gelatin was seen as a small white spot. Granulation tissue formation and cell migration into the fibrin-based sheets were evident, and therefore, fibrin-based sheets are not only efficient hemostats but showed optimum degradation and wound healing.     

Effects of fibrin pad hemostat on the wound healing process in vivo and in vitro

Fibrin Pad is a hemostatic pad designed to control surgical-related bleeding. It consists of a fully absorbable composite matrix scaffold coated with human-derived active biologics that immediately form a fibrin clot upon contact with targeted bleeding surfaces. Studies were conducted to investigate the effect of Fibrin Pad and its biologics-free composite matrix component (Matrix) on the wound healing process in in vitro and in vivo models. Fibrin Pad was evaluated in solid organ, soft tissue defects, and subcutaneous tissues. Immunocompromised rodents were used to avoid xeno-mediated responses. Extracts created from both materials were evaluated for biological activity using in vitro cell culture assays. Neither Fibrin Pad nor Matrix alone showed any inhibition of the wound healing of treated defect sites. An apparent accelerated healing was noted in the soft tissue and subcutaneous tissue defects with Fibrin Pad as compared to Matrix. Both materials showed desirable properties associated with tissue scaffolds. The in vitro study results show that Fibrin Pad extract can induce dose-dependent increases in fibroblast proliferation and migration. These studies confirm that the biologic components of Fibrin Pad can enhance wound healing processes in in vitro assays and fully support wound healing at the site of in vivo application.     

Structural Changes in the Fibrin Network of a Pretoria Family with Dysfibrinogenemia: A Scanning Electron Microscopical Study

Inborn errors of fibrinogen structure are by definition congenital dysfibrinogenemias. The present study assesses the scanning electron microscope characteristics in the fibrin network morphology in a Pretoria family with an amino-acid substitution defect at position 139 on the γ chain where the cystein residue is replaced by tyrosine. This anomaly results in a disturbance of the interchain disulfide bond, an ultrastructural defect that interferes with fibrin polymerization. Clinical manifestations showed that 2 of the family members presented with thrombosis, as well as a bleeding tendency, while 2 were asymptomatic. Fibrin clot analysis revealed that in all 4 family members a tighter fibrin network with increased fibrin density and reduced pore size was present. The fibers showed a “stellate” appearance where they converge and some were fused longitudinally to form sheets of “matted” fibrin. Furthermore, there was a conspicuous absence of platelets. Fibrin dysfunction is associated with the development of vascular complications, while proneness to the formation of tight and rigid fibrin networks is independently associated with thrombotic disease. Although this does not explain the proneness of some family members who present with excess bleeding, bleeding might be related to the defective binding of fibrin to activated platelets, resulting in inadequate prothrombotic stimulus that is normally enhanced by the second wave of thrombin generation, which occurs on the platelet surface.     

可吸收材料生物蛋白胶及明胶海绵在肝部分切除的应用

背景：生物蛋白胶广泛应用于各种外科手术中对富含小血管创面渗血的处理。 目的：通过在肝部分切除中应用组织可吸收性医用生物蛋白胶,分析其对手术时间及肝部分切除后止血效果的影响。 方法：对42例肝部分切除患者随机等分为实验组和对照组。实验组在肝部分切除后,缺损处喷洒医用生物蛋白胶封闭,并以明胶海绵剪成多块小片段混合医用生物蛋白胶以覆盖断面来代替常规缝合断面。对照组仅缝合收拢肝组织缺损。 结果与结论：实验组使用的生物蛋白胶可迅速附着于创面,实验组患者肝部分切除的手术时间、出血量、引流量及渗血持续时间均明显小于对照组(P < 0.05),且2组患者的住院天数和住院费用的差异无显著性意义(P > 0.05)。提示在肝部分切除中应用医用生物蛋白胶可以在不增加患者费用及住院时间的同时,有效降低手术时间、减少肝部分切除后出血。 关键词：生物蛋白胶;可吸收性材料;明胶海绵;肝部分切除;生物材料 doi:10.3969/j.issn.1673-8225.2012.12.021     

