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OBJECTIVE: Fibrin sealants are routinely used for intra-articular surgical fixation of cartilage fragments and implants. However, the mechanical properties of fibrin sealants in the context of cartilage repair are unknown. The purpose of this study was to characterize the adhesive and frictional properties of fibrin sealants using an ex vivo model. DESIGN: Native bovine cartilage-bone composites were assembled with a single application of Tisseel or Vistaseal. Composites were tested in tension and lap shear. In addition, the coefficient of friction (COF) was measured in a native cartilage annulus model alone and with minced cartilage. Finally, the effect of a double application of fibrin sealant was evaluated. RESULTS: There were no significant differences in tensile modulus, ultimate tensile strength (UTS), shear modulus, or ultimate shear strength (USS) between the 2 fibrin sealants. Both fibrin sealants demonstrated a UTS and USS of

Objective: Histopathological examination of the effects of Tisseel, Cova, Glubran and Coseal, which are used for sealing purposes in spinal surgery practice, on epidural fibrosis is aimed. Methods: Forty Sprague Dawley rats were randomly divided into five groups in our study as Group 1 (n=8) control group (Laminectomy); Group 2 (n=8) Cova group (Laminectomy + Cova); Group 3 (n=8) Tissel group (Laminectomy + Tisseel); Group 4 (n=8) Coseal group (Laminectomy + Coseal); and Group 5 Glubrane group (Laminectomy + Glubrane). Control group was only applied laminectomy. After laminectomy to other groups, Cova was applied to the 2nd group, Tissel to the 3rd group, Coseal to the 4th group and Glubran to the 5th group in surgical fields. After the rats were monitored in separate cages for 6 weeks after the operation, the relevant spinal level was extracted and the samples were examined histopathologically and the results were evaluated statistically. Results: It was found that there was a statistically significant difference in Tisseel and Glubran groups in terms of fibrosis grading compared to the control group, and this had a positive effect on fibrosis. Compared to the control group, there was no statistically significant difference on fibrosis in Cova and Coseal groups. Conclusion: As dura adhesive agents used in spinal surgery practice did not increase spinal epidural fibrosis statistically significantly, we concluded that these products can be used safely during spinal surgery if necessary. [ABSTRACT FROM AUTHOR]

Fibrin sealants are well‐established components of the surgical toolbox, especially in procedures that harbor a high risk of perioperative bleeding. Their widespread use as hemostats, sealants or tissue‐adhesives in various surgical settings has shown that the choice of the appropriate sealant system affects the clinical outcome. While many studies have compared the hemostatic efficiency of fibrin sealants to that of other natural or synthetic sealants, there is still limited data on how subtle differences in fibrin sealant formulations relate to their biological performance. Here, we performed an in‐depth physicochemical and biological characterization of the two most commonly used fibrin sealants in the US and Europe: TISSEEL™ ("FS") and VISTASEAL™/VERASEAL™ ("FS+Osm"). Our chemical analyses demonstrated differences between the two sealants, with lower fibrinogen concentrations and supraphysiological osmolality in the FS+Osm formulation. Rheological testing revealed FS clots have greater clot stiffness, which strongly correlated with network density. Ultrastructural analysis by scanning electron microscopy revealed differences between FS and FS+Osm fibrin networks, the latter characterized by a largely amorphous hydrogel structure in contrast to the physiological fibrillar network of FS. Cytocompatibility experiments with human fibroblasts seeded on FS and FS+Osm fibrin networks, or cultured in presence of sealant extracts, revealed that FS+Osm induced apoptosis, which was not observed with FS. Although differential sealant osmolality and amounts of fibrinogen, as well as the presence of Factor XIII or additives such as antifibrinolytics, may explain the mechanical and structural differences observed between the two fibrin sealants, none of these substances are known to cause apoptosis at the respective concentrations in the sealant formulation. We thus conclude that hyper osmolality in the FS+Osm formulation is the primary trigger of apoptosis—a mechanism that should be evaluated in more detail, as it may affect the cellular wound healing response in situ. [ABSTRACT FROM AUTHOR]

