P-236THE OPTIMUM SHEET FOR COMBINED APPLICATION OF FIBRIN SEALANT AND BIOABSORBABLE SHEET AGAINST ALVEOLAR AIR LEAKAGE

Abstract

The combination of fibrin sealant (FS) and bioabsorbable sheet (BS) is known to provide a better sealing effect on alveolar air leakage compared to the single use of FS. Previously, we studied the optimum techniques for their combination. This time, we studied on what BS is optimum. Tachosil was also compared with them. Standardized pleural defects produced by electric cauterization in retrieved swine lungs. Experiment I: The 2x3 cm defects were covered with the following BS (3 pieces) by the abovementioned Rub + Soak B technique: 0.15mm polyglycolic acid (PGA) felt (Neoveil) (Group I), 0.3 mm PGA felt (Neoveil) (Group II), 0.5 mm PGA felt (Neoveil) (Group III), oxidized cellulose sheet (OCS) (Surgicel absorbable hemostat) (Group IV), woven PGA sheet (woven Vicryl mesh) (Group V), knitted PGA sheet (knitted Vicryl mesh) (Group VI), knitted OCS (Interceed) (Group VII). Experiment II: The defects were covered with one piece of 0.15 mm PGA felt (Neoveil) by Rub + Soak B technique (Group VIII), Tachosil alone (Group IX), and thrombin applied Tachosil after rubbing with fibrinogen solution (Group X). The minimum seal-breaking airway pressure was compared among the groups. The seal-breaking pressure (SBP) was significantly higher in Group I than in Groups III, IV, V and VII, in Group VI than in Groups III, IV and VII, and in Group X than in Groups III, IV and VII. The SBP was significantly lower in Group IX than in Groups VIII and X (P < 0.05). Histologically, clot penetration into the tissue was significant in Groups I, VIII and X. 0.15 mm PGA felt was the optimum sheet in Rub + Soak B technique, followed by knitted Vicryl mesh. Tachosil with FS was comparable to them in this model. Further studies are needed to determine responses in living tissue and SBP over time in vivo. This study was supported by CSL Behring Co.