Fibrin Glue Research Articles

Perioperative Outcomes of Branchial Cleft Sinus Tract Excision in Pediatric Patients Without the Use of Intraoperative Dye.

Branchial cleft cysts are pediatric congenital anomalies that can present as sinus tracts to the neck. Intraoperative methylene blue dye with fibrin glue has been suggested as an effective tool for tracking the tract's depth to help definitively excise. In this large retrospective study of 118 patients spanning a decade, we aim to elucidate outcomes of branchial cleft anomaly excision without methylene blue dye. A retrospective review was conducted with patients who received branchial cleft anomaly (BCA) with sinus tract excision at Monroe Carrell Jr. Children's Hospital from June 2012 to June 2022. We collected demographic variables, BCA characteristics, perioperative care variables (ie, prior drainage, imaging, and concurrent procedure), and perioperative outcomes (ie, intra- and post-operative complications). Median and interquartile range (IQR) were calculated for continuous demographic variables, and average and standard deviation (SD) were calculated for sinus tract length. Two-tailed Chi-square or Fisher's exact tests were performed to compare categorical samples where applicable with a statistical significance threshold set a priori at P < .05, and multivariable logistic regression assessed significant associations. The sample included 118 patients with an average tract length of 3.3 cm (SD = 1.7 cm). Incision/drainage was performed before definitive excision in 16 (13.6%) patients and was associated with age above the median (aOR = 5.29, 95% CI = 1.39-20.09, P = .015) and female sex (aOR = 3.81, 95% CI = 1.12-13.01, P = .032). Most patients (N = 85, 72.0%) did not receive imaging. Among 118 cases, 2 (1.7%) required return to the operating room for surgical site complications. No patients experienced intra-operative complications or tract recurrence necessitating revision surgery. Patients with branchial cleft sinus tracts that were surgically excised without intraoperative dye achieved definitive resection with no recurrence and limited post-operative complications. While not a direct comparison, these results suggest that using intraoperative dye may be associated with unnecessary costs without benefit in outcomes.

Pilonidal Disease Management in Young Adults: A Retrospective Analysis of Practices in a single tertiary centre in Bahrain

Abstract Background Pilonidal disease is a prevalent skin condition that predominantly affects young males. This study, conducted at Salmaniya Medical Complex in Bahrain, aimed to analyze the demographics, treatment methodologies, and complications associated with pilonidal disease. Materials and Methods We analyzed the medical records of 56 patients, comparing our practices to the American Society of Colon and Rectal Surgeons (ASCRS) guidelines. Variables collected included patient demographics (age and gender), details on preoperative and postoperative antibiotics, the type of surgical intervention performed, the closure technique used, and follow-up results at 2 months post-discharge, Results Our findings confirmed the high prevalence of the disease in young males (75%), with a median age at presentation being 20.5 years. Our practices showed minimal compliance (≤69%) to key recommendations. We found no documented practices for hair removal, phenol application, fibrin glue, or minimally invasive approaches. The most common surgical approach was primary closure (60%), followed by flap reconstruction (16%) and leaving wounds open (7%). The commonest complications were wound dehiscence and surgical site infection (27% each). Post-operative complications were significant, with 67.6% in patients who received pre- operative antibiotics and 63.6% in those who received post-operative antibiotics. However, no statistical link to closure type was found, likely due to our small sample size. Conclusion We recommend reassessing our management protocols to align with ASCRS guidelines and considering non-operative treatments to reduce morbidity. This study underscores the need for guideline adherence and the potential benefits of non-operative treatments in managing pilonidal disease.

Progress in application of medical absorbable haemostatic materials for haemostasis in orthopaedic surgery

The application progress of medical absorbable haemostatic material (MAHM) in hemostasis during orthoapedic surgery was reviewed, in order to provide reference for clinical hemostasis program. The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized. According to biocompatibility, MAHM can be divided into oxidized cellulose/oxidized regenerated cellulose materials, chitosan and its derivatives materials, starch materials, collagen and gelatin materials, and fibrin glue materials, etc., which can effectively reduce blood loss when used in orthopedic surgery for hemostasis. Each hemostatic material has different coagulation mechanism and suitable population. Oxidized cellulose/oxidized regenerated cellulose, chitosan and its derivatives, starch hemostatic material mainly stops bleeding by stimulating blood vessel contraction and gathering blood cells, which is suitable for people with abnormal coagulation function. Collagen, gelatin and fibrin glue hemostatic materials mainly affect the physiological coagulation mechanism of the human body to stop bleeding, suitable for people with normal coagulation function. Reasonable selection of MAHM can effectively reduce perioperative blood loss and reduce the risk of postoperative complications, but at present, single hemostatic material can not meet clinical needs, and a new composite hemostatic material with higher hemostatic efficiency needs to be developed.

