Autologous Fibrin Sealant Research Articles

Clinical and patient reported outcomes using autologous fibrin sealant as adjunct to diode light amplification by stimulated emission of radiation‐assisted gingival depigmentation: A randomized controlled trial

AbstractBackgroundGingival depigmentation is quite an invasive procedure and often results in healing by secondary intention, postoperative morbidity, and repigmentation. Autologous fibrin sealant (AFS), a platelet concentrate commonly used due to its adhesive nature and presence of growth factors, has shown good clinical results and improved healing with anti‐inflammatory properties. Hence, the current study aims to evaluate clinical outcomes and patient reported outcomes (PROs) with the adjunctive use of AFS along with Diode light amplification by stimulated emission of radiation (LASER) in gingival depigmentation.MethodologyThis was a randomized double blinded split mouth clinical trial including 10 participants (six females and four males) in age range of 20 to 50 years with gingival hyperpigmentation (Dummet's index 2–3). Test (AFS) and control (no AFS [N‐AFS]) groups received Diode LASER depigmentation with and without adjunctive application of AFS, respectively, along with periodontal dressing. Clinical outcomes assessed were postoperative healing (Landry healing index) and repigmentation. PROs were patient comfort and aesthetics. Healing was assessed at 7 and 15 days and 1 month postoperatively. Repigmentation was assessed at 1, 3, and 6 months postoperatively. Patient comfort was assessed immediately after surgery and 1 week postoperatively using visual analog scale (VAS). Aesthetics was assessed at 1, 3, and 6 months postoperatively using VAS.ResultsBetter early postoperative healing was found at 1 (4.7 ± 0.516, p = 0.043) and 2 weeks (5.0 ± 0.0, p = 0.048) postoperatively in AFS group. No significant difference between the groups was observed in postoperative discomfort, that is, AFS‐1.4 ± 0.516 and N‐AFS‐1.7 ± 0.483 (p = 0.591), aesthetic satisfaction (AFS‐0.1 ± 0.316, N‐AFS‐0.3 ± 0.483, p = 0.168), and repigmentation (p = 0.00).ConclusionThe use of autologous fibrin sealant as adjunct to Diode LASER‐assisted depigmentation in the treatment of gingival pigmentation showed improved clinical outcomes in terms of postoperative healing.

Biochemical and biomechanical characterization of an autologous protein-based fibrin sealant for regenerative medicine

Accidental events or surgical procedures usually lead to tissue injury. Fibrin sealants have proven to optimize the healing process but have some drawbacks due to their allogeneic nature. Autologous fibrin sealants present several advantages. The aim of this study is to evaluate the performance of a new autologous fibrin sealant based on Endoret®PRGF® technology (E-sealant). One of the most widely used commercial fibrin sealants (Tisseel®) was included as comparative Control. E-sealant´s hematological and biological properties were characterized. The coagulation kinetics and the microstructure were compared. Their rheological profile and biomechanical behavior were also recorded. Finally, the swelling/shrinkage capacity and the enzymatic degradation of adhesives were determined. E-sealant presented a moderate platelet concentration and physiological levels of fibrinogen and thrombin. It clotted 30 s after activation. The microstructure of E-sealant showed a homogeneous fibrillar scaffold with numerous and scattered platelet aggregates. In contrast, Control presented absence of blood cells and amorphous protein deposits. Although in different order of magnitude, both adhesives had similar rheological profiles and viscoelasticity. Control showed a higher hardness but both adhesives presented a pseudoplastic hydrogel nature with a shear thinning behavior. Regarding their adhesiveness, E-sealant presented a higher tensile strength before cohesive failure but their elastic stretching capacity and maximum elongation was similar. While E-sealant presented a significant shrinkage process, Control showed a slight swelling over time. In addition, E-sealant presented a high enzymatic resorption rate, while Control showed to withstand the biodegradation process in a significant way. E-sealant presents optimal biochemical and biomechanical properties suitable for its use as a fibrin sealant with regenerative purposes.Graphical

Biological and Adhesive Properties of an Autologous Protein-Based Fibrin Sealant for Ophthalmological Applications.