Structural changes in the fibrin network of a pretoria family with dysfibrinogenemia: a scanning electron microscopical study

Inborn errors of fibrinogen structure are by definition congenital dysfibrinogenemias. The present study assesses the scanning electron microscope characteristics in the fibrin network morphology in a Pretoria family with an amino-acid substitution defect at position 139 on the γ chain where the cystein residue is replaced by tyrosine. This anomaly results in a disturbance of the interchain disulfide bond, an ultrastructural defect that interferes with fibrin polymerization. Clinical manifestations showed that 2 of the family members presented with thrombosis, as well as a bleeding tendency, while 2 were asymptomatic. Fibrin clot analysis revealed that in all 4 family members a tighter fibrin network with increased fibrin density and reduced pore size was present. The fibers showed a “stellate” appearance where they converge and some were fused longitudinally to form sheets of “matted” fibrin. Furthermore, there was a conspicuous absence of platelets. Fibrin dysfunction is associated with the development of vascular complications, while proneness to the formation of tight and rigid fibrin networks is independently associated with thrombotic disease. Although this does not explain the proneness of some family members who present with excess bleeding, bleeding might be related to the defective binding of fibrin to activated platelets, resulting in inadequate prothrombotic stimulus that is normally enhanced by the second wave of thrombin generation, which occurs on the platelet surface.     

生物止血材料医用胶黏合儿童额面部开放性伤口创面的可行性

背景：生物止血材料医用胶在体液、血液作用下的扩散性好,可迅速发生聚合反应,产生较理想的止血、促进愈合等作用。 目的：观察医用胶作为止血材料在儿童额面部开放性伤口创面中的临床应用价值。 方法：选择以生物材料医用胶黏合额面部开放性伤口的1 218例儿童为观察组,以常规丝线缝合额面部开放性伤口的600例儿童为对照组,比较两组伤口愈合时间、术后伤口出血情况、缝线反应、色素沉着情况及瘢痕增生程度。 结果与结论：观察组手术时间、出血量及伤口愈合时间均少于对照组(P < 0.05),有效止血率高于对照组(P < 0.05);观察组中1 215例伤口Ⅰ期愈合,对照组中586例伤口Ⅰ期愈合。随访12个月,观察组瘢痕愈合平整,无线结瘢痕及针眼瘢痕,与临近皮肤肤色相近,美容效果良好;对照组瘢痕较明显,可见线结瘢痕及针眼瘢痕,大部分伤口周围出现红斑、硬结及瘢痕增生。使用生物止血材料医用胶黏合儿童额面部开放性伤口具有良好的生物相容性及美容效果,且使用安全、方便。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程      

Interaction of fibrin with red blood cells: the role of iron

Activation of coagulation pathways results in the formation of hemostatic fibrin plugs. Under normal physiologic conditions fibrin clots are gradually, albeit completely, degraded by a fibrinolytic enzyme system to ensure proper wound healing and/or blood vessel patency. Yet in pathological situations, thrombi are not effectively removed, leading to chronic thrombosis. The susceptibility of blood clots to enzymatic degradation depends on the structure and properties of fibrin fibers. Many factors have been suspected as culprits, including red blood cells (RBCs) that become transiently trapped within fibrin mesh. Here, the authors show that there is indeed a specific interaction between RBCs and fibrin-like fibers identified here as dense matted deposits (DMDs) by means of scanning electron microscopy (SEM). It is emphasized that such interactions can be observed in ischemic stroke patients, but not from healthy subjects. However, DMD/RBC aggregates can be induced in normal blood by the additions of trivalent iron ions. The plausible mechanism of the enhanced fibrin-red blood cell interaction is based on the previously described iron-induced generation of hydroxyl radicals. These radicals cause, in turn, non-enzymatic formation of fibrinogen aggregates remarkably resistant to fibrinolysis that are also similar to DMDs described in this paper. In conclusion, this relatively simple SEM analysis may become a convenient tool for diagnosing prothrombotic conditions associated with iron overload. It is suggested that future research on prevention and treatment of ischemic stroke and other thrombosis associated diseases should include testing of iron-chelating and hydroxyl radical-scavenging agents.     

