Seroma prevention using fibrin glue during modified radical neck dissection in a rat model

Seroma is a frequent sequelae of neck dissection involving cervical lymphadenectomy. The incidence is correlated with flap elevation, lymphovascular interruption, and tissue removal. Current methods of resolving seroma, such as vacuum drainage, are not risk free. A novel approach to this problem was the use of intraoperative topical fibrin glue. A model producing seromas was developed by modified radical neck dissection on Sprague-Dawley rats. Forty rats underwent this procedure. Twenty rats were treated with saline solution (control group) and 20 were treated with fibrin glue. At necropsy on day 5, a significant reduction in the frequency of seroma was noted in the fibrin glue group. Seventeen of 20 control rats had seroma whereas only 2 of 20 experimental animals had serous collection. The Fisher exact statistical correlation revealed p less than 0.000002; therefore, the use of fibrin glue in this role merits further evaluation.     

Seroma prevention using Mytilus edulis protein in a rat mastectomy model

Abstract:   Seroma formation is common following mastectomy and autologous breast reconstruction and is a potential cause of significant morbidity in patients. For this reason, many methods have been investigated to prevent this complication. BD Cell-Tak is a tissue adhesive formulated from the proteins excreted by the marine mussel Mytilus edulis . The purpose of this study was to determine if Cell-Tak is able to prevent seroma formation in a rat mastectomy seroma model. Twenty Sprague-Dawley rats underwent unilateral radical mastectomy, partial axillary lymph node dissection, and disruption of the dermal lymphatics. The animals were randomly assigned to either control ( n  = 10) or experimental groups ( n  = 10). The experimental animals received 0.3 ml of the topical adhesive in the wound prior to closure, whereas control animals received no treatment. On postoperative day 7, seroma collections were aspirated and quantified and the tissue flaps were sent for histologic analysis. The control rats had a mean seroma volume of 5.3 ± 2.6 ml, whereas the rats treated with Cell-Tak tissue adhesive had a mean seroma volume of 1.8 ± 1.5 ml ( p  < 0.004). Histologic analysis revealed mild inflammation consistent with postoperative changes in both groups and no evidence of foreign body reaction to the adhesive. BD Cell-Tak tissue adhesive significantly reduces seroma formation in the rat mastectomy model. This tissue adhesive may prove beneficial in patients undergoing mastectomy with or without breast reconstruction.     

Seroma prevention by using Corynebacterium parvum in a rat mastectomy model

Seroma formation is the most common complication after mastectomy and continues to be an important problem during the early postoperative period. Several surgical and medical methods have been developed to try to overcome this problem; however, so far none have been used successfully in the routine clinical practice. The aim of this study is to evaluate the effects of Corynebacterium parvum (CP) as a sclerosing agent in both prevention and treatment of seromas after mastectomy and axillary dissection in an animal model. Sixty female Sprague-Dawley rats underwent mastectomy and axillary dissection under general anaesthesia. Following surgery, the rats were treated in 1 of 3 ways. In the prevention group, 1 cm3 (0.35 mg) CP solution was injected beneath the skin flap just before closure of the incision after mastectomy. In the treatment group, animals in which a seroma was formed, the fluid was aspirated, and 1 cm3 CP solution was injected beneath the flap. In the control group, animals in which seromas formed, aspiration only was performed. The frequency of seroma formation decreased when CP solution was injected immediately after the operation (p < 0.01). In addition, seroma formation was effectively treated by CP injection when compared with the control group (p < 0.05). CP was effective as a prophylactic agent in the prevention group and as a therapeutic agent in the treatment group in this experimental model. CP injection may be useful for the management of this problem in a clinical setting.     

Seroma prevention using an albumin-glutaraldehyde-based tissue adhesive in the rat mastectomy model