The aim of this study was to evaluate the biological and adhesive properties of a new autologous sealant based on plasma rich in growth factors (PRGF), named E-Sealant. Conventional PRGF and a commercial fibrin sealant (Tisseel) were included as controls. The hematological and protein content of E-Sealant was determined. Its bioactivity and biocompatibility were tested for human keratocytes (HKs). To evaluate its adhesion and regenerative capacity, E-Sealant was used on an animal model of conjunctival autograft surgery and compared to Tisseel. E-Sealant presented a high growth factor content with levels similar to those of conventional PRGF. E-Sealant induced proliferative and migratory activity on HK cells equivalent to PRGF. Although autologous membranes induced the proliferation of HKs, cells cultured over Tisseel did not adhere nor proliferate. HK cells showed increased number and flattened morphology over PRGF and E-Sealant compared to scarce and round-shape cells detected in Tisseel. Conjunctival autograft glued with E-Sealant adhered successfully, whereas Tisseel application formed irregular clots. During follow-up, both adhesives showed good integration and no dehiscence. However, Tisseel-treated samples presented slightly increased hemorrhage and inflammation. In contrast to Tisseel, E-Sealant-treated autografts presented a continuous layer of non-keratinized stratified squamous epithelium. Inflammatory infiltrates were minimal in E-Sealant-treated conjunctiva, whereas the Tisseel group showed noticeable immune reactions. Unlike Tisseel-treated grafts, E-Sealant presented low immunoreactivity for smooth muscle actin (SMA), suggesting decreased fibrotic tissue formation. E-Sealant presents optimal biological and adhesive properties suitable for use as an ophthalmic glue, with regenerative purposes superior to commercial fibrin sealants. Our study analyzed the characterization and biological activity of a new autologous fibrin sealant in ocular surface cells and in an animal model in which the adhesive and regenerative properties of the fibrin sealant were evaluated.

Autologous Fibrin Sealants Have Comparable Graft Fixation to an Allogeneic Sealant in a Biomechanical Cadaveric Model of Chondral Defect Repair

PurposeThe purpose of this study is to assess the integrity of chondral defect repairs filled with a cartilage allograft and sealed with either allogeneic fibrin sealant or autologous fibrin sealants created with platelet-rich plasma (PRP) or platelet-poor plasma (PPP) in a cadaver model.MethodsTwenty-millimeter medial femoral condyle (MFC) chondral defects were created in five human cadaveric knees. The defects were filled with particulated cartilage allograft hydrated with PRP from human donors until slightly recessed. Sealants were applied until flush with the articular surface using PRP and autologous thrombin serum, PPP and autologous thrombin serum, or commercial allogeneic sealant. The MFC defects were cycled using a multiaxial testing system to simulate continuous passive motion undergone during rehabilitation. After testing, the repairs were assessed for integrity by quantitatively comparing defect exposure and qualitatively assessing sealant delamination.ResultsThe mean defect exposures were 4.20% ± 5.02% for the PRP group, 4.60% ± 5.18% for the PPP group, and 1.80% ± 2.95% for the allogeneic sealant group. No significant differences were observed between groups (P = .227), and each group had significantly less defect exposure when compared to the critical clinically relevant value assigned to be 30% (P = <.001 for all). No complete sealant delamination was observed, although the allogeneic sealant delaminated with a higher magnitude than did the autologous sealants.ConclusionsThe PRP and PPP sealants were comparable to the allogeneic sealant for graft fixation when used in conjunction with an underlying PRP-hydrated particulated cartilage allograft. The autologous sealants had better delamination resistance than the allogeneic sealant.Clinical RelevanceThe time-zero model is critical in elucidating the retention properties of fibrin and allogenic sealants after cartilage repair and before healing processes help stabilize the repair.