Diabetic rats skin wounds treated with heterologous fibrin sealant followed by photobiomodulation therapy.

Diabetes mellitus is characterized by elevated blood glucose levels causing sometimes impairment of the body's ability to repair itself. Promising treatments for tissue repair have included photobiomodulation therapy and heterologous fibrin biopolymer (HFB). This study aimed to evaluate the impact of photobiomodulation therapy by LED, both as a standalone treatment and in conjunction with heterologous fibrin biopolymer in treatment of skin lesions of diabetic rats. Diabetes was induced using alloxan. Full-thickness skin wounds were induced on the backs of 56 Wistar rats, which were randomly allocated into four groups: control group, heterologous fibrin biopolymer group, photobiomodulation therapy by LED group, and photobiomodulation therapy by LED combined with heterologous fibrin biopolymer group. The treatments spanned two experimental periods, lasting 7 and 14 days. Notably, the HFB group exhibited results similar to those of the LED group concerning wound regression, while demonstrating superior resistance to healing. Interestingly, the LED + HFB group showed greater skin damage at 7 days, but an improved repair process at 14 days compared to the control group. The findings indicate that combining photobiomodulation by LED with HFB did not enhance wound healing in diabetic rats beyond the effects of each treatment alone. Both treatments were effective individually, with HFB showing particular strength in promoting collagen maturation and improving tissue biomechanical properties.This study contributes tothe ongoing body of research on skin repair with this innovative HFB. Future clinical trials will be essential to validate this proposition.

Dorsolateral Transdural Surgical Management of Spontaneous Intracranial Hypotension From Ventral Dural Cerebrospinal Fluid Leaks: Case Series and Technical Report

BACKGROUND and OBJECTIVES: Spontaneous intracranial hypotension is an uncommon but debilitating condition that commonly involves positional headaches and vertigo. One cause is cerebrospinal fluid (CSF) leakage from ventral dural defects from calcified spinal discs. Patients can undergo epidural blood or fibrin glue patches as treatment; however, in cases where the leak does not resolve, surgical repair of the dural tear may be warranted. We aim to describe a case series and technical notes for these patients. METHODS: Patients with spontaneous intracranial hypotension because of myelography-confirmed ventral dural defect from calcified thoracic disc, who were treated surgically between June 2020 and March 2024, were included in the study cohort. Demographic information, clinical course, and postoperative outcomes were collected. The surgical technique was also described based on an illustrative case. RESULTS: Twelve consecutive patients underwent surgery between June 2020 and March 2024 with postoperative records. The median age at the time of surgery was 41.5 years (range: 28-58 years). Male patients comprised 50% of the cohort. Dural defects were spread throughout the thoracic spine in the cohort. While all patients reported positional headaches, other symptoms included vertigo, pulsatile tinnitus, and neck pain. Median length of follow-up time was 6.5 weeks. There were no surgical complications or permanent neurologic deficits. All patients had radiologic cure of their leaks with absence of extradural CSF on postoperative MR imaging. Ten patients (83.3%) had complete resolution of spontaneous intracranial hypotension-related symptoms. Two patients did suffer from rebound headaches postoperatively. CONCLUSION: The dorsolateral transdural surgical approach is a safe and effective method to repair type 1 CSF leaks caused by ventral dural defects. Our case series of 12 patients did not involve any surgical or immediate postoperative complications, and all patients had radiologic resolution of their leaks with relief of positional headaches. Two patients experienced continued headaches after treatment.