Background and Objectives: The efficacy of tranexamic acid (TXA) in reducing perioperative blood loss during total knee arthroplasty (TKA) is well established. However, the potential synergistic blood-conservation effect of topical fibrin sealant (Tisseel@) remains unclear. This study aims to assess the effectiveness of the combination of Tisseel and TXA during TKA. Materials and Methods: A single-blinded, prospective, randomized controlled trial was conducted with 100 patients (100 knees) undergoing primary TKA. Participants were randomly assigned to either the TXA group (n = 50), receiving intravenous (IV) TXA, or the Tisseel@ + TXA group (n = 50), receiving intra-articular Tisseel@ combined with IV TXA. The primary outcomes included blood transfusion rate, decrease in Hb level, calculated blood loss, and estimated total postoperative blood loss. Secondary outcomes involved assessing clinical differences between the groups. Results: The transfusion rate was zero in both groups. The average estimated blood loss in the Tisseel@ + TXA group was 0.463 ± 0.2422 L, which was similar to that of the TXA group at 0.455 ± 0.2522 L. The total calculated blood loss in the Tisseel@ + TXA group was 0.259 ± 0.1 L, compared with the TXA group’s 0.268 ± 0.108 L. The mean hemoglobin reduction in the first 24 h postoperatively was 1.57 ± 0.83 g/dL for the Tisseel@ + TXA group and 1.46 ± 0.82 g/dL for the TXA-only group. The reduction in blood loss in the topical Tisseel@ + TXA group was not significantly different from that achieved in the TXA-only group. The clinical results of TKA up to the 6-week follow-up were comparable between the groups. Conclusions: The combination of the topical fibrin sealant Tisseel@ and perioperative IV TXA administration, following the described protocol, demonstrated no significant synergistic blood-conservation effect in patients undergoing TKR.

We report a case of cauda equina syndrome related to the use of fibrin glue dural sealant "TISSEEL". Incidental durotomy (ID) is not uncommon in revision spinal surgery. Augmentation of the dural repair after primary closure is gaining popularity. The use of dural sealants is not risk-free. A 65-year old man who underwent revision lumbar decompression surgery developed postoperative cauda equina syndrome. He had urinary retention, bilateral leg pain and perianal numbness on the third postoperative day. We believe this complication was related to the use of fibrin glue to manage an ID. After the urgent surgical removal of the fibrin glue patch, the patient fully recovered with no residual neurological deficit. Cauda equina syndrome development is a potential complication after the use of fibrin glue to augment intraoperative ID. Surgeons should be aware of this potential risk so it can be managed in a timely fashion. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the use of a human fibrin glue (Tisseel) for minor bleeding control and approximation of ovarian defect during transvaginal natural orifice ovarian cystectomy (TNOOC) of benign and non-endometriotic ovarian tumors. Methods A total of 125 women with benign and non-endometriotic ovarian tumors who underwent TNOOC between May 2011 and January 2020: 54 with the aid of Tisseel and 71 with traditional suture for hemostasis and approximation of ovarian defect. Surgical outcomes such as length of surgery, operative blood loss, postoperative pain score, and postoperative hospital stay were recorded. Before and immediately (10 days) and at 6 months after the procedure, serum anti-Müllerian hormone (AMH) levels were also determined. Results Complete hemostasis and approximation of ovarian defect were achieved in all cases. No significant difference was noted in the operating time, operative blood loss, postoperative pain scores after 12, 24 and 48 h, length of postoperative stay, and baseline AMH levels between the two groups. The operation did not have a negative effect on the immediate and 6-month postoperative AMH levels in the suture group. However, the decline in the AMH levels was significant immediately after surgery in the Tisseel group, nevertheless, no significant difference was noted in the AMH levels at 6 months (3.3 vs. 1.7 mg/mL; p = 0.042, adjusted p = 0.210). Conclusion The use of Tisseel in TNOOC of benign and non-endometriotic ovarian tumors without suturing the ovarian tissue is clinically safe and feasible.

