Intrapleural administration of a large amount of diluted fibrin glue for intractable pneumothorax

Objective: Pleurodesis using chemical agents has been applied to high-risk patients with pneumothorax. This treatment, however, is sometimes unsuccessful in patients with intractable pneumothorax. We have developed intrapleural administration of diluted fibrin glue as an effective treatment for such patients.Methods: Fibrin glue was diluted 4-fold with saline and/or contrast media. Pleurodesis with a large amount of the diluted fibrin glue was performed in 55 high risk patients (57 cases, bil.2 patients) with intractable pneumothorax.Results: The air leaks were stopped by administration of the glue in all except 2 patients. During the follow-up period, a recurrence rate of 10.5% was observed. These recurrent pneumothoraces were successfully treated using the same procedure with no further recurrence. Pyrexia (12.3%) and chest discomfort (8.8%) were observed as side effects, and there was no occurrence of severe chest pain or thoracic empyema.Conclusions: These results suggested that intrapleural administration of a large amount of diluted fibrin glue was an effective treatment for intractable pneumothoraces in high-risk patients.     

Tracheal repair with fibrin glue

This animal study evaluated Fibrin Sealant, a multicomponent biologic adhesive, in tracheal operations. We conclude that the use of Fibrin Sealant in tracheal reconstruction results in a stable, leakless trachea, has good systemic and local compatibility, promotes tracheal wound healing, and reduces significantly the number of sutures required for end-to-end anastomosis.     

Arthroscopic meniscal repair with fibrin glue

Since 1984 we have arthroscopically repaired 40 meniscal tears in 32 patients using fibrin glue in our operative technique. This technique was reported initially in 1985 (Ishimura M, Samma M, Habata T, Fujisawa Y. The use of fibrin glue for fresh knee injury. Cent Jpn Orthop Traumat 1985; 28:1404-8), with a more detailed study published in 1987 [Ishimura M, Samma M, Fujisawa Y, et al. Arthroscopic repair of the meniscus tears with fibrin glue. Arthroscopy (Jpn) 1987;12:31-6]. During the follow-up period, which ranged from 10 months to 6 years and 7 months (mean: 3 years and 8 months), only two patients complained of meniscal symptoms and underwent arthroscopic partial meniscectomy. Twenty patients with 25 repairs underwent repeat arthroscopy at an average of 5.7 months (range: 2 months-1 year and 2 months) after the initial repair. Twenty repairs were rated as good, four as fair, and one as poor by arthroscopic evaluation criteria. At present, the most appropriate use of this arthroscopic meniscal gluing technique is in tears in the posterior segment, which are difficult to suture without arthrotomy. Even a long tear with a stable reduced position can be expected to show good healing. When reduction of the tear is not stable, additional sutures should be used.     

Single-donor fibrin glue for hand burns

Early tangential excision sometimes results in considerable blood loss, prolonged operative time, and partial loss of the graft secondary to hematoma formation. Previous reports document positive hemostatic effects and improved skin fixation with fibrin "glue." The commercial preparation used in Europe, however, has not been approved by the United States Food and Drug Administration because of the high risk of hepatitis and human immunodeficiency virus transmission. Using a method developed at the University of Virginia, we applied single-donor fibrin glue as an adjunct in early excision and grafting in 16 patients (26 hands). The overall graft take was 99%. In all patients, better adherence of the split-thickness graft to the recipient bed, during and immediately after application, was noted. We have observed no negative effects with regard to infection or healing. We recommend the use of single-donor fibrin glue to reduce operative blood loss, improve survival and ease of graft application, and possibly to accelerate healing.     

A facial low-flow venous malformation treated with fibrin glue.

A young girl with recurrent swelling of a facial low-flow venous malformation was treated successfully by injection of fibrin glue.     

Skin grafting with fibrin glue in burns

Summary In an attempt to obtain better function and appearance minimize blood loss and increase graft survival with minimal postoperative care, deep burns are treated by applying the fibrin glue to difficult recipient sites. A two-component fibrin sealant is used, fibrinogen made from pooled human plasma and bovine thrombin (Tissucol, Immuno AG, Vienna, Austria). The fibrin sealant is described as well as the technique used to seal the skin grafts in 15 patients (18 procedures). Indications for graft sealing are limited to grafts over areas subject to movement (joints, face, neck, hands) and to non-meshed grafts for cosmetic reasons. This clinical experience demonstrates several advantages of sealing skin grafts on burn wounds: hemostasis, early adherence and wound healing are improved; better cosmetic results are obtained with sheet grafts on the face and neck; operating time is reduced; no special dressings are required; physiotherapy starts after 24 h; the period of rehabilitation is reduced as well as the incidence of secondary procedures.     

Restoration of skin defects with fibrin glue

After experiments with absorbable bioplasts for substitution of skin defects, this time the absorbable fibrin glue named Tissucol was used by the authors. The experiments on 22 dogs unanimously proved that, beneath the layer of tissue adhesive, scarring occurred free of inflammation as compared to the controls where inflammatory phenomena were not excluded. The procedure has been found good and useful in high-degree burns and injuries up to their final management.     

