Fibrin Glue In Repair Research Articles

The Role and Efficacy of Fibrin Glue in Repair of Peripheral Nerves; Meta-Analysis Study

The Role and Efficacy of Fibrin Glue in Repair of Peripheral Nerves; Meta-Analysis Study

Efficacy of a sheet combined with fibrin glue in repair of pleural defect at the early phase after lung surgery in a canine model.

Polyglycolic acid and oxidized regenerated cellulose have been widely used as a sealant for repairing pulmonary air leakage during respiratory surgery. However, fundamental research of these materials has not been sufficiently conducted. Therefore, we conducted studies to assess the pressure resistance ability of these materials using a canine visceral pleural defect model at the early phase. The 6-mm circular defect and the 12-mm square defect were created on the visceral pleura of anesthetized beagles. These defects were then repaired using one of four methods: method A using polyglycolic acid and fibrin glue; method B using oxidized regenerated cellulose and fibrin glue; method C using oxidized regenerated cellulose; method D using fibrin glue. Airway pressure was measured as bursting pressure when air leakage from the repaired areas occurred at 5min, 3h, and 24h after repair. For the 6-mm circle defect, method A showed higher bursting pressures than the other methods at 5min and 3h (p < 0.05); method B showed higher than methods C and D at 5min and 3h (p < 0.05). For the 12-mm square defect, method A showed higher bursting pressures than the other methods at all time points (p < 0.05). Moreover, method B showed higher than method C at 24h (p < 0.05). Visceral pleural repairs using polyglycolic acid combined with fibrin glue showed the highest bursting pressure. Oxidized regenerated cellulose combined with fibrin glue showed sufficiently high bursting pressure in repair of small 6-mm circular defects.

Fibrin glue repair leads to enhanced axonal elongation during early peripheral nerve regeneration in an in vivo mouse model.

Microsurgical suturing is the gold standard of nerve coaptation. Although literature on the usefulness of fibrin glue as an alternative is becoming increasingly available, it remains contradictory. Furthermore, no data exist on how both repair methods might influence the morphological aspects (arborization; branching) of early peripheral nerve regeneration. We used the sciatic nerve transplantation model in thy-1 yellow fluorescent protein mice (YFP; n = 10). Pieces of nerve (1cm) were grafted from YFP-negative mice (n = 10) into those expressing YFP. We performed microsuture coaptations on one side and used fibrin glue for repair on the contralateral side. Seven days after grafting, the regeneration distance, the percentage of regenerating and arborizing axons, the number of branches per axon, the coaptation failure rate, the gap size at the repair site and the time needed for surgical repair were all investigated. Fibrin glue repair resulted in regenerating axons travelling further into the distal nerve. It also increased the percentage of arborizing axons. No coaptation failure was detected. Gap sizes were comparable in both groups. Fibrin glue significantly reduced surgical repair time. The increase in regeneration distance, even after the short period of time, is in line with the results of others that showed faster axonal regeneration after fibrin glue repair. The increase in arborizing axons could be another explanation for better functional and electrophysiological results after fibrin glue repair. Fibrin glue nerve coaptation seems to be a promising alternative to microsuture repair.

The Use of Fibrin Glue in Repair of Peripheral Nerves

Gluing of nerves with histocompatible and resorbable materials offers a distinct advantage on suturing alone because results in clinical surgery are similar and often better. This method, when applied properly, allows a considerable gain of operative time, which we estimate to be 3-fold (ie, instead of taking 1 hour for grafting one nerve trunk, it takes 20 minutes). It does not represent a breakthrough in peripheral nerve surgery because it does not guarantee that each nerve fiber will be aligned with its own stump. Gross evaluation shows that the percentage of good results is increased by approximately 15 per cent. It must be stressed, however, that a portion of this improvement, difficult to evaluate, may be caused not by the method but by the experience we have gained over the years practicing nerve repair. The commercial fibrin glue is not yet released in the United States by the Food and Drug Administration; however, it seems, at the time of this writing, that this will be done by the first months of 1988.