NIMG-61. TRANSVENTRICULAR MIGRATION OF CESIUM-131 BRACHYTHERAPY SEEDS TO THE SACRAL THECAL SAC IN A PATIENT TREATED FOR RECURRENT GLIOBLASTOMA

Abstract Cesium-131 brachytherapy (GammaTileTM) is a relatively new form of surgically targeted radiation therapy for recurrent glioblastoma. While seed migration is a well-documented complication of solid tumor brachytherapy, it has not been reported in the treatment of glioblastoma. Here, we describe a rare occurrence of seed migration in a 71-year-old patient treated for recurrent left temporal lobe glioblastoma. The GammaTile is comprised of a resorbable collagen matrix containing four titanium-encapsulated radioactive Cs-131 seeds. Each seed emits a localized dose of radiation with a 9.7-day half-life. To prevent displacement from the resection cavity, oxidized regenerated cellulose (SurgicelTM) was applied to the cavity surface under the tiles and fibrin sealant (TisseelTM) was applied over the tiles. Margins of the lateral ventricles were not breached during the surgery and surface was non-ulcerated. The tiles remained in place on follow-up imaging for at least 7 weeks. At least 97% of the prescribed dose was delivered before seed migration. Bevacizumab systemic treatment was initiated. Abdominal CT obtained after 3 months incidentally noted migration of 2 seeds to the sacral spinal canal. Additional seeds had migrated to the suprasellar region, left lateral ventricle, and lateral cerebellomedullary cistern. Despite seed migration, the patient maintained progression-free survival for at least 10 months, with at least 30 months of overall survival from the time of diagnosis. Although the patient did not experience any symptoms related to seed migration, this has the potential to cause radiation-related toxicity to healthy tissue, particularly if it occurs early after surgery. The use of bevacizumab may have contributed to penetration of the lateral ventricle. Despite meticulous surgical technique, the potential for seed migration should be considered during treatment planning when using anti-angiogenic therapies. Further research is needed to better understand the factors contributing to seed migration and to develop strategies for minimizing this risk.

Cartilage extracellular matrix collagen type II and aggrecan expressions in rabbit cartilage following mesenchymal stem cell implantation

Collagen II and aggrecan are the major components of the cartilage extracellular matrix (ECM) that determine the structure and function of the hyaline articular cartilage. Therefore, their examination should be included in the evaluation of the repair tissue, which is formatted into osteochondral defects (ODs). In this study, the effect of allogeneic-derived stem cells (DSCs), including bone marrow-DSCs (BMDSCs), adipose-DSCs (ADSCs), and synovial membrane-DSCs (SMDSCs), implantation on collagen II and aggrecan production was evaluated. Forty-eight New Zealand rabbits underwent the creation of 3×3mm sized ODs in the femoral patellar groove on both knees and were then randomly assigned to three groups. In all groups, the ODs in the right limbs were filled with fibrin glue (FG), whereas the ODs in the left limbs were filled with ADSCs+FG in group A, with BMDSCs+FG in group B and with SMDSCs+FG in group C. After 12 weeks the repair tissues were immunohistologically assessed for collagen II and aggrecan. Accordingly, FG and ADCSs (p=0.003), BMDSCs (p=0.017), and SMDSCs (p=0.003) implantation resulted in significantly stronger expression of collagen II in the reparative tissue compared with the FG groups. Also, the newly formed tissue in the BMDSCs+FG (p=0.015) and SMDSCs+FG (p=0.003) groups expressed significantly higher aggrecan compared with the FG groups, whereas BMDSCs+FG (p=0.030) and SMDSCs+FG (p=0.002) transplantation promoted significantly higher aggrecan composition compared with ADSCs+FG. These findings indicate the profound impact of BMDSCs and SMDSCs on the ECM quality of the repair tissue. Additionally, the inefficiency of FG to induce a well-developed ECM in the repair area was highlighted.

Modeling Fibrin Accumulation on Flow-Diverting Devices for Intracranial Aneurysms.