Background Context: Early postoperative MR images are frequently necessary after spine surgery. The appearance of commonly used adjunct hemostatic agents and dural sealants in MR images has not been systematically evaluated.Purpose: The purpose of this experimental study was to systematically analyze and describe the characteristics of the most commonly applied hemostatic agents and dural sealants in spine surgery on early postoperative MR images.Study Design: Cadaver Study METHODS: Four commonly applied dural sealants (Duraseal, Bioglue, Tachosil, Tisseel) and five commonly used hemostatic agents (Surgiflo, Bonewax, , Spongostan, Gelfoam, Avitene) were investigated. The experimental setting involved a human cadaver where a standard left-sided laminotomy was performed on nine levels of the thoracolumbar spine, and the materials were separately applied and mixed with fresh blood or water for hemostatic and dural sealants, respectively. The cadaver model was scanned at a 3 Tesla MRI and the imaging findings for all materials were compared to the surrounding tissue and systematically reported.Results: All investigated dural sealants and hemostatic agents were distinguishable from the surrounding tissue on MR images with different appearances on the MR sequences. A detailed atlas for the identification of the materials in postoperative spine MRI was established.Conclusion: Commonly used hemostatic agents and dural sealants can be successfully identified on early postoperative spine MRI.Clinical Significance: Knowledge about MRI appearances of commonly used adjunct surgical materials helps in interpretation of postoperative imaging and supports clinical decision making. [ABSTRACT FROM AUTHOR]

Background: To evaluate the use of a human fibrin glue (Tisseel) for minor bleeding control and approximation of ovarian defect during transvaginal natural orifice ovarian cystectomy (TNOOC) of benign and non-endometriotic ovarian tumors.Methods: A total of 125 women with benign and non-endometriotic ovarian tumors who underwent TNOOC between May 2011 and January 2020: 54 with the aid of Tisseel and 71 with traditional suture for hemostasis and approximation of ovarian defect. Surgical outcomes such as length of surgery, operative blood loss, postoperative pain score, and postoperative hospital stay were recorded. Before and immediately (10 days) and at 6 months after the procedure, serum anti-Müllerian hormone (AMH) levels were also determined.Results: Complete hemostasis and approximation of ovarian defect were achieved in all cases. No significant difference was noted in the operating time, operative blood loss, postoperative pain scores after 12, 24 and 48 h, length of postoperative stay, and baseline AMH levels between the two groups. The operation did not have a negative effect on the immediate and 6-month postoperative AMH levels in the suture group. However, the decline in the AMH levels was significant immediately after surgery in the Tisseel group, nevertheless, no significant difference was noted in the AMH levels at 6 months (3.3 vs. 1.7 mg/mL; p = 0.042, adjusted p = 0.210).Conclusion: The use of Tisseel in TNOOC of benign and non-endometriotic ovarian tumors without suturing the ovarian tissue is clinically safe and feasible. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of Tisseel, a 2-component fibrin sealant agent for the control of minor bleeding and repair of the ovarian defect at the end of laparoscopic cystectomy (LC) of endometriomas. Materials and methods: From January 2011 to December 2015, an observational study of all patients who underwent LC of endometrioma using Tisseel (group A) was performed. The demographic and operative data, including age, body mass index, operative indications, operative time, estimated blood loss, complications, and postoperative hospital stay duration were recorded. A contemporary cohort of patients, who underwent LC of endometrioma without Tisseel (group B) was also retrospectively compared. Results: A total of 274 patients were recruited in this study (53 LCs with Tisseel and 221 LCs without Tisseel, respectively). Complete hemostasis was achieved in all patients. The mean size of main mass was significantly larger in the group A than in the group B (7.8 ± 2.4 cm vs. 7.0 ± 2.3 cm, p = 0.033) but the mean operating time, operative blood loss, febrile morbidity, and length of hospitalization were not significantly different between the two groups. Conclusion: This preliminary series demonstrated the use of Tisseel in LC of endometriomas without any bipolar coagulation and/or suturing of ovarian tissue is clinically safe and feasible.

