Anastomosis with fish-mouth technique using fibrin glue

Researchers have made numerous attempts to shorten anastomosis duration since Jacobson first used the term microvascular surgery in 1960. However, none of these alternatives has its combination of facility, low cost, reliability, durability, and high success rate. This study aimed to shorten the anastomosis duration, especially in operations that require multiple anastomoses, and the authors performed experimental anastomoses with the fish-mouth technique using fibrin glue. This technique first involves 2 longitudinal incisions made 180 degrees apart in the shape of a fish mouth at each vessel end, thus creating a pair of equal-sized, full-thickness flaps on both vessels. These incisions, equal in length, were as long as the radius of the vessel. Two simple stay-sutures placed on the corners of the flap bases and vessels were approximated. Then, the anastomosis site was sealed with fibrin glue. Both control and experimental groups are consisted of 32 rats. This study assessed and statistically evaluated the groups with biopsies on days 3, 7, 14, and 21 and also assessed patency rates, microaneurysm formation, histologic healing patterns, and operation duration. The present study concluded that anastomosis with fish-mouth technique using fibrin glue takes less time, requires fewer sutures, decreases the amount of foreign materials in direct contact with the blood stream, creates less foreign-body reaction in the vessel wall, and everts contact surfaces. With these advantages, this technique provides a reliable and successful alternative, especially in operations requiring multiple anastomoses.     

Use of a microvascular coupler device for end-to-side venous anastomosis in oral and maxillofacial reconstruction

The aim of this study was to compare the use of a microvascular coupler device (MCD) for end-to-side venous anastomosis (ETS group) and phleboplasties combined with MCD for end-to-end venous anastomosis (ETE group) in free tissue transfer for oral and maxillofacial reconstruction, with regard to the anastomosis time and occurrence of postoperative vascular crisis. The ETS group included 22 patients and the ETE group included 40 patients. Patient demographic data, anastomotic time, coupler size, microvascular complications, and flap survival rates were collected and analyzed. In the ETS group, the most suitable donor vessel size was greater than 2 mm, varying from 2 mm to 4 mm. The average anastomosis time was 3.35 ± 0.89 min in the ETS group and 7.80 ± 2.93 min in the ETE group; the difference between the groups was statistically significant (p < 0.0001). There were no statistically significant differences in complications or outcomes between the two groups. The ETS venous anastomosis with MCD technique is a better choice for anastomosis when the donor vessel size is greater than 2 mm. In those cases with mismatched veins, ETS venous anastomosis with MCD could significantly reduce the anastomosis time compared to ETE venous anastomosis with MCD after phleboplasties.     

Autologous fibrin glue with growth factors in reconstructive maxillofacial surgery

The aim of this paper was to describe a method for the preparation of autologous fibrin glue with platelet growth factors and to report its use with particulate cancellous bone in reconstructive maxillofacial surgery. The fibrin glue is a two-component glue, where the one component is a concentrated fibrinogen solution with platelet growth factors and the other component is a thrombin solution. Both components were produced from the patients own blood, thus making the glue entirely autologous. The glue was prepared from platelet rich plasma separated from 200 ml of the patient's blood prior to the operation. The fibrinogen in the glue was precipitated from the platelet rich plasma by ethanol precipitation at low temperature and separated together with the platelets by centrifugation. Raising the temperature to 37 degrees C redissolved the precipitate. The thrombin solution in the glue was produced from prothrombin precipitated from 10 ml of the platelet rich plasma by lowering the pH and the ionic strength. The precipitate was separated by centrifugation and dissolved in a calcium ion solution. Increasing the pH to neutral value induced activation to thrombin. Preparation of the fibrin glue was performed in the blood bank within 60 to 90 min with the use of standard equipment. The outcome from 200 ml of blood was approximately 8 ml of fibrin glue: 6 ml fibrinogen to be coagulated with 2 ml of thrombin. The glue had a fibrinogen concentration of approximately 12 times the value in platelet rich plasma and the concentration of growth factors was approximately eight times the value in platelet rich plasma. We have used this glue successfully with particulate bone grafts for reconstructive purposes within the oral and maxillofacial field. It might as well be applied to other surgical areas. Whenever larger amount of the glue will be needed, a whole unit of blood may be taken from the patient, and the red cells re-transfused to the patient during or after the operation.     