Novel autologous, high concentrated fibrin as advanced hemostatic agent for coronary surgery

BackgroundVariability in transfusion outcomes and excessive postoperative bleeding represents a significant problem in cardiac surgery. The effort to reduce bleeding complications and transfusion outcomes is desirable. Our study investigated the feasibility of reducing bleeding complications and transfusion requirements by applying perioperatively prepared autologous bio-regenerative fibrin sealant. MethodsA prospective, case-control study enrolled 74 patients undergoing coronary artery bypass grafting by a single surgeon. Patients in the control group (N = 43), received traditional methods of hemostasis, while patients in the experimental group (N = 31) were treated additionally with autologous bio-regenerative fibrin. ResultsPatients were well-matched with regard to basic demographic, laboratory and procedural data. Allogeneic blood transfusion requirement in control group was 39.5 % (17 of 43 patients), compared to 6.5 % (2 of 31 patients) in treated group (p < 0,001). The lower infection rate in the experimental group was also noted. No safety issues were identified during the preparation and application process. ConclusionAutologous bio-regenerative fibrin can be safely prepared, with no time consuming, and was demonstrated to be a useful tool to decrease allogeneic blood transfusion requirements following elective coronary artery bypass grafting surgery. A prospective randomized trial is needed to confirm these findings.

Skull Base Csf- Leak Closure with Autologous Fibrin Sealant.

IntroductionThere are many fibrin-derived sealants used as topical haemostatic agents in many surgical procedures. Fibrin sealants are usually non-autologous derivatives or animal derivatives, with the exception of Vivostat®, an autologous fibrin sealant derived from patients own blood.Materials and MethodsWe present our experience on the use of Vivostat® in skull base closures in 20 patients operated at the Otorhinolaryngology Unit of the Hospital Ospedali Riuniti Villa Sofia - Cervello of Palermo. All postoperative patients were placed in an anti-trendeleburg position for 48 hours. After removal of the nasal swabs we did not find any rhinorrhea and we checked the tightness of the skull base defect with computed tomography.ResultsOn a total of the 20 patients (10 post-traumatic and 10 with iatrogenic leaks), 9 out of 10 post-traumatic cases had a leak in the border area between the anterior and posterior portion of the ethmoid, while 1 patient out of 10 post-traumatic cases had a leak at the level of the sella. In all 20 patients, we repaired skull base defects by fixing grafting materials with Vivostat®. We have not had any complications. Vivostat® is a useful product in skull base repair and safe for the patients.ConclusionVivostat® has been used as a sealant on body tissues with greater elasticity and more resistant allowing better and safer wound repair, especially in skull base surgery. In particular, its immediate polymerisation is very useful for an evaluation of the mechanical sealants in the closure of the skull base cerebrospinal fluid leak.

Autologous fibrin sealant application in cardiac surgery - a single-centre observational study.

IntroductionTo minimize the risk of blood loss and post-transfusion complications in patients undergoing cardiovascular surgery, different strategies are used.AimTo analyse the efficacy of the intraoperative use of autologous fibrin glue to seal suture lines of cardiac and vascular structures.Material and methodsThe early results of 62 patients who underwent complex cardiac operations in extracorporeal circulation were analysed. In a half of them Vivostat autologous fibrin sealant in addition to the routine haemostatic agents was applied (study group), whereas in the second group (matched-pair control group) only standard haemostatics were used. Among many other factors, special attention was paid to postoperative drainage and blood products used.ResultsThe mean age of the patients and prevalence of comorbidities did not differ between groups. Generally, in the study group fewer haemostatic agents were used. For example, Preveleak tissue glue was applied in 3.2% of studied cases compared to one third of control patients (p = 0.008). The thoracic drainage on either day 0 or day 1 was also similar. The number of patients who received blood products did not differ between groups. More importantly, there were no significant differences in in-hospital mortality and prevalence of other postoperative complications.ConclusionsIn this study it was found that application of autologous fibrin glue was safe and might limit use of standard haemostatic agents. Taking into account the lack of potential threats related to the transmission of infections and immune responses, it may be an interesting alternative to the previously used local haemostatics.

Autologous cartilage and fibrin sealant may be superior to conventional fat grafting in preventing physeal bone bridge formation - a pilot study in porcines.

