Fibrin Glue

Fibrin glue is made with highly concentrated human fibrinogen and clotting factors achieving haemostasis. The fibrin adhesive consists of dried sealer protein concentrate, aprotinin, dried thrombin, and calcium chloride. Sealer protein concentrate is made from donor human plasma. Kram et al.53 used fibrin glue (FG) in 1987 for achieving haemostasis in superficial and deep hepatic injuries. The experimental study was done on 12 adult, mongrel dogs. Half of the dogs received two penetrating hepatic injuries each, and the other half underwent resection of a large segment of left lobe of liver. Haemostasis was achieved by applying FG into and over the bleeding wounds without hepatic arterial occlusion. Complete haemostasis was achieved in all animals before skin closure. One dog from each group was re-exposed and the liver specimens harvested for gross and microscopic examination at postoperative intervals of 12 hours,

24 hours, and two, three, six, and eight weeks. There were no cases of intra-abdominal infection, abscess formation, or bile fistulae. Histo-logical examination showed a thickened capsule containing fibrous connective tissue and neovascular proliferation. There were no signs of local or systemic toxicity. One dog died on the postoperative day 1 due to re-bleeding from the hepatic injury, but all others survived without complications.

Subsequent studies were conducted by Kram et al..54 in 1985 to repair trachea with fibrin glue. Eight mongrel dogs were taken for the experiment, and a large partial transaction was made through the anterior tracheal wall between the sixth and the seventh tracheal rings. One absorbable suture was placed around the tracheal cartilages. FG was applied over the incision and allowed to harden. At five-minute intervals, two additional layers of FG were applied. All dogs survived with intact anastomoses, with no postoperative air leaks or complications. Later Kram et al.55 studied the use of fibrin glue for sealing pancreatic injuries, resections, and anastomoses. Postopera-tively, no patient developed pancreatic fistulas, pancreatic abscesses, or pseudocysts. In 1995, Suzuki et al.8 studied the role of FG in the prevention ofpancreatic fistulas following distal pancreatectomy. The overall incidence of pancreatic fistulas was 28.6%, but that in the fibrin glue group was 15.4%. Kuderna et al..56 evaluated the repair of several peripheral nerves using FG. Nerve repair requires the junctions to be free of tension, and sutures were used for stabilising the junctions, which lead to foreign body reaction. Instead of a suture, FG seal was used for stabilising the junctions, and the results were encouraging.

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