The mechanisms leading to aneurysm occlusion after treatment with flow-diverting devices are not fully understood. Flow modification induces thrombus formation within the aneurysm cavity, but fibrin can simultaneously accumulate and cover the device scaffold, leading to further flow modification. However, the interplay and relative importance of these processes are not clearly understood. A computational model of fibrin accumulation and flow modification after flow diversion treatment of cerebral aneurysms has been developed under the guidance of invitro experiments and observations. The model is based on the loose coupling of flow and transport-reaction equations that are solved separately by independent codes. Interaction or reactive terms account for thrombin production from prothrombin stimulated by thrombogenic metallic wires and inhibition by antithrombin as well as fibrin production from fibrinogen stimulated by thrombin and flow shear stress, and fibrin adhesion to device wires and already attached fibrin. The computational model was demonstrated and tested on idealized vessel and aneurysm geometries. The model was able to reproduce the salient features of fibrin accumulation after the deployment of flow-diverting devices in idealized invitro models of cerebral aneurysms. Namely, fibrin production in regions of high shear stress, initial accumulation at the inflow zone, and progressive occlusion of the device and corresponding flow attenuation. The computational model linking flow dynamics to fibrin production, transport, and adhesion can be used to investigate and better understand the effects that lead to fibrin accumulation and the resulting aneurysm inflow reduction and intra-aneurysmal flow modulation.

The influence of suturing and or gluing of perforated Schneiderian membrane during sinuslift procedure on the outcome: a retrospective study

The sinus lift procedure has become the most common method for maxillary bone augmentation. The most frequently observed intraoperative complication is the perforation of the Schneiderian membrane. Various treatment options have been proposed for managing these perforations, including the use of resorbable membranes, centrifugated blood products as PRF, or PRGF, suturing, and fibrin glue application. While long-term studies exist for the use of resorbable membranes to close perforations, there is limited data on the long-term outcomes of suturing or gluing the perforated sinus membrane. The aim of this retrospective study is to evaluate the long-term outcomes of suturing and/or applying fibrin glue to repair perforated sinus mucosa during sinus floor elevation procedures. Between 2005 and 2009, a total of 692 patients underwent 923 sinus lift surgeries, and Schneiderian membrane perforation occurred in 202 sinus floor elevations (21.98%) across 168 patients. The main documented causes of perforations, which ranged from 2 to 10 mm in diameter, were the presence of septa, followed by thin and adherent membranes. Of the perforations, 100 (49.5%) were treated with microsurgical suturing combined with fibrin glue, 78 (38.6%) were treated with fibrin glue alone, and 24 (11.9%) were treated exclusively with suturing. Sinus grafting was performed using autogenous bone in combination with a biomaterial, following the layering technique. All surgeries resulted in primary healing without complications, enabling all patients to undergo restoration as planned. The long term clinical and radiological evaluations of 44 randomly selected patients who followed the recall program up to 10 years post operative confirmed the effectiveness of this treatment approach.

FIXATION OF OSTEOCHONDRAL PATELLAR FRACTURE BY TRANSOSSEOUS SUTURE: REPORT OF TWO CASES

Objectives The article aims to explore two cases of osteochondral patellar fracture after acute dislocation, emphasizing the importance of appropriate treatment to prevent early progression to patellofemoral osteoarthritis. The study describes a surgical approach involving transosseous suture fixation and fibrin glue adjuvant, presenting it as a potential alternative over existing techniques. Methods Two patients (a 38 years-old male, and a 12 years-old female) with patellar osteochondral fracture due acute patellar dislocation were underwent surgical intervention. The procedure was performed by medial parapatellar arthrotomy and a transosseous suture fixation by high-strength sutures in the male and absorbable sutures in the female, plus use of fibrin glue as an adjuvant in both. Additionally, reconstruction of the medial patellofemoral ligament (MPFL) with the medial third of the patellar tendon was performed in the male and MPFL and medial patellar tibial ligament using hamstrings in the female. Results Postoperative follow-up revealed good clinical and radiographic outcomes. The patients exhibited complete symptom resolution, full ROM, patellar stability and completely cartilage healing on MRI at 3 and 9 months, respectively. The technique showed potential advantages, including simple reproducibility, low cost, and minimal postoperative complications. Conclusion Fixation of osteochondral patellar fracture by transosseous sutures combined with fibrin glue emerges as a reproducible, cost-effective technique with excellent clinical and radiological outcomes. The method displayed advantages over traditional implants, offering a potential alternative for surgeons. Despite the positive results in these cases, the limited literature calls for further research to confirm the technique superiority compared to isolated sutures and other available methods.