PurposeThe article compares physeal recovery after insertion of autologous cartilage and a conventional fat graft in a standardized porcine physeal gap model. Presence of a bone bridge was the primary outcome.MethodsTen porcines in two groups of five were included in a paired design. A standardized physeal gap in the distal femur was made in all animals. One group (n = 5) was randomized for deposition of autologous cartilage and a Tisseel® or Tisseel® alone. The autologous cartilage was harvested from the femoral articular surface. The other group was randomized for fat grafting or no grafts at all. All animals were housed for 14 weeks. Magnetic resonance imaging (MRI) was performed at 14 weeks prior to euthanasia. The physis was harvested for histology.ResultsMRI – Three bone bridges were seen in the fat grafted gaps. All empty gaps formed a bone bridge. No gaps filled with autologous cartilage and Tisseel® resulted in bone bridges. One gap filled with Tisseel® only caused a bone bridge. Histology – The cartilage grafted gaps recovered with physeal-like cartilaginous tissue in histological analysis.ConclusionsFat grafts seems ineffective in preventing bone bridges. The use of autologous cartilage may be superior to the current treatment. However, donor site complications were not investigated. The study serves as a proof of concept study and requires further investigation.Level of evidenceIII

Comparison of Length of Postoperative Hospital Stay in Pulmonary Resection Patients With and Without Autologous Fibrin Sealant: a Retrospective Descriptive Study

Prolonged air leak and excessive pleural fluid drainage are important factors affecting morbidity and mortality following pulmonary resection. This study investigated the effects of autologous fibrin sealant on length of hospital stay in patients who underwent pulmonary resection. A total of 90 patients who underwent lobectomy or bilobectomy in our center were included in the study. Thirty-seven of the patients were treated with autologous fibrin sealant after resection, while the other 53 patients were not (control group). The patients’ records were retrospectively examined to compare demographic, surgical, and postoperative data between the groups. There were no significant differences between the autologous fibrin sealant group and the control group in terms of age, sex, type of operation, indications for surgery, or preexisting comorbidities (p > 0.05). Mean time to drain removal and mean postoperative time to hospital discharge were significantly shorter in the autologous fibrin sealant group (p = 0.0001). Our results indicate that using autologous fibrin sealant decreases the time to drain removal as well as length of postoperative hospital stay.

The clot thickens: Autologous and allogeneic fibrin sealants are mechanically equivalent in an ex vivo model of cartilage repair.

Fibrin sealants are commonly used in cartilage repair surgeries to adhere cells or grafts into a cartilage defect. Both autologous and commercial allogeneic fibrin sealants are used in cartilage repair surgeries, yet there are no studies characterizing and comparing the mechanical properties of fibrin sealants from all-autologous sources. The objectives of this study were to investigate (i) the effect of fibrinogen and thrombin sources on failure mechanics of sealants, and (ii) how sealants affect the adhesion of particulated cartilage graft material (BioCartilage) to surrounding cartilage under physiological loading. Allogeneic thrombin and fibrinogen were purchased (Tisseel), and autologous sources were prepared from platelet-rich plasma (PRP) and platelet-poor plasma (PPP) generated from human blood. To compare failure characteristics, sealants were sandwiched between cartilage explants and pulled to failure. The effect of sealant on the adhesion of BioCartilage graft to cartilage was determined by quantifying microscale strains at the graft-cartilage interface using an in vitro cartilage defect model subjected to shear loading at physiological strains well below failure thresholds. Fibrinogen sources were not equivalent; PRP fibrinogen created sealants that were more brittle, failed at lower strains, and resulted in sustained higher strains through the graft-cartilage interface depth compared to PPP and allogeneic sources. PPP clotted slower compared to PRP, suggesting PPP may percolate deeper into the repair to provide more stability through the tissue depth. There was no difference in bulk failure properties or microscale strains at the graft-cartilage interface between the purely autologous sealant (autologous thrombin + PPP fibrinogen) and the commercial allogeneic sealant. Clinical Significance: All-autologous fibrin sealants fabricated with PPP have comparable adhesion strength as commercial allogeneic sealants in vitro, whereas PRP creates an inferior all-autologous sealant that sustains higher strains through the graft-cartilage interface depth.

