Platelet Fibrin Glue Research Articles

Persistent pneumothorax treatment following congenital cardiac surgery by platelet-fibrin glue.

Persistent pneumothorax is a life-threatening complication that can occur after congenital cardiac surgery. Traditional treatment such as chest tube drainage may not be effective in managing this condition. This study presents a new minimally invasive method for treating persistent pneumothorax using platelet-rich plasma-fibrin glue (PRP-FG). The method has been successful in treating postoperative chylothorax in previous studies, and its use has decreased morbidity, mortality, and hospital stay in chylothorax patients. Ten patients with persistent pneumothorax following cardiothoracic surgery (3 TAPVC, 2 d-TGA, 2 VSD + IAA,1 TRUNCUS + TAPVC, 1 VSD + COA, 1 GLENN), who did not respond to conservative management, underwent treatment with PRP-FG. Follow-up was done for a period of 1-4years. The age and diagnoses of pneumothorax after surgery were 85.5 ± 36.0days and 62.4 ± 34.3h, respectively. Persistent pneumothorax of 8 patients (80%) was cured completely after PRP-FG injection. PRP-FG therapy was failed in two patients who died. All cured patients had a normal life without any complications during follow-up. After PRP-FG injection, 3 patients stopped bubbling at one-time injection, 3 patients stopped bubbling at two-time injection, and 2 patients stopped bubbling at three-time injection. Two patients died during treatment; in these cases, one-time injections were done which was not successful. Persistent pneumothorax after congenital-cardiac surgery can be treated successfully with PRP-FG. This bedside minimal-invasive procedure may significantly decrease the morbidity and mortality rate. Further research is needed to confirm the efficacy of this promising treatment through multicentre clinical trials.

Effects of Combination of BMP7, PFG, and Autograft on Healing of the Experimental Critical Radial Bone Defect by Induced Membrane (Masquelet) Technique in Rabbit.

Healing of large segmental bone defects can be challenging for orthopedic surgeons. This research was conducted to provide further insight into the effects of BMP7 in combination with autograft and platelet fibrin glue (PFG) on bone regeneration by Masquelet technique (MT). Twenty five domestic male rabbits, more than 6 months old, weighing 2.00±0.25 kg were randomly divided into five equal groups as follows: MT-blank cavity (without any biological or synthetic materials) (1), blank cavity (2), MT-autograft (3), MT-autograft-BMP7 (4), and MT-BMP7-PFG (5). A 20 mm segmental defect was made in radial bone in both forelimbs. The Masquelet technique was done in all groups except group 2. The study was evaluated by radiology, biomechanics, histopathology and scanning electron microscopy. The results showed that Masquelet technique enhanced the healing process, as, the structural and functional criteria of the injured bone showed significantly improved bone healing (P<0.05). Treatment by PFG-BMP7, Autograft-BMP7, and autograft demonstrated beneficial effects on bone healing. However, Autograft-BMP7 was more effective than autograft in healing of the radial defect in rabbits. Our findings introduce the osteogenic materials in combination with Masquelet technique as an alternative for reconstruction of the big diaphyseal defects in the long bones in animal models. Our findings may be useful for clinical application in future.

Effectiveness of Nanosilver, Nanogold and their Combination on the Healing Potential of Critical Radial Bone Defects in Rats

A new composition of platelet-fibrin glue (FPG), gelatin (Gel), nanohydroxyapatite (nHA), silver nanoparticles (SNPs) and gold nanoparticles (GNPs) was synthesized and employed in preparation of hybrid scaffolds and was applied in bone tissue engineering in the surgically critical-sized bone defect in a rat model. Sixty bilateral radial bone defects were randomly divided into six groups including untreated defects, autograft and those treated with Gel/FPG/nHA containing scaffolds including nHA alone, nHA/SNPs, nHA/GNPs and nHA/SNPs/GNPs (n=10 in each group). The defects were assessed by radiography, histopathology, scanning electron microscopy and biomechanical testing. In comparison with the untreated defects, all the treated defects demonstrated significantly superior new bone formation, remodeling and bone tissue volume. Moreover, the defects treated with GNPs showed significantly higher ultimate strength, yield strength and stiffness. The nHA and nHA/SNPs moderately improved bone regeneration that were not close to the autograft in some parameters, whereas nHA/GNPs and nHA/SNPs/ GNPs significantly improved bone healing closely comparable with those of the autograft group in most parameters. In conclusion, although all the scaffolds had some beneficial effectiveness on bone regeneration, the scaffolds containing GNPs were more effective in improving the structural and functional properties of the newly formed bone and were more osteoinductive than other scaffolds and were comparable to the autograft. Therefore, the scaffolds including GNPs can be regarded as a promising option to be used in bone tissue engineering.