Hemostatic efficacy of fibrin sealant patch (TachoSil®) in the loop electrosurgical excisional procedure: A prospective randomized controlled study

Hemostatic efficacy of fibrin sealant patch (TachoSil®) in the loop electrosurgical excisional procedure: A prospective randomized controlled study

Injectable tissue-engineered human cartilage matrix composite fibrin glue for regeneration of articular cartilage defects

Due to the lack of blood vessels and nerves, the ability of cartilage to repair itself is limited, and the injury of articular cartilage urgently needs effective treatment. Currently, the limitation of clinical repair for cartilage defects is that it is difficult to form pure hyaline cartilage repair, and the source of cartilage tissue and cells is limited. To obtain high-purity regenerated hyaline cartilage, we proposed to construct an injectable hydrogel precursor by using human living hyaline cartilage graft (hLhCG) secreted by human chondrocytes as the dispersed phase and fibrinogen solution as the continuous phase, by double injection with thrombin, three-dimensional network hydrogel structure was formed under the action of thrombin to repair joint defects. The component phenotypes of hLhCG and biomechanical properties of composite gel scaffolds were verified. After 12 weeks of injection of the mixed phase at the defect site, the regenerated tissues are similar in composition to adjacent natural tissues and exhibit similar biomechanical properties. The phenotype of regenerated cartilage was verified, confirming the successful regeneration of hyaline cartilage.

A New "Tube-in-tube" Method to Extend Glaucoma Drainage Devices Using Paul Glaucoma Implant.

To describe a novel and uncomplicated technique of elongating the tubing of a glaucoma drainage device (GDD) sourced from a segment of the tube from a Paul® Glaucoma Implant (PGI). Conjunctival and Tenon's peritomy are performed with relaxing incisions to expose the original tube. The original tube is then removed from the anterior chamber, and the original entry site is closed. The tip of the original Baerveldt/Ahmed tubing is shortened to near the plate, and the lumen is stretched open using Burke's forceps (nontoothed to avoid damage to the tubing) while the appropriate length of the Paul tube was being pushed inside and is secure without the need for any suturing. The new smaller Paul tube is then inserted back into the anterior chamber using a 26-gauge tract. An 8-0 Ethilon® was then used to secure the tube to the sclera, and TISSEL® was used to secure it (Baxter, United States). Depending on the positioning, either the original Tutoplast® pericardium or new double-layered Tutoplast® can be placed over the tube to prevent erosion. The Tenon's and conjunctiva were then closed to secure the conjunctival and Tenon's back in their original position at the limbus, and the radial conjunctival incisions can be closed using TISSEL® fibrin glue or further sutures if required. This method offers several benefits over previously documented techniques; it avoids significant bulkiness, and the elongated tube conforms to the curvature of the globe owing to the suitable rigidity of the extended section. The additional tubing segment fits securely without the need for sutures. Introducing a smaller diameter tube into the anterior chamber in comparison to other GDDs minimizes the surface area between the tube and corneal endothelium, therefore decreasing the rate of potential endothelium cell loss. This novel "tube-in-tube" technique is efficient, safe, and straightforward to perform. It eliminates the need for alterations in glaucoma medication since the PGI is not thought to offer any flow resistance. Berman T, Au L. A New "Tube-in-tube" Method to Extend Glaucoma Drainage Devices Using Paul Glaucoma Implant. J Curr Glaucoma Pract 2024;18(3):130-133.

Use of fibrin sealant in vein anastomosis in renal transplantation and its effect in preventing blood loss and postoperative peri-graft collection.

This study is to assess efficacy of fibrin sealant in vein anastomosis in renal transplantation in preventing blood loss and postoperative peri-graft collection. This is a retrospective analytical case-control study of renal transplantations done in a tertiary care center in India in a 1-year period. Fibrin sealant was randomly used in vein anastomosis during the period. All the data were extracted and retrospectively analyzed. Those with fibrin sealant use were the study group and without sealant use were the control group. Primary objective was to assess effectiveness of fibrin sealant in preventing blood loss and postoperative peri-graft collection. Secondary objectives were to evaluate patients' demographic profile, hospital stay and other intraoperative and postoperative characteristics. During the study, 163 patients were enrolled, 82 study group and 81 control group. Warm ischemia, cold ischemia and operative times of study group were 2.57 ± 2.03, 44.23 ± 8.89 and 189.6 ± 51.6min, respectively, and that of control group were 2.67 ± 2.07, 42.37 ± 8.5 and 178.8 ± 54.6min, respectively. The mean intraoperative blood loss in study and control groups was 124.83 ± 110.89 and 155 ± 50.27ml, respectively, and the difference was statistically significant (p .027). The mean peri-graft collection in study group and control group were 72.33 ± 29.18ml and 134.67 ± 102.84ml, respectively, but the difference was not statistically significant (p .086). The study also demonstrated that the duration of hospital stays significantly differed between two groups (p < .043). In this study, fibrin sealant has demonstrated both safety and efficacy in effectively managing bleeding, sealing vascular anastomoses, and mitigating peri-graft collection.