Does autologous fibrin sealant (vivostat©) reduce the incidence of postoperative pancreatic fistula after distal pancreatectomy? – a matched pairs analysis

Background Postoperative pancreatic fistula (POPF) is the most common complication following distal pancreatectomy. This retrospective study investigated the effects of autologous fibrin sealant (Vivostat©) in reducing the incidence of POPF after distal pancreatectomy. Methods A matched pairs analysis was performed to compare the incidence of clinically relevant POPF of 41 patients who underwent a distal pancreatectomy with application of autologous fibrin sealant (Vivostat©) with a historical control group. Results Clinically relevant POPF were present in 11 patients in the study group (27%) and in 13 patients in the control group (32%, p = .639). No patient of the study group required emergency angiographic treatment for postoperative hemorrhage due to POPF, whereas three patients were identified in the control group (7%, p = .079). Conclusions POPF cannot be prevented under treatment with autologous fibrin sealant (Vivostat©). We observed the tendency of a lower rate of postoperative pancreatic hemorrhage due to POPF. However, prospective randomized controlled studies are required.

The clot thickens: pooled plasma and autologous fibrin sealants' show equivalent failure mechanics and repair adhesion to articular cartilage

The clot thickens: pooled plasma and autologous fibrin sealants' show equivalent failure mechanics and repair adhesion to articular cartilage

Fibrin tissue sealant and minor skin grafts in burn surgery: A systematic review and meta-analysis

The indications for use of fibrin glue in skin grafting burn patients remains understudied. The purpose of this study is to review the efficacy of fibrin tissue sealant in skin graft adherence, establish guidelines for use of fibrin tissue sealant, and review the cost effectiveness of fibrin glue. Publications with the following criteria were included: comparative human studies, autologous skin grafts, and autologous or commercial fibrin sealant. Outcomes assessed included evidence of engraftment, wound closure, rates of hematoma/seroma, graft loss and infection. Meta-analysis obtained pooled odds ratios for outcomes of interest. Cost analysis was performed using data available in the literature. 7 studies and 751 interventions (fibrin) and controls (staples) were included in the final analysis. 67.6% grafts with fibrin were 100% adherent by one week, vs. 55.5% (OR 1.45, p = 0.086). Complete wound closure by one month was 80.2% with fibrin, vs. 73.3% (OR 1.34, p = 0.187). Hematoma/seroma occurred 38.2% with fibrin, vs. 64.7% (OR 0.487, p = 0.122). Graft loss was higher in the control group, 21% vs. 12.6% (OR 0.891, p = 0.604). Average cost of fibrin glue was $50 per ml, and averaged costs of stapler and staple remover was $30 USD ($10-50). Fibrin glue is as effective as staples for adhering skin grafts, and trends towards lower rates of hematoma/seroma. In topographically complex regions, fibrin glue may be a better choice for adherence of skin grafts.

Autologous Activated Fibrin Sealant for the Esophageal Anastomosis: A Feasibility Study

BackgroundEsophageal cancer is surgically treated by means of an esophagectomy. However, esophagectomies are associated with high morbidity rates with dehiscence of the anastomosis occurring in 19% of these procedures in the Netherlands. Application of a fibrin sealant may improve mechanical strength of the anastomosis. The aim of this study was to determine the technical feasibility of the application of an autologous fibrin sealant by aerosolized spraying on esophageal anastomoses. MethodsThis study was designed as a single-center feasibility study. Patients undergoing elective minimal invasive esophageal surgery with the creation of a thoracic or a cervical anastomosis were eligible. Fibrin sealant (Vivostat) was applied to the anastomosis intraoperatively. Feasibility was measured using a nine-item checklist, designed for intraoperative application. ResultsIn total, fifteen patients, between the ages of 43-79 y, were included in this study. One procedure scored eight out of nine points on the feasibility checklist, so application was considered as unsuccessful. The other fourteen procedures obtained a 100% score and were documented as successful procedures. Together, this led to a success rate of 93%. Grade III anastomotic leakage occurred in one of the fifteen patients (6.7%). ConclusionsThis study showed that application of fibrin sealant on esophageal anastomoses is technically feasible and safe. Future studies may investigate the possible protective effects of fibrin sealant application on the development of anastomotic leakage. NCT03251040.