• Posterior fossa decompression with duraplasty can alleviate symptoms of Chiari I Malformations. • A watertight dural closure is critical to prevent post-operative complications. • Fibrin glue dural sealant reduced the risk of postoperative complications by more than two-thirds in our series. • The use of PEG hydrogel sealant did not show a significant complication rate reduction. [ABSTRACT FROM AUTHOR]

Post-dural puncture headache is an uncommon entity in young children and adolescents. Percutaneous epidural blood patching has been classically used to manage refractory post-dural puncture headaches. Injectable fibrin sealant has been shown in a few adult cases to relieve symptoms where blood patching has either failed or was not appropriate. We report a 10-year-old boy who experienced rapid relief of post-dural puncture headache symptoms following percutaneous lumbar epidural fibrin sealant injection under computed tomography guidance. Percutaneous epidural fibrin sealant injection may be an acceptable treatment for post-dural puncture headaches refractory to epidural blood patching, or when an epidural blood patch is otherwise contraindicated. The pediatric interventional radiologist should be aware of this off-label use of fibrin sealant. [ABSTRACT FROM AUTHOR]

Abstract Hematoma formation has persisted as the most common complication in rhytidectomy. The objective of this study is to determine the efficacy and safety of Artiss (Baxter) for use in rhytidectomies. In addition, we determine the use of fibrin tissue sealants by facial plastic surgeons. In this retrospective chart review, 120 patients in a single private practice were identified who underwent a rhytidectomy from August 2013 to January 2015 by a single facial plastic surgeon. The last 60 rhytidectomies performed with Tisseel (Baxter) were compared with the first 60 rhytidectomies performed with Artiss. All perioperative or postoperative complications were identified and recorded, focusing on the incidence of hematoma. In addition, a six-question survey was created and sent to all members of the American Academy of Facial Plastic and Reconstructive Surgery. Results of the survey were recorded and analyzed for trends or patterns in the data. In total, 120 patients were assessed. In the Tisseel group, two complications of fluid collection requiring needle aspiration were recorded. No other complications were found. In the Artiss group, 10 complications were recorded, including 9 fluid collections requiring needle aspiration and 1 hematoma. In total, 179 members of the American Academy of Facial Plastic and Reconstructive Surgery completed the six-question survey. Of all respondents, 61 (34%) use tissue sealants for rhytidectomies, whereas 118 (66%) do not. Artiss is efficacious and safe for use in rhytidectomies. Its use obviates the need for surgical drains, and complications are minimal and similar in rate to the use of Tisseel.

Background Fibrin glues are widely used in orthopedic surgery as adhesives and hemostatic agents. We evaluated the compressive properties of selected fibrin glues in order to identify which are appropriate for tissue regeneration applications subject to compression. Methods Uniaxial unconfined compression tests were performed on fibrin gels prepared from commercial and autologous products: (1) Evicel (Ethicon), (2) Tisseel (Baxter), (3) Angel (Arthrex), and (4) ProPlaz (Biorich). Cyclic loads were applied from 0 to 30% strain for 100 cycles at 0.5 Hz. Following cyclic testing, specimens were subjected to ramp displacement of 1% strain per second to 80% strain. Findings Throughout cyclic loading, Evicel and Tisseel deformed (shortened) less than Angel at all but one time point, and deformed less than ProPlaz at cycles 10 and 20. The dynamic moduli, peak stress, and strain energy were significantly greater in Tisseel than all other groups. Evicel displayed significantly greater dynamic moduli, peak stress, and strain energy than Angel and ProPlaz. Following cyclic testing, Tisseel and Evicel were significantly less deformed than Angel. No specimens exhibited gross failure during ramp loading to 80% strain. Ramp loading trends mirrored those of cyclic loading. Interpretation The tested commercial glues were significantly more resistant to compression than the autologous products. The compressive properties of Tisseel were approximately twice those of Evicel. All preparations displayed moduli multiple orders of magnitude less than that of native articular cartilage. We conclude that in knee surgeries requiring fibrin glue to undergo compression of daily activity, commercial products are preferable to autologous preparations from platelet-poor plasma, though both will deform significantly. [ABSTRACT FROM AUTHOR]