Dural Injury During Spinal Surgery and Postoperative Cerebrospinal Fluid Leakage: A Single-Center Experience.

The incidence of dural injury during spinal surgery and postoperative cerebrospinal fluid leakage varies between studies. We examined these rates in our institution. Among 4014 patients who underwent a spinal operation between January 2012 and February 2020, 176 experienced an intraoperative dural injury (176 of 4014 cases, 4.3%). Among these, 22 (22 of 176 cases, 12.5%) developed postoperative cerebrospinal fluid leakage. The cause of dural injury was identified in 74 of 176 patients (42%). The rates of dural injury associated with thoracic, cervical, and lumbar operations were 7.8% (25 of 321 cases), 3.2% (19 of 602 cases), and 4.3% (132 of 3091 cases), respectively. Corresponding rates of cerebrospinal fluid leakage were 28% (seven of 25 cases), 5.3% (one of 19 cases), and 11% (14 of 132 cases), respectively. Most patients who experienced cerebrospinal fluid leakage recovered with bed rest; however, cerebral hemorrhage occurred in two patients. Although it was difficult to identify the cause of dural injury in more than half of patients, suturing the dura and using polyglycolic acid mesh with fibrin glue was effective. No patients required reoperation, even those who developed cerebrospinal fluid leakage.

The efficacy of wrapping with polyglycolic acid mesh and fibrin glue in preventing clinically relevant pancreatic fistula after minimally invasive distal pancreatectomy (WRAP Study): study protocol for a multicenter randomized controlled trial in Japan

BackgroundPostoperative pancreatic fistula (POPF) continues to be the most common complication after distal pancreatectomy (DP). Recent advancements in surgical techniques have established minimally invasive distal pancreatectomy (MIDP) as the standard treatment for various conditions, including pancreatic cancer. However, MIDP has not demonstrated a clear advantage over open DP in terms of POPF rates, indicating the need for additional strategies to prevent POPF in MIDP. This trial (WRAP study) aims to evaluate the efficacy of wrapping the pancreatic stump with polyglycolic acid (PGA) mesh and fibrin glue in preventing clinically relevant (CR-) POPF following MIDP.MethodsThis multicenter, randomized controlled trial will include patients scheduled for laparoscopic or robotic DP for tumors in the pancreatic body and/or tail. Eligible participants will be centrally randomized into either the control group (Group A) or the intervention group (Group B), where the pancreatic stump will be reinforced by PGA mesh and fibrin glue. In both groups, pancreatic transection will be performed using a bioabsorbable reinforcement-attached stapler. A total of 172 patients will be enrolled across 14 high-volume centers in Japan. The primary endpoint is the incidence of CR-POPF (International Study Group of Pancreatic Surgery grade B/C).DiscussionThe WRAP study will determine whether the reinforcement of the pancreatic stump with PGA mesh and fibrin glue, a technique whose utility has been previously debated, could become the best practice in the era of MIDP, thereby enhancing its safety.Trial registrationThis trial was registered with the Japan Registry of Clinical Trials on June 15, 2024 (jRCTs032240120).