Endoscopic application of autologous fibrin glue to treat postoperative CSF leak after expanded endonasal approach: Report of two cases

Abstract Since the introduction of endoscopic surgery for the treatment of skull base lesions, one of the main issues has been the CSF leak. The implementation of efficient reconstructive techniques has reduced the post-operative CSF leak rate. However, none of the techniques for closure has proved to be totally effective in preventing CSF leakage. We propose a possible solution to this problem. Two patients underwent surgery for suprasellar meningioma via an expanded endoscopic endonasal approach and subsequently presented post-operative CSF leakage. They were treated via injections of autologous fibrin glue at the patients' bedside. The autologous fibrin glue was obtained using the automated Vivostat® system, that prepares 5 ml of autologous fibrin sealant from 120 ml of the patient's own blood. In both patients, we obtained the permanent closure of the small defects and the interruption of the leakage. The application of autologous fibrin glue made it possible to successfully treat these two cases of postoperative CSF leak without the need of a second operation. The advantage of using autologous fibrin glue is probably related to the high biological activity of such material in promoting a faster healing, it might be a solution in selected cases.

The use of an autologous fibrin sealant during a complex cardiac surgical procedure.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Jarząbek R, Bugajski P, Greberski K, Kalawski R. The use of an autologous fibrin sealant during a complex cardiac surgical procedure. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2018;15(1):62-64. doi:10.5114/kitp.2018.74680. APA Jarząbek, R., Bugajski, P., Greberski, K., & Kalawski, R. (2018). The use of an autologous fibrin sealant during a complex cardiac surgical procedure. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 15(1), 62-64. https://doi.org/10.5114/kitp.2018.74680 Chicago Jarząbek, Radosław, Paweł Bugajski, Krzysztof Greberski, and Ryszard Kalawski. 2018. "The use of an autologous fibrin sealant during a complex cardiac surgical procedure". Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 15 (1): 62-64. doi:10.5114/kitp.2018.74680. Harvard Jarząbek, R., Bugajski, P., Greberski, K., and Kalawski, R. (2018). The use of an autologous fibrin sealant during a complex cardiac surgical procedure. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 15(1), pp.62-64. https://doi.org/10.5114/kitp.2018.74680 MLA Jarząbek, Radosław et al. "The use of an autologous fibrin sealant during a complex cardiac surgical procedure." Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, vol. 15, no. 1, 2018, pp. 62-64. doi:10.5114/kitp.2018.74680. Vancouver Jarząbek R, Bugajski P, Greberski K, Kalawski R. The use of an autologous fibrin sealant during a complex cardiac surgical procedure. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2018;15(1):62-64. doi:10.5114/kitp.2018.74680.

A prospective randomized trial comparing homologous and autologous fibrin sealants for the control of alveolar air leak.

Postoperative air leak is a common complication seen after pulmonary resection. It is a significant reason of morbidity and also leads to greater hospital cost owing to prolonged length of stay. The purpose of this study is to compare homologous sealant with autologous one to prevent air leak following pulmonary resection. A total of 57 patients aged between 20 and 79 (mean age: 54.36) who underwent pulmonary resection other than pneumonectomy (lobar or sublobar resections) were analyzed. There were 47 males (83%) and 10 females (17%). Patients who intraoperatively had air leaks were randomized to receive homologous (Tisseel; n=28) or autologous (Vivostat; n=29) fibrin sealant. Differences among groups in terms of air leak, prolonged air leak, hospital stay, amount of air leak were analyzed. Indications for surgery were primary lung cancer in 42 patients (71.9%), secondary malignancy in 5 patients (8.8%), and benign disease in 10 patients (17.5%). Lobectomy was performed in 40 patients (70.2%), whereas 17 patients (29.8%) had wedge resection. Thirteen (46.4%) patients developed complications in patients receiving homologous sealant while 11 (38.0%) patients had complication in autologous sealant group (P=0.711). Median duration of air leak was 3 days in two groups. Time to intercostal drain removal was 3.39 and 3.38 days in homologous and autologous sealant group respectively (P=0.978). Mean hospital stay was 5.5 days in patients receiving homologous sealant whereas it was 5.0 days in patients who had autologous agent (P=0.140). There were no significant differences between groups in terms of measured maximum air leak (P=0.823) and mean air leak (P=0.186). There was no significant difference in the incidence of complications between two groups (P=0.711). Autologous and heterologous fibrin sealants are safe and acts similarly in terms of air leak and hospital stay in patients who had resectional surgery.