To investigate cerebrospinal fluid (CSF) leak rates after mainly endoscopic endonasal transsphenoidal surgery with and without polyethylene glycol hydrogel dural sealant (DuraSeal ® ), we prospectively collected data from a single-centre consecutive case series over four years from January 2007 to December 2010 inclusive. 250 patients were identified (135 male, 115 female; median age 52 years, range 14–83). 180 patients received DuraSeal ® (72%). 85 (34%) had intra-operative dural breach and 13 (5.2%) developed post-operative CSF leaks (3 without intra-operative dural breach) requiring lumbar drainage or formal repair. Of this group 5/251 (2.0%) patients required a formal repair. Post-operative CSF leak was seen in 5/189 (2.7%) of patients with pituitary adenoma, of which 2/5 (40%) were in cases undergoing revision surgery. 5/13 (38.4%) patients who developed a CSF leak presented with either Rathke’s cleft cyst or craniopharyngioma. 3/71 patients not receiving DuraSeal ® leaked (4.2%) and 10/180 patients receiving DuraSeal ® leaked (5.6%). 11/234 patients without Tisseel (4.7%) and 2/16 receiving Tisseel (12.5%) leaked. 54 patients (22%) received intra-operative lumbar drains, one of whom developed subsequent CSF leak (1.9%), in contrast to 12/197 (6.1%) of patients without intra-operative lumbar drains who later developed CSF leak. The rate of post-operative CSF leak requiring re-exploration and nasoseptal flap repair was low (2.0%) in this mainly endoscopic case series without statistically significant benefit from either DuraSeal ® or Tisseel. Intra-operative and post-operative lumbar drainage appears beneficial in patients at higher risk of post-operative CSF leak. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a common complication arising after conventional open herniorrhaphy and to a lesser extent postlaparoscopic inguinal hernia repairs as groin incision is avoided. Although published studies support elimination of mesh fixation during endoscopic procedures, the vast majority of surgeons will still recommend it by fear of encountering increased recurrence rates, if omitted. Regrettably, penetrating staple or tack fixation devices are the preferred methods to secure the mesh and cannot be applied at the level of the triangles of 'doom' and 'pain' where hernia tends to reoccur the most. This ongoing prospective cohort study aimed to confirm the safety and advantages of fibrin glue, as a substitute to staple mesh fixation during totally extraperitoneal (TEP) inguinal hernia repair.Methods: Over a 10-year period, 703 patients underwent 1000 elective TEP inguinal hernia repairs. Mesh fixation was achieved using exclusively fibrin sealant. Patients were reviewed at 2, 6 weeks and thereafter on an ad hoc basis if judged necessary until complete resolution of their symptoms. Quality of life (QoL) was assessed in a subgroup of 320 patients using the Carolina Comfort Scale (CCS).Results: No conversion to open surgery was observed. There were three cases of major morbidities and no mortality. Three months after surgery, only seven patients (1 %) experienced chronic groin or testicular discomfort and none of them required prescription painkillers. When using the CCS, at 2 weeks 93.1 % of the patients were either satisfied or very satisfied with their outcome. This satisfaction index increased up to 99.2 % at 6 weeks post surgery. Finally, only eight hernia recurrences (1.1 %) were reported, of which five occurred during the first month of the study.Conclusion: Fibrin glue mesh fixation of inguinal hernia during TEP repair is extremely safe and reliable, with a very high satisfaction index for the patients and limited risk of developing chronic pain. [ABSTRACT FROM AUTHOR]