生物止血材料在妇产科手术中的应用

背景：良好的生物敷料或纱布可直接促进凝血过程,不仅可用于广泛渗血创面,且在一些常用的妇产科手术中能有效降低渗血率。 目的：评价不同生物止血敷料及纱布的材料学性能及应用于妇产科切口的生物相容性,寻找符合不同切口创面需要的止血材料。 方法：采用电子检索的方式,在万方数据库(http://www.wanfangdata.com.cn/)中检索1999-01/2011-04有关妇产科生物止血材料应用的研究文章,关键词为“妇产科,生物材料,止血敷料,纱布,胶原/壳聚糖”,排除重复研究、普通综述或Meta分析类文章,筛选纳入30篇文献进行评价。 结果与结论：近几年国内外生物医用可吸收止血材料主要包括纤维蛋白胶、壳聚糖、明胶海绵、氰基丙烯酸酯类组织胶、氧化纤维素和氧化再生纤维素等。各种止血性伤口急救材料都有各自的特点,但在妇产科应用的选择上,应考虑多方面因素,包括手术部位、出血部位、切口形态大小、不同渗/出血情况的填塞要求、不同止血材料的自身性能及与机体的相容性等。但因目前尚无完全符合理想标准的材料,因此开发新的快速止血和与宿主相容性良好的止血材料及复合材料势在必行。     

可溶性止血纱布对兔肝脏创伤的止血作用

BACKGROUND: Modified cellulose dressing as an important part of polysaccharide hemostatic material has its unique advantages compared with gelatin sponge and fibrin glue. OBJECTIVE: To compare the hemostatic effect and histocompatibility of medical gauze, absorbable hemostatic gauze and soluble hemostatic gauze.  METHODS: After establishment of liver trauma models, 36 New Zealand rabbits were randomly divided into three groups (n=12) depending on different hemostatic materials. Injury wounds were covered with soluble hemostatic gauze (mainly made of sodium carboxymethyl cellulose, experimental group), absorbable hemostatic gauze (mainly made of sodium carboxymethyl cellulose, control group) and medical gauze (normal group), respectively. The gauze was only taken out in the normal group. A hemostasis trial on liver injury was carried out to investigate the bleeding time and bleeding amount. After 1, 3, 7 and 10 days, wound healing was observed histologically in each group.  RESULTS AND CONCLUSION: The bleeding time and bleeding amount in the experimental and control groups were lower than those in the normal group (both P < 0.05), but no statistical difference was found between the experimental and control groups. After 1 day of implantation, the soluble hemostatic gauze was absorbed completely, and the absorbable hemostatic gauze was absorbed with no residual until the 10th day. Experimental and control groups shared similar pathological changes. In these two groups, mild fibrosis and fibrous scar appeared, a better improvement in wound inflammation was shown at 10 days compared with that at 7 days, and the wound gradually healed. In the normal group, there were no obvious lesions except mild tissue edema around the wound. All these findings suggest that the soluble hemostatic gauze has better hemostatic effect and histocompatibility.     

Fibrin scaffold as an effective vehicle for the delivery of acidic fibroblast growth factor (FGF-1)

The effect of wound healing by fibrin and acidic fibroblast growth factor (FGF-1) in an in vivo model was evaluated in this study. Four full-thickness wounds were made on the dorsum of each rabbit (n = 5). Each of these wounds had different treatment groups: control, topical FGF-1 (100 microg/9 cm2), fibrin (2.0 mL at 60 mg/mL fibrinogen), and FGF-1 (100 microg/9 cm2)/fibrin. The animals were sacrificed at the end of 2 weeks. Histomorphometric analysis and mechanical testing were conducted to assess the healing response. FGF-1/fibrin treatment improved the mechanical properties of the healed tissue. Fibrin scaffold exhibited the desired tissue response, as demonstrated by the lack of inflammation, and was deemed an effective carrier for FGF-1.     