Seroma formation is a common postoperative complication in plastic surgery, resulting in notable patient morbidity and expense. In this study the authors investigated the efficacy of a synthetic glutaraldehyde-based tissue adhesive (BioGlue; Cryolife, Inc., Kennesaw, GA) in seroma prevention in the rat mastectomy seroma model. This tissue adhesive is composed of purified bovine serum albumin (45%) and glutaraldehyde (10%). Twenty-two Sprague-Dawley rats received mastectomies along with axillary lymphadenectomy and disruption of subcutaneous lymphatics. The control group (N = 11) received 2.5 ml saline into the wound before closure. In the experimental group (N = 11), 2.5 ml BioGlue was injected into the wound. On postoperative day 7, the resultant seromas were quantified and adjacent tissues were harvested for histological examination. The rats in the control group had a mean seroma volume of 5.19 ml (standard deviation, +/- 3.65 ml; N = 11), whereas the rats treated with BioGlue had a mean seroma volume of 0.25 +/- 0.43 ml (N = 11). Histology revealed an inflammatory response consistent with postoperative changes as well as a mild foreign body reaction. This study demonstrates that BioGlue can be used as a tissue adhesive that reduces seroma formation significantly in the rat mastectomy model (p = 0.0008). Further studies are warranted to investigate the long-term effect of BioGlue on surrounding tissue.     

Seroma prevention after modified radical mastectomy.

The most common mastectomy-associated complication is seroma formation. Seromas can be associated with other more serious complications such as skin flap necrosis, delayed wound healing, infection, and lymphedema. The flap tacking procedure that closes the axillary fossa dead space and tacks the mastectomy flaps to the chest wall has been suggested as one potential technique to reduce the incidence of postmastectomy seromas. This institution-wide study of modified radical mastectomies demonstrated a significant decrease (P < 0.0381) in the incidence of seroma when flap tacking was performed. Women who developed a seroma, compared to those who did not, averaged nearly twice as any office visits in the first 2 months after the operation. Distribution of office visits between the seroma patients and nonseroma patients was significant (P < 0.0001). When practiced by several surgeons, the flap tacking procedure 1) reduces postmastectomy seromas and 2) reduces the amount of postoperative patient office visits and care.     

Rhinoplasty using fibrin glue

Summary Human fibrin glue was used in augmentation rhinoplasties to simplify the procedure of graft fixation. There was stable and safe adhesion of bone and cartilage grafts to the recipient site and reduced formation of hematoma, thereby enhancing healing.     

Techniques of splenic preservation using fibrin glue

Fibrin glue (FG) was used to achieve hemostasis of 16 splenic injuries in 14 patients. The etiologies of injury included five gunshot wounds, two stab wounds, four iatrogenic injuries, and five patients with blunt splenic trauma. The intraoperative blood loss averaged 1.8 +/- 2.4 (SD) liters and patients were transfused 3 +/- 2 units of blood perioperatively. The amount of FG required to achieve splenic hemostasis averaged 11 +/- 8 ml and varied directly with the grade of injury. One patient with a splenic hilar vascular injury (Grade V) underwent splenectomy following failure to achieve complete hemostasis despite the use of 25 ml of FG. All other splenic injuries were successfully managed using less than 25 ml of FG. Postoperative computerized tomographic (CT) scanning, performed in ten patients, was negative for rebleeding or abscess formation. The overall splenic salvage rate was 86%. FG was effective in achieving hemostasis of both superficial and deep splenic injuries. Its use as an adjunct in trauma surgery should result in increased splenic salvage rates compared with that obtained using conventional surgical techniques.     

Common bile duct anastomosis using fibrin glue

Transection of the common bile duct (CBD) secondary to iatrogenic or civilian trauma is a devastating injury associated with a high incidence of complications, especially biliary fistula and stricture formation. We evaluated the efficacy of Fibrin Sealant--a biologic adhesive containing highly concentrated human fibrinogen--in primary end-to-end anastomosis of the transected CBD in ten adult mongrel dogs. Postoperative T-tube stents in the CBD anastomosis and abdominal drainage were not used. Only two absorbable sutures were used for each CBD anastomosis. The dogs were reexplored postoperatively at intervals varying from one week to nine months; cholangiography was performed at postoperative intervals varying from one to six months. Examination of CBD specimens harvested one month or more after surgery revealed complete healing and no signs of previous injury. Histologic examination disclosed well-healed ductal tissue, without a significant inflammatory response. One dog had an anastomotic leak, and two had moderate narrowing of the CBD anastomosis. Our experience in experimental CBD anastomosis indicates that Fibrin Sealant helps seal biliary anastomoses against leakage; controls bleeding from cut edges of bile duct segments; has good systemic and local compatibility; may promote bile duct wound healing; and significantly reduces the number of sutures needed for primary repair, thereby decreasing the potential for anastomotic ischemia, mucosal damage, and biliary stricture formation.     