Platelet gels

Platelet gels (PG) are blood‐derived biomaterials that are generally obtained through the activation of a platelet‐rich plasma or a platelet concentrate by thrombin or calcium chloride, resulting in the simultaneous conversion of fibrinogen into a fibrin gel and in the generation of a platelet releasate rich in a physiological cocktail of growth factors. To reinforce the physical strength of the fibrin network, a fibrinogen‐rich fraction – generally cryoprecipitate – can be added to the platelet fraction prior to activation, resulting in the generation of platelet fibrin glue (PFG). PG and PFG, prepared from single donations, either autologous or allogeneic, are increasingly used, alone or in combination with grafting materials, in various field of regenerative medicine where the presence of growth factors is expected to stimulate the healing of soft or hard tissues. Being obtained from human blood, they are physiological and biodegradable preparations and do not induce tissue necrosis. So far, the viral safety of most allogeneic PG and PFG relies on donors selection and donation testing, as is the case for all non‐virally inactivated blood components for transfusion. Major fields of clinical applications of PG and PFG in osseous tissue regeneration include maxillo‐facial surgery, implantology, reconstructive and plastic surgery. Platelet gels are also used for enhancing the healing of soft tissues, most particularly recalcitrant lower extremity ulcers of various aetiologies, and burns. Newer promising indications include the treatment of osteo‐arthritis and joint inflammation, and the repair of musculoskeletal tissue lesions in sports medicine. Autologous PG and PFG are mostly ‘home‐made’ single‐donor preparations prepared using medical devices. They suffer from the variability in donor characteristics and in isolation procedures of the platelet fraction. Clinical application methods are not standardized. Variability in autologous product characteristics is high, and optimal content of growth factors is unknown, confusing the analysis of product efficacy. The evidence of clinical benefits of these products based on controlled clinical studies is lacking in most indications, although many case studies do support an objective benefit in soft and probably hard tissues healing. Improvement in the standardization and formulation of PG and PFG is a mandatory step forward for improving the reliability and the predictability of clinical outcomes of these interesting blood preparations.

Single-Donor Allogeneic Platelet Fibrin Glue and Osteoconductive Scaffold in Orbital Floor Fracture Reconstruction

Commonly used materials for orbital floor fracture reconstruction include autologous cranial bone graft and titanium mesh. We have evaluated here a biomaterial combining biphasic calcium phosphate (hydroxyapatite [HA]/β-tricalcium phosphate [TCP]) osteoconductive scaffold with single-donor allogeneic platelet fibrin glue. The study was conducted on 10 consecutive patients with a follow-up of up to 4 years. Platelet fibrin glue was prepared by mixing equal volumes of single-donor platelet-rich plasma and cryoprecipitate with HA/β-TCP followed by activation with human thrombin prepared by plasma activation. Postoperative evaluations included serial photographs, repeated physical examination, and 3-dimensional computed tomography scan performed 2 years after surgery. The fibrin-rich platelet biomaterial was easy to mold and to apply on the surgical site allowing the surgeon to sculpt accurately the bone defect, providing mechanical stability while avoiding spillage of the scaffold. No infection of the orbit or extrusion of HA/β-TCP was observed. Ocular motility was normal, and no diplopia or enophthalmos of the injured orbit was noted. Coronal computed tomography scans of the reconstructed orbits revealed good restoration of the orbital floor defect in all 10 patients. The use of single-donor platelet fibrin glue combined with an osteoconductive scaffold offers a valuable alternative to autologous cranial bone graft or titanium mesh in the reconstruction of orbital floor bone defect.

Blood‐derived biomaterials: fibrin sealant, platelet gel and platelet fibrin glue

Blood‐derived biomaterials include fibrin sealant (FS) (also called fibrin glue), platelet gel (PG), and platelet fibrin glue. They are used in many surgical fields because of their functional properties and unique physical advantages compared to synthetic products. FS can be made industrially by the fractionation of large plasma pools, or from single plasma donations. Thanks to a high content in fibrinogen, FS exhibits, after activation by thrombin and formation of a strong fibrin clot, tissue sealing and haemostatic properties. PG and platelet fibrin glue are made from single blood donations (platelet concentrates combined or not with cryoprecipitate). Owing to their richness in platelet, PG and PFG can release, upon thrombin activation, a myriad of growth factors that can stimulate cell growth and differentiation, generating much interest for hard and soft tissues regeneration and healing, as well as, increasingly, cell therapy protocols to replace fetal bovine serum. Blood‐derived biomaterials have the advantages, over synthetic glues and other biomaterials, of being physiologically compatible with human tissues, and of not inducing tissue necrosis or other tissue reactions. They can be readily colonized by cells and are totally biodegradable in a matter of days to weeks. These blood‐derived biomaterials are used increasingly as tissue engineering tools, allowing surgeons to influence and improve the in vitro or in vivo cellular environment to enhance the success of tissue grafting. We review here the three main types of biomaterials that can be made from human blood and describe their biochemical and physiological properties as well as their clinical applications.