Formation and regulation of platelet and fibrin hemostatic plug

Formation of a hemostatic plug represents one of the earliest responses to vessel wall injury. Platelets react to any discontinuity in the vascular endothelium through initial contact, spreading, and formation of a thrombus (or aggregate). This development of a primary hemostatic plug requires platelet membrane receptors through which the adhesive macromolecules, von Willebrand factor (vWF) and fibrinogen, anchor platelets to the vessel wall and link them to each other. There are two receptor pathways--classic and alternative--for the binding of vWF to platelets; the latter induced by thrombin, and adenosine diphosphate (ADP) is shared with fibrinogen. Synthetic peptides, patterned after known binding domains of adhesive molecules, have been designed to inhibit their interactions with platelet receptors. A secondary hemostatic plug, composed of platelets enmeshed in fibrin, results from the action of thrombin, which is not only essential for formation of fibrin but also for exposure of platelet receptors for adhesive molecules and for "activation" of factors V and VIII. Thrombin generation is greatly enhanced through the activity of the prothrombinase complex formed on the surface of platelets, perturbed endothelial cells, and leukocytes. A pivotal event is activation of factor X through the intrinsic and extrinsic coagulation pathways. Binding of factors IXa and VIIa to the vascular endothelium represents a localized mechanism for factor Xa generation. Formation of a platelet and fibrin thrombus is controlled by regulatory mechanism: prostacyclin, endogenous heparin-antithrombin III complex, thrombomodulin-protein C-protein S system, and the fibrinolytic system. The balance of all components--vessel wall, platelets, adhesive and coagulation proteins, regulatory mechanisms--determines the effectiveness of the hemostatic plug in maintaining the structural and functional integrity of the circulatory system. An approach to detection of hemostatic derangements in patients at risk evolves from a full understanding of inherited and acquired deficiencies affecting each step of hemostatic plug formation and from selective use of laboratory tests.     

Use of concentrated fibrinogen in experimental splenic trauma

This study evaluated Fibrin Sealant (FS), a two-component biologic adhesive that is effective in establishing hemostasis, in 27 experimentally produced splenic injuries in five adult mongrel dogs. Ten small superficial lacerations (2.0 cm in length), six large superficial lacerations (3.0-6.0 cm in length), three small wedge resections, and eight stab wounds extending into the splenic hilum were effectively repaired with FS without suture splenorrhaphy or temporary splenic hilar occlusion. Complete hemostasis was achieved in all animals prior to skin closure. Dogs were reexplored postoperatively at intervals varying from 4 h to 6 weeks. When animals were killed, there was no gross evidence of splenic disruption or recurrent bleeding; the spleens all had developed well-healed capsules. Histologic examination demonstrated a regenerated fibrous capsule extending over the injuries without significant inflammatory response. We conclude that FS provides adequate hemostatic control of superficial and deep splenic injuries; has good systemic and local compatibility; can be applied to bleeding parenchymal wounds; organ ischemia is generally not required; avoids the use of parenchymal sutures, which may be traumatic; and may promote splenic wound healing. Thus, use of FS is an effective technique for splenic preservation after trauma.     

Mesenchymal stromal cells form vascular tubes when placed in fibrin sealant and accelerate wound healing in vivo

Non-healing, chronic wounds are a growing public health problem and may stem from insufficient angiogenesis in affected sites. Here, we have developed a fibrin formulation that allows adipose-derived mesenchymal stromal cells (ADSCs) to form tubular structures in vitro. The tubular structures express markers of endothelium, including CD31 and VE-Cadherin, as well as the pericyte marker NG2. The ability for the MSCs to form tubular structures within the fibrin gels was directly dependent on the stoichiometric ratios of thrombin and fibrinogen and the resulting gel concentration, as well as on the presence of bFGF. Fibrin gel formulations that varied in stiffness were tested. ADSCs that are embedded in a stiff fibrin formulation express VE-cadherin and CD31 as shown by PCR, FACS and immunostaining. Confocal imaging analysis demonstrated that tubular structures formed, containing visible lumens, in the stiff fibrin gels in vitro. There was also a difference in the amounts of bFGF secreted by ADSCs grown in the stiffer gels as compared to softer gels. Additionally, hAT-MSCs gave rise to perfusable vessels that were VE-cadherin positive after subcutaneous injection into mice, whereas the softer fibrin formulation containing ADSCs did not. The application of ADSCs delivered in the stiff fibrin gels allowed for the wounds to heal more quickly, as assessed by wound size, amount of granulation tissue and collagen content. Interestingly, following 5 days of healing, the ADSCs remained within the fibrin gel and did not integrate into the granulation tissue of healing wounds in vivo. These data show that ADSCs are able to form tubular structures within fibrin gels, and may also contribute to faster wound healing, as compared with no treatment or to wounds treated with fibrin gels devoid of ADSCs.     