Intrathoracic fibrin glue for postoperative pleuropulmonary fistula

Twenty cases of persistent pleuropulmonary fistula after a thoracic surgical procedure were successfully treated with fibrin glue injection into the thoracic cavity through a drainage tube. A new technique, the overlying method, which is a modification of the conventional technique of fibrin glue injection, was devised. Each patient received one to four injections (mean number, 1.6). This method resulted in closure of the pleuropulmonary fistula in all but 1 patient. Minor complications included pain in 1 patient and fever in 3 patients. A control study involving 24 patients with pleuropulmonary fistula was performed. Autoblood, OK-432, and tetracycline were used instead of fibrin glue. The fistula resolved in 12 patients. Complications after injection included pain in 15 patients, fever in 10, and occlusion of the chest tube in 4. With our new method, patients rarely exhibited pain and fever, and occlusion of the chest tube did not occur.     

Deep inferior epigastric arteriovenous shunt for hemodialysis.

The deep inferior epigastric artery and vein may be satisfactorily utilized for chronic hemodialysis in patients who have no extremity vessels available.     

Management of low-output pancreatic fistulas with fibrin glue

BACKGROUND: Despite advances in surgical, endoscopic, and percutaneous therapeutic techniques, pancreatic fistulas remain a source of significant morbidity and long-term patient discomfort. The intraoperative use of fibrin sealant has been used prophylactically to prevent formation of fistula. We recognized the potential use of fibrin glue as a therapeutic modality for successful resolution of low-output pancreatic fistulas. METHODS: Three patients with low (<20 ml per day) output pancreatic fistulas underwent fluoroscopically directed injection of fibrin glue along their fistula tract. RESULTS: All 3 patients underwent successful fibrin glue injection without procedural complication. All fistula output stopped, and the 3 patients remained asymptomatic at 1 year. CONCLUSIONS: Fibrin glue inserted with image-guided catheter delivery systems may be a useful option in selected patients with low-output pancreatic fistulas.     

Successful management of congenital chyloperitoneum with fibrin glue

Chylous ascites in children has been treated in a variety of ways, including a low-fat diet, medium chain triglycerides, diuretics, total parental nutrition, surgical exploration, and internal peritoneo-venous shunting. The authors describe a child with persistent congenital chyloperitoneum treated successfully with the application of fibrin glue and recommend this as an effective alternative to traditional approaches.     

The maximization of wound healing with fibrin glue

Our experience in the application of so-called fibrin glue in 304 patients submitted to a variety of operations in plastic surgery from January 1981 to May 1982 is presented. The results seem to be much better than without this substance and afford greater comfort for the patient. Addition of factor XIII seems to be unnecessary.     

Homologous controlled-viscosity fibrin for endovascular embolization

Summary Part I of the present paper described the development of a substance for endovascular embolization from homologous fibrinogen, aprotinin, thrombin, metrizamide and CaCl₂. Part II deals with the applicability of a controlled-viscosity fibrin mixture via different types of arterial catheters. In a flow-dynamic model the embolizing medium injected via a double syringe was shown to block a blood flow corresponding approximately to the flow encountered in cerebral angioma vessels.In the course of animal experiments the embolization of mesenteric arteries of rabbits showed the distribution of the embolizing medium to be dependent on its viscosity; the action of an embolizing medium applied by means of a double syringe was studied in the femoral arteries of rabbits. Scintigraphy was used to study the distribution of the substance in the body of the experimental animal after intravenous (i.v.) application; long-term studies of embolized auricular arteries in rabbits revealed parchment-like necroses after 5 to 10 days and the presence of radiopaque substances in the ear stumps after 6 weeks.     

Treatment of postoperative chylothorax with intrapleural fibrin glue

Two patients with chylothorax after pulmonary resection for lung cancer were successfully treated without thoracotomy by injection of fibrin glue components into the pleural cavity. This new technique for closing the chylous leak is described.     

Treatment of fistulas in ano with fibrin glue

BACKGROUND: Recent publications show promising results using fibrin glue in the treatment of anal fistulas. The technique is simple, repeatable, with minor surgical trauma so that sphincter function is preserved and further treatment options are not compromised. The aim of this pilot study was to analyse if we could reproduce the results reported in the literature, using this simple technique. METHODS: Patients with a primary or recurrent anal fistula were included in this trial. Patients with a complex fistula were excluded. Under general or spinal anaesthesia, the fistulas were curetted and injected with fibrin glue. Follow-up visits were scheduled for 1 week, 6 weeks and 6 months. RESULTS: Twenty-seven patients were included. The overall success rate was 33% after a mean follow-up of 27 weeks. Patients with a recurrent fistula had a poorer outcome (success rate 14%). None of the patients suffered from postoperative continence problems, and no other complications were recorded. CONCLUSION: This study confirms the safety of fibrin glue in the treatment of anal fistulas. However, a high success rate could not be reproduced.     

Cartilage chips synthesized with fibrin glue in rhinoplasty

A new type of cartilage graft that is synthesized from cartilage fragments minced by our instrument and mixed with fibrin glue is described. This new material is useful when particular grafts are required in primary or secondary rhinoplasty.