Use of fibrin glue in oral surgery

Patients with progressive thromboembolic diseases usually are administered a daily therapy with anticoagulants-antiaggregants drugs: oral surgical procedures may be performed in these conditions without reduction of the systemic therapy, using topically fibrin glue.     

纤维蛋白凝胶在组织工程中的应用

具有良好生物相容性和生物活性的支架材料一直是组织工程研究的重点之一。纤维蛋白凝胶主要由天然的细胞外基质成分构成,具有良好的生物相容性、有效的生物活性以及生物可降解性,同时还具有三维多孔结构和良好的可塑性。近年来,纤维蛋白凝胶作为支架材料日益广泛地应用到组织工程研究中,其对肌组织、骨及软骨组织、上皮组织等的形成具有重要作用,但同时却不能为骨及软骨组织工程提供足够的机械强度。     

Initial experience with hemostatic fibrin glue as adjuvant during drainless parotidectomy

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.     

Treatment of chylous fistula with fibrin glue and clavicular periosteal flap

We describe a new treatment for chylous fistula using fibrin glue and clavicular periosteal flap.     

Human fibrin glue versus sutures in periodontal surgery

A fibrin-sealing system consisting of symmetrical flap and graft procedures versus silk sutures in a split-mouth clinical trial was tested in 51 patients. Clinical parameters and operative times were recorded and compared. In clinical use, the fibrin glue provided quick hemostasis and adequate tissue adhesion on the whole inner surface of grafts or flaps. Its use saved remarkable amounts of time and made it easier to fix tissues in difficult areas. The time saved ranged from 3 to 19.5 minutes per procedure, and 1 to 8.5 minutes per tooth. The convenience of the fibrin glue was especially appreciated in pedicle flap procedures.     

应用纤维蛋白胶和医用OB胶修复兔面神经损伤的实验研究

目的:探讨用纤维蛋白胶或医用OB胶修复兔面神经的损伤效果。方法:手术制作实验用健康30只新西兰大耳白兔右侧面神经下颊支损伤模型,随机分成3组,分别为显微外科吻合组(Ⅰ组)、纤维蛋白胶粘合组(Ⅱ组)、医用OB胶粘合组(Ⅲ组),分别进行修复。术后16周进行大体观察、神经电生理检测、组织学观察、图像分析,评价神经再生恢复情况。结果:16周时肉眼观察3个组吻合口处均见神经再生,可抵抗一定拉力,Ⅰ组和Ⅲ组修复神经的周围软组织粘连较Ⅱ组严重;与Ⅰ组相比,Ⅱ组轴突再生率和再生轴突恢复比均有提高。结论:纤维蛋白胶和医用OB胶均有较好的生物相容性,可修复神经损伤,纤维蛋白胶对神经损伤的修复效果更佳。     

Neuronal structure of microvascular transplants with and without neuronal anastomosis