Fibrin degradation and angiogenesis: quantitative analysis of the angiogenic response in the chick chorioallantoic membrane

Fibrin deposition and removal is a feature common to major pathological processes such as wound healing, chronic inflammation and tumour invasion: processes involving the ingrowth of new blood vessels. Low molecular weight fibrin degradation products (MW less than 50,000) are now shown to induce angiogenesis in the chick chorioallantoic membrane (CAM). This effect has also been shown by new quantitative assays to be associated with stimulation of both DNA and protein synthesis. Autoradiography indicates that all cell types in the CAM are stimulated to divide, and it is proposed that fibrin degradation products are a pathological growth factor.     

Fibrin/platelet plug counteracts cutaneous wound contraction: the hypothesis of "skipping stone"

Cutaneous wound contraction and epithelialization act collaboratively to minimize the exposed wound surface. However excessive wound contraction is undesirable due to the resultant disfigurement and scarring. Fibrin clot has greater stiffness than surrounding tissue and mechanical strain further enhances its stiffness. On the contrary, skin exhibits diminished stiffness when affected by high strain rates. Therefore during early stages of wound healing, the contractile wound border is confronted by fibrin clot forming a high strain region in the interface of contractile tissue and fibrin clot--which is evidenced by computer simulation. Due to the stress relaxation property of skin, the contractile strain is partly neutralized. Meanwhile, gradually the stiffness of fibrin clot decreases which is followed by another cycle of wound contraction. This cyclic pattern of contraction resembles the movement of a stone over water or "skipping stone". The stone bounces repeatedly when thrown across the surface of water with reduction of jumping altitude with each bounce till the stone stops completely. This hypothesis is further supported by the observed initial delay in wound contraction and the chronological correlation of enhanced wound contraction with loss of superficial eschar and substitution of fibrin clot with granulation tissue. Also there is evidence that fibrin inhibits fibroblast-mediated contraction of collagen. Furthermore, modest increase in wound contraction rate in fibrinogen deficient mice and fibrin-mediated diminished wound contraction are agreement with the proposed hypothesis.     

Evaluation of fibrin sealants in cutaneous wound closure.

Human fibrin sealant (HFS) and bovine fibrin sealant (BFS) were delivered as preformulated fibrinogen-thrombin mixtures that are light activated. These formulations were evaluated in the healing of incised cutaneous wounds in beagle dogs. Four groups were differentiated by sealant type and study duration with group: BFS for 10 days, HFS for 10 days, BFS for 30 days, and HFS for 30 days. Healing was evaluated by noting incidences of open wounds, laser Doppler perfusion imaging (LDPI), planimetry, breaking strength, and histopathology. In the absence of tension, both sealants tended to hold wound edges together; however, HFS tended to be better than its controls and BFS. Both sealants augmented suture closure, necessitating fewer sutures for wound closure. At 5 and 30 days BFS wounds had more perfusion than HFS wounds, indicating more inflammation. At 10 and 30 days BFS wounds had larger scar areas than their controls, while scar areas of HFS wounds were smaller than either BFS wounds or controls. Breaking strengths indicated that HFS wounds were stronger than their controls and BFS wounds. Histologically, mild to moderate chronic-active inflammation was observed in wounds receiving either sealant, and this persisted longer in BFS wounds. Overall, HFS had positive qualities, thus showing potential for functional and cosmetic wound closure.