Comparative Study Between Autologous Platelet-rich Fibrin Membrane and Local Flaps as Intervening Layer in Management of Distal Hypospadias

Background/PurposeThe most frequent complication following hypospadias correction is fistula formation. Recently, fibrin glue has been employed as a 2nd layer covering the urethroplasty resulting in a reduction in the incidence of fistulas. Platelet-rich fibrin (PRF) is an autologous growth factor-rich source. Although the authors recommend the use of additional layers in hypospadias correction, there remains a controversy. In a trial to address this issue, our research was conducted to compare the accessibility of urethroplasty coverage using PRF to traditional local flaps, aiming to prevent fistula formation in hypospadias repair. Patients and methodsThis is a prospective single-blinded randomized controlled study that involved 60 hypospadias cases admitted to Mansoura University Children Hospital's Pediatric Surgery department between March 2021 and March 2023. These 60 cases were randomly divided into 2 equal groups: (group A platelet-rich fibrin coverage membrane & group B local dartos flap as an additional layer). Both groups were compared regarding the rate of complications. All cases were evaluated regarding age at repair, type of hypospadias, urethral plate width, length of urethroplasty, and size of the 2nd layer. The blood loss and operative time were documented and post-operatively; the cases were assessed for the repair intactness, shape, and size of the neo-meatus, existence of any post-operative problems such as urethral fistula, urethral stricture, meatal stenosis, failure of the repair, or diverticulum. Statistical analysis was carried out following data collection. ResultsThe median length of the 2nd layer in group A was 20 mm (range 15–23 mm) and in group B was 22.5 mm (range 19.5–25 mm) and the difference between the two groups was statistically significant (p = 0.012∗), while its median width in group A was 10 mm (range 10–11 mm) and in group B was 15 mm (range 10–18 mm) and also there was statistically significant difference (p = 0.001∗). The mean operative time in group A was 95.73 ± 11.9 min and in group B was 102.33 ± 10.32 min and there was a statistically significant difference (P < 0.001). The length of hospital stay in group A was 5.47 ± 1.11 days and in group B was 5.47 ± 0.89 days. The urethral fistula was detected in 4 cases of group A (13.3%) and 3 cases of group B (10%). The failure of repair was similar, one case of each group (3.3%). The meatal stenosis was reported in only one case of group A (3.4%) and 7 cases of group B (24.1%) (P = 0.02∗) and the difference was statistically significant. There were no reports of urethral strictures among the cases in either group over the follow-up period (mean 9 months, range 5–17 months). ConclusionPRF patch may be employed as a coverage layer over the urethroplasty in repair of the distal hypospadias, especially in cases without accessible vascular flap with comparable outcome to traditional local flaps. Type of studyA prospective single blinded randomized controlled trial (computer-generated numbers method). Level of evidenceLevel 2.

Fibrin glue-coated collagen matrix is superior to fibrin glue-coated polyglycolic acid for preventing cerebral spinal fluid leakage after spinal durotomy

After surgery for intradural lesions, dural reconstruction is essential for preventing cerebrospinal fluid (CSF) leakage, which can cause serious complications. However, there is currently no established intraoperative procedure. While hydrophobic polyglycolic acid (PGA) sheets and fibrin glue are effective for dural reconstruction, the usefulness of hydrophilic artificial dura mater made of a porous collagen matrix has also been reported. This study aimed to compare the ability of a fibrin-coated porous collagen matrix and a fibrin-coated PGA sheet to prevent CSF leakage during spinal surgery. This study included 319 patients who underwent surgery for intradural lesions requiring dural reconstruction. Patients in the PGA sheet group (group P) and the porous collagen matrix group (group C) were compared. The median age was 60 years. A total of 319 patients were included, with 219 in Group P and 100 in Group C. CSF leakage occurred in 11 patients (5.0%) in Group P and 0 patients in Group C (P < 0.05). This is the first report showing the superiority of a porous collagen matrix sheet over a PGA sheet in preventing CSF leakage during spinal surgery. The porous collagen matrix is hydrophilic and may be more effective against CSF leakage than hydrophobic PGA sheets.

Growth Differentiation Factor 5-Induced Mesenchymal Stromal Cells Enhance Tendon Healing.