Osteoregenerative lateral suboccipital craniectomy using fibrin glue

Summary This report describes a simple technique of cranioplasty for suboccipital craniectomy and the results of a clinical study to assess the effects of fibrin glue on regeneration of the skull. Cranioplasty using a mixture of autologous bone chips and human allogenic fibrin glue was performed in 31 patients who received lateral suboccipital craniectomy. Long-term observations with three-dimensional CT showed satisfactory reconstruction of the mastoid-occipital bone plate in 25 patients (81%); among them, a nearly complete reconstruction of the occipital bone (plate) was found in 14 patients. Regeneration of the bone began 6 months after surgery on the inner surface, adjacent to the dura mater. In conclusion, the present technique provides a new simple method to restore an autologous bone plate in a cranial defect made by piecemeal craniectomy.     

Subcutaneous pancreatic islet transplantation using fibrin glue as a carrier

Background

Pancreatic islet grafts are difficult to manipulate and implant in the recipient site mainly because they are formed by a group of cells suspended in a solution. This physical property determines various characteristics that are unique for pancreatic islet transplantation. The purpose of this study was to evaluate the role of fibrin glue as a delivery method for islet transplantation.

Methods

C3H mouse islets were syngeneically transplanted into streptozotocin-diabetic recipients using fibrin glue in a subcutaneous pocket (Group 1) and using liquid islets injected under the kidney capsule (Group 2). Blood glucose levels were measured during 4 weeks of follow-up and compared against normal (Group 3) and diabetic levels (Group 4).

Results

No statistical differences were observed between the normal, kidney capsule, and fibrin glue groups. Only the diabetic group had a statistical difference when compared with the normal control group (P < .01). At the beginning, levels in Group 1 (fibrin glue) were higher than in Group 2 (kidney capsule), but turned into similar values after time and no statistical differences were observed between them during follow-up.

Conclusions

Islet/fibrin glue grafts placed in a subcutaneous pocket obtained the same results as liquid grafts placed under the kidney capsule, proving to be an adequate delivery method for islet transplantation and solving some of the engraftment problems we find with liquid grafts.     

Effect of fibrin glue on lymphatic drainage after modified radical mastectomy: a prospective randomized trial

Fibrin as a tissue sealant has been used since the turn of the century for hemostasis. The development of cryoprecipitate and the resultant availability of higher concentrations of fibrinogen have led to a resurgence of interest in this material. Fibrin glue has since been shown to be effective for numerous applications throughout the field of surgery. Animal studies have shown fibrin glue to be effective at reducing drain output after mastectomy. Human studies, however, have been equivocal. Our objectives were to determine whether the use of fibrin glue would decrease lymphatic drainage after modified radical mastectomy and subsequently reduce time to drain removal. A prospective randomized trial was conducted consisting of 27 women. All women received modified radical mastectomy. At the completion of the mastectomy they were randomized to receive either standard closure or the application of fibrin glue before standard closure. Patients were then monitored for daily drain output, time to drain removal, and wound complications. A total of 14 women received fibrin glue and 13 received no glue. Those patients receiving fibrin glue had a significantly higher average drain output than patients who did not receive glue (1308 vs 754 cm3; P = 0.012). Time to drain removal was also increased by 4 days, although this did not reach statistical significance. The overall complication rate was higher for the fibrin glue group, although again, this did not reach significance. The application of fibrin glue significantly increased drain total drain output after modified radical mastectomy. Time to drain removal was increased as was the complication rate. On the basis of these data fibrin glue cannot be recommended for routine use in modified radical mastectomy.     

Use of fibrin glue in prevention and therapy of intra-abdominal adhesions

In prevention of the recurrent intestinal obstruction we performed at the Department of Pediatric Surgery of the University of Mannheim a sutureless plication of the small bowel with fibrin glue only over the last 7-year period. The postoperative course was uncomplicated in all patients. The clinical and experimental experiences suggest that the high concentrated human fibrinogen is able to start healing of the lesions of the serosa to prevent intraabdominal adhesions prospectively. Furthermore the time saving and easy procedure is to be stressed. First of all the high risk of tissue necrosis or intestinal perforation due to ischemia by sutures and stitches like in the traditional technique of plication is not present.     