OBJECTIVE: Latissimus dorsi transplants have little neuronal regenerative capacity without neuronal anastomosis. Histologic differences between transplants with and without neuronal anastomosis and 2 distinct types of neurosurgical reanastomosis are highlighted in this study. PATIENTS AND METHODS: Fifty-four patients with squamous cell carcinomas of the oral cavity (T4) were treated by tumor resection and homolateral neck dissection. The defect was covered with a microvascular latissimus dorsi transplant. In 15 patients, no neuronal anastomoses were performed. In 21 patients, the thoracodorsal nerves were used for microneurosurgical reanastomosis, whereas in 18 patients, the cutaneous branches of the intercostal nerves were used for microneurosurgical reanastomosis. The transplant was examined during surgery and 9 months after surgery by means of a histologic examination of a biopsy specimen. The number of fascicles, the degree of fibrosis, and the myelination were examined. Furthermore, a neurosensory examination was performed 9 months after surgery. RESULTS: Overall, our patients had an average of 12.1 fascicles during surgery. After surgery, patients without neuronal anastomosis showed an average of 4.9 fascicles, patients with nerve anastomosis to the cutaneous branches of the intercostal nerve showed an average of 6.2 fascicles, and patients with anastomosis to the thoracodorsal nerve showed an average of 9.6 fascicles. In cases of nerve anastomosis, a lesser degree of fibrosis was found, together with good myelinization. The clinical examination showed the best neurosensory function in the transplants with anastomosis to the thoracodorsal nerve and the worst function in those without neuronal anastomosis. CONCLUSION: Neuronal reanastomosis led to more surviving neuronal structures in the postoperative histologic specimen. The highest density of fascicles was found in the well vascularized thoracodorsal nerve. The neurosensory function agrees with the histologic result.     

Dental extractions in patients with bleeding disorders: The use of fibrin glue

Eighty patients with various bleeding disorders underwent 135 extractions without preventive replacement hematologic therapy. The local hemostatic control involved the use of fibrin glue Beriplast. Secondary bleeding occurred in 9 of 12 patients with severe hemophilia when the concentration of the aprotinin in the fibrin glue was 1,000 KIU/ml. When it was increased to 10,000 KIU/ml and swish and swallow rinses of tranexamic acid before and after the dental extractions were added, only 3 of 25 hemophilia patients suffered from secondary bleeding. Local use of fibrin glue is a safe and cost-effective tool to treat patients with severe bleeding disorders. None of the 43 patients with coagulopathies other than severe hemophilia suffered bleeding after extractions.     

Effects of fibrin glue on wound healing in oral cavity

Objectives. Healing after oral cavity surgery may be problematic in some cases, because it is a contaminated cavity. The purpose of this investigation was to evaluate the effect of fibrin glue on healing after surgical procedures in the oral cavity.

Methods. Forty-two Sprague-Dawley rats were used at this study, 24 in study (Group 1) and 18 in control (Group 2) groups. First molars of the rats were extracted with some cortical bone. The exposed cavities were filled with fibrin glue after hemostasis in study group but 5/0 silk suture was used in control group. The rats were sacrified after two, four and six weeks and histologic analysis was performed.

Results. Healing was better in the study group. Foreign body reaction was lower in Group 1 (1/24, 4.1%) than Group 2 (6/18, 33.3%) (p<0.05). Also abcess formation scores were better in Group 1 (3/24, 12.5%) than Group 2 (10/18, 55.5%) (p<0.008, χ²=7). The last significant difference was on necrosis and better results were obtained in Group 1 (2/24, 8.3%) than Group 2 (10/18, 55.5%) (p<0.001, χ²=11.24).

Conclusions. The use of fibrin glue on wound healing in the oral cavity has a positive effect when compared with traditional suture techniques.     

Experimental reimplantation utilizing microvascular anastomosis in animals.

The use of the operating microscope and special microsurgical instruments make it possible to achieve successful anastomosis of blood vessels of less than 1 mm in diameter. Microvascular surgery offers newer possibilities in the transplantation of dermisfat grafts, and has led to an unusually high degree of success in the reimplantation of tissues. This paper describes a technique for microvascular anastomosis in animal experiment, using as a model the reimplantation of a completely amputated rabbit ear. In 10 amputated rabbit ears, the central auricular artery with a diameter of 0.5 mm and the two marginal auricular veins with diameter of 0.5-1.0 mm were microsurgically anastomosed. Of the 10 reimplanted ears, 8 survived. The postoperative angiogram showed an unrestricted patency of all the vessels.