Mesenchymal stromal cells (MSCs) have immense potential for use in musculoskeletal tissue regeneration; however, there is still a paucity of evidence on the effect of tenogenic MSCs (TMSCs) in tendon healing invivo. This study aimed to determine the effects of growth differentiation factor 5 (GDF5)-induced rabbit MSCs (rbMSCs) on infraspinatus tendon healing in a New Zealand white rabbit model. In this study, bone marrow-derived rbMSCs were isolated, and 100 ng/mL GDF5 was used to induce tenogenic differentiation in rbMSC. The effects of GDF5 on rbMSC in vitro were assessed by total collagen assay, gene expression analysis, and immunofluorescence staining of tenogenic markers; native tenocytes isolated from rabbit tendon were used as a positive control. In invivo, a window defect was created on the infraspinatus tendons bilaterally. After 3 weeks, the rabbits (n = 18) were randomly divided into six groups and repaired with various interventions: (1) surgical suture; (2) fibrin glue (FG); (3) suture and FG; (4) suture, FG, and rabbit tenocytes (rbTenocyte); (5) suture, FG, and rbMSCs, and (6) suture, FG, and TMSC. All animals were euthanized at 6 weeks postoperatively. The in vitro GDF5-induced rbMSCs (or TMSC) showed increased total collagen expression, augmented scleraxis (SCX), and type-I collagen (COL1A1) mRNA gene expression levels. Immunofluorescence showed similar expression in GDF5-induced rbMSC to that of rbTenocyte. In vivo histological analysis showed progressive tendon healing in the TMSC-treated group; cells with elongated nuclei aligned parallel to the collagen fibers, and the collagen fibers were in a more organized orientation, along with macroscopic evidence of tendon callus formation. Significant differences were observed in the cell-treated groups compared with the non-cell-treated groups. Histological scoring showed a significantly enhanced tendon healing in the TMSC- and rbMSC-treated groups compared with the rbTenocyte group. The SCX mRNA expression levels, at 6 weeks following repair, were significantly upregulated in the TMSC group. Immunofluorescence showed COL-1 bundles aligned in parallel orientation; this was further confirmed in atomic force microscopy imaging. SCX, TNC, and TNMD were detected in the TMSC group. In conclusion, GDF5 induces tenogenic differentiation in rbMSCs, and TMSC enhances tendon healing invivo compared with conventional suture repair. Impact Statement Tendon tears and degeneration are debilitating clinical conditions. To date, the suture method is the only gold standard for repairing tendons. Mesenchymal stromal cells (MSCs) have been suggested for many years for their potential in tissue regeneration, especially in tendon-degenerative conditions. Growth differentiation factor 5 (GDF5) has been reported to induce human MSC into a tenogenic lineage (or TMSC), hence a potential cell source for tendon regeneration. This study reported on the potential of rabbit MSC to differentiate into TMSC via GDF5 induction and the potential of TMSC in tendon healing in a New Zealand white rabbit infraspinatus tendon model fulfilled with the 3R principle (reduce, reuse, and replace).

Effectiveness of surgical approach in the management of non-traumatic corneal perforations

ABSTRACT Clinical relevance Non-traumatic aetiologies are one of the leading causes of corneal perforations. The management of corneal perforation is quite challenging and complex for anterior segment surgeons. The appropriate surgical approach for each case is usually determined on the basis of a combination of many different parameters. Background The study aimed to evaluate surgical approach options and outcomes in the treatment of non-traumatic corneal perforations. Methods Patient data who underwent surgery for non-traumatic corneal perforation between 2016 and 2023 were retrospectively evaluated. Medical records were assessed in terms of age, gender, perforation aetiology, the first and last examination notes, surgical approach, follow-up time, and additional surgeries and outcomes according to anatomical, therapeutic and functional success. Anterior segment photographs were investigated for thorough explanation of the examinations. Results Forty-five eyes of 45 patients were included (mean age 61.2 ± 22.4 (90-2), female/male ratio 20/25). Surgical approaches applied according to the size and location of the perforation site included fibrin glue application (6), amniotic membrane transplantation (AMT) (9), corneal patch graft application(15), and tectonic keratoplasty (15). The ratio of inflammatory and infectious causes as the two main indications was 29/16. Globe integrity was ensured with the first surgery in 27 eyes. However, 17 eyes required secondary surgical attempts due to failure of the first approach and 1 eye underwent evisceration. AMT was the least successful method among other methods in anatomical, therapeutic, and functional assessment. Conclusion There are various surgical approaches for repairing non-traumatic corneal perforations, each with its own advantages and disadvantages. These include high tissue resistance, the ability to remove necrotic tissue, ease of access, and anti-inflammatory activity. It is possible to successfully repair corneal perforations with single and combined methods, considering the above-mentioned features, especially depending on the size and location of the defect. While AMT is a viable and time-saving choice − especially in the lack of donor tissues − further interventions are necessary in most circumstances.