Surgical repair of left ventricular free wall rupture using layered fibrin glue sheet and fibrin glue; report of a case

A 57-year-old man with acute myocardial infarction (#13:90%, #6-#8:75%) was admitted to our hospital after the administration of tissue plasminogen activator. Three hours' after emergent percutaneous transluminal coronary angioplasty, he developed left ventricular free wall rupture in the left circumflex artery area. After bleeding was completely controlled by aortic cross clamping, a three-layered of fibrin glue sheet (TachoComb) with fibrin glue was extensively applied to the ruptured site including the infarcted area. He was discharged on the 25th postoperative day and underwent coronary artery bypass grafting to the left anterior descending artery three weeks later. This experience suggests that the layered TachoComb and fibrin glue are effective for left ventricular free wall rupture.     

Use of fibrin glue in the prevention of leakage in pancreatico-jejunal anastomoses

The aim of this study was to test the protective effects of fibrin sealing on the pancreatico-jejunostomy (PJA), the high-risk anastomosis following pancreas head resection. Experimental study was performed on the mongrel dogs, divided in two groups (20 animals each): Experimental group-with end to end "dunking" PJA, protected by temporary occlusion of the pancreatic duct with fibrin sealant/Tissucol/Immuno Ag/, while control group was without any protective procedure. The animals were followed 5 months in order to study: protective effects of such procedure on the PJA quantified with the percent of anastomotic leakage, effects of the exocrine secretion and effects the endocrine function Results: PJA leakage occurred in 13.33% in control group. No leakage was registered in experimental group. Biochemical, histological and electron microscopic study showed slight transitory elevation of amylase levels. Fibrin glue plug was dissolved and pancreatic juice output was reestablished 12th days postoperatively. Long term follow-up showed no damages of the endocrine and exocrine pancreas. Pancreatic duct occlusion with fibrin glue appeared to be an useful method in the prevention of pancreatico-jejunostomy leakage, without negative effects on the exocrine and endocrine pancreas.     

Surgical management of penetrating cardiac injuries using a fibrin glue sheet

A penetrating cardiac injury is among the most lethal of all injuries. We present a case of penetrating cardiac injuries to both ventricles. A laceration on the right ventricle was repaired using buttressed sutures, while an injury to the left ventricle was repaired using a collagen mesh dressing covered by fibrin glue (TachoComb patch) without employing cardiopulmonary bypass. The patient recovered uneventfully without a ventricular pseudoaneurysm. Our results demonstrate the usefulness of a TachoComb patch for penetrating cardiac injuries occurring adjacent to the large coronary artery in the posterior wall of the heart.     

Effects of fibrin glue on rat facial nerve regeneration

Studies of nerve repair comparing fibrin glue with suture techniques have produced mixed results. To test the effect of fibrin glue on nerve regeneration without the confounding variables of distraction and/or movement of the anastomosis, nerve repairs were performed with and without fibrin glue on the intratemporal facial nerve of the rat. The location of the nerve transection was the same for control and experimental nerves, but on the experimental side the nerve was repaired with fibrin glue and on the control side of the nerve was reapproximated in the fallopian canal, without glue or sutures. Axon counts distal to the repair revealed no statistically significant difference between the two methods of repair. This result suggests that mechanical obstruction by the fibrin glue between the nerve ends has a negligible effect on nerve regeneration.     

Stabilization of microvascular pedicles in intricate locations using fibrin glue

In reconstructive microsurgery, it is occasionally advantageous to use long recipient or donor vessels for optimal flap inset. These long vessels are prone to kinking or torsion along their longitudinal axis from vessel distension during blood inflow and rising blood pressure. More often than arteries, the veins can also be compressed by overlying tissue sutured under tension or by developing edema. Reanastomosis can no longer be feasible or desirable for several reasons, and the elongated vessels may have to be shifted to a curved course. To avoid detrimental kinking or torsion, fibrin glue can be administered along this new vessel course in order to ensure stabilization. In 20 such cases, we successfully avoided complications when the danger of kinking, torsion, or vein compression was evident after successful anastomosis. On the basis of this experience, we recommend the use of fibrin glue in microsurgical procedures, especially for vessels in intricate geometrical locations.     

Microvascular anastomosis using polyethylene glycol 4000 and fibrin glue

Rat femoral arteries and veins were anastomosed using fibrin glue and a soluble intravascular stent made of polyethylene glycol 4000 (PEG-4000) with a patency rate of 100%. The anastomoses were strong enough to tolerate a pressure of 250 cm H2O. Histological changes at anastomosed sites and toxicity of PEG-4000 were also examined. With this method, an end-to-end anastomosis can be performed easily and quickly.