Distal Pancreatectomy with Autologous Fibrin Sealant - Implementation of an Established Concept of Tissue Sealing in Pancreatic Surgery

Background: Postoperative pancreatic fistulas (POPF) remain a major concern after distal pancreatectomy. Irrespective of the technique to close the pancreatic remnant, pancreatic fistulas will occur in approximately 30 % of patients undergoing distal pancreatectomy. For the first time ever, autologous fibrin sealant (Vivostat®) was used to additionally seal the pancreatic remnant after a distal pancreatectomy. The aim was to analyse whether this changes the postoperative outcome. Patients/Material and Methods: In 2015, a technical case series was performed in 15 patients who underwent distal pancreatectomy. The pancreatic remnant was additionally sealed with autologous fibrin sealant (Vivostat®). Results: A postoperative pancreatic fistula (POPF) occurred in 5/15 patients (33 %). One patient had a POPF grade A (1/15, 6.7 %), whereas a POPF grade B occurred in 4/15 patients (26.7 %). 75 % (3/4) of the patients with a POPF grade B were sufficiently treated with antibiotics, whereas a CT-guided percutaneous drainage had to be placed only in one case. Conclusion: Autologous fibrin sealant is simple to apply and seems to be well tolerated. However, it does not seem to avoid the development of postoperative pancreatic fistulas after distal pancreatectomy.

Effects of an autologous fibrin sealant on lymphatic leakage after radical cystectomy: A matched case‐control study

AimThe aim of the present study was to investigate the effect of an autologous fibrin sealant (Vivostat) on the prevention of lymphatic leakage after radical cystectomy.Patients and MethodsPatients who underwent laparoscopic radical cystectomy (LRC) or robot‐assisted radical cystectomy (RARC) for the treatment of bladder cancer were enrolled. Autologous fibrin sealant was applied after the completion of bilateral pelvic lymph node dissection. The data were compared with those from matched RARC patients in a historical cohort.ResultsTen consecutive RARC or LRC were performed using an autologous fibrin sealant. A statistically nonsignificant reduction in drain output (1165.5 mL, range = 225–3150 mL) was observed compared with 10 matched historical RARC patients who did not receive the autologous fibrin sealant (1927.2 mL, range = 240–4010 mL). No difference in the number of days of in‐situ drainage or the length of hospital stay was found. Two patients in the control group developed asymptomatic lymphocele. One patient in the group treated with the autologous fibrin sealant developed deep vein thrombosis after RARC.ConclusionThe use of an autologous fibrin sealant did not reduce lymphatic leakage after radical cystectomy.

Aulogous fibrin sealant (Vivostat(®)) in the neurosurgical practice: Part II: Vertebro-spinal procedures.

Background:Epidural hematomas, cerebrospinal fluid fistula, and spinal infections are challenging postoperative complications following vertebro-spinal procedures. We report our preliminary results using autologous fibrin sealant as both fibrin glue and a hemostatic during these operations.Methods:Prospectively, between January 2013 and March 2015, 68 patients received an autologous fibrin sealant prepared with the Vivostat® system applied epidurally to provide hemostasis and to seal the dura. The surgical technique, time to bleeding control, and associated complications were recorded.Results:Spinal procedures were performed in 68 patients utilizing autologous fibrin glue/Vivostat® to provide rapid hemostasis and/or to seal the dura. Only 2 patients developed postoperative dural fistulas while none exhibited hemorrhages, allergic reactions, systemic complications, or infections.Conclusions:In this preliminary study, the application of autologous fibrin sealant with Vivostat® resulted in rapid hemostasis and/or acted as an effective dural sealant. Although this product appears to be safe and effective, further investigations are warranted.