Background: Partial nephrectomy has gained wider acceptance as a surgical technique in treating small renal tumors. Laparoscopic partial nephrectomy (LPN) still remains a technically demanding surgery to this day. We present our technique of laparoscopic partial nephrectomy, one that is performed without intracorporeal suturing.Methods: We performed LPN on 31 patients with localized renal parenchymal tumor (stage T1). The procedures were done from September 2009 to March 2015 at the Kaohsiung Medical University Hospital and the Kaohsiung Municipal Ta-Tung Hospital. Our technique involves the covering of renal defect layer by layer with FloSeal, Tisseel and a fat pad after monopolar coagulation.Results: Thirty-one patients were included in this study. Mean patient age was 53 years old (range 39-70). Mean tumor size was 2.9 cm (range 1.8-6.3). Mean RENAL nephrometry score was 5.3 (range 4-7). The average operation time was 188 min (range 120-290), and the average warm ischemic time was 19.0 min (range 9-26). Mean estimated blood loss was 171 ml (range 10-650), with no postoperative bleeding among the total 31 patients. No recurrent tumors were identified at a mean follow-up of 29 months postoperatively. The mean change in eGFR was 6.5 (ml/min/m2).Conclusion: Laparoscopic partial nephrectomy is a feasible surgical method for most patients with stage 1 tumor. Our technique has shown to reduce warm ischemic time significantly and provide patients with excellent functional outcomes without affecting oncological results. With this technique, surgeons can perform LPN with more efficiency and with fewer complications. [ABSTRACT FROM AUTHOR]

Purpose: The authors evaluated the ability of a fibrin sealant (TISSEEL™: Baxter Healthcare Corp, Deerfield, IL, USA) to reduce the incidence of post-operative seroma following abdominal wall hernia repair.Methods: We performed a 4-year retrospective review of patients undergoing abdominal wall hernia repair, with and without TISSEEL, by a single surgeon (FEE) at The Johns Hopkins Hospital. Demographics, surgical risk factors, operative data and 30-day outcomes, including wound complications and related interventions, were compared. The quantity and cost of Tisseel per case was reviewed.Results: A total of 250 patients were evaluated: 127 in the TISSEEL group and 123 in the non-TISSEEL control group. The average age for both groups was 56.6 years (P = 0.97). The majority of patients were female (TISSEEL 52.8%, non-TISSEEL 56.1%, P = 0.59) and ASA Class III (TISSEEL 56.7%, non-TISSEEL 58.5%, P = 0.40). There was no difference in the average defect size for both groups (TISSEEL 217 ± 187.6 cm(2), non-TISSEEL 161.3 ± 141.5 cm(2), P = 0.36). Surgical site occurrences occurred in 18.1% of the TISSEEL and 13% of the non-TISSEEL group (P = 0.27). There was a trend towards an increased incidence of seroma in the TISSEEL group (TISSEEL 11%, non-TISSEEL 4.9%, P = 0.07). A total of $124,472.50 was spent on TISSEEL, at an average cost of $995.78 per case.Conclusions: In the largest study to date, TISSEEL™ application offered no advantage for the reduction of post-operative seroma formation following complex abdominal hernia repair. Moreover, the use of this sealant was associated with significant costs. [ABSTRACT FROM AUTHOR]

Summary Introduction Although available for decades, fibrin-based tissue adhesives (FTAs) have enjoyed only variable popularity in aesthetic surgery since their introduction in the 1980s. Whilst benefits in facelift surgery have been reported for a range of measures, including expanding haematoma, oedema and ecchymosis, irrefutable evidence has not yet been forthcoming. We instigated a prospective study to test the hypothesis that an underappreciated property of FTA, namely its ability to distribute tension, would reduce complications and revision due to early relapse. Patients and methods The study group comprised 100 consecutive facelifts with FTA. The comparative group comprised the immediate preceding 100 patients who underwent similar interventions, but with drains instead of FTA. All surgery was undertaken by the senior author using standard techniques and statistical analysis employing Fisher's exact test. Results The groups were comparable in age, gender distribution, co-morbidity and declared cigarette smoking. Complications were recorded in 24 patients with significantly more in the comparative group ( p = 0.048), particularly hypertrophic scarring ( p = 0.029). Although there appeared a greater prevalence of revision and cutaneous necrosis in the comparative group, these did not reach statistical significance. Discussion To the many published benefits, we can add that FTA can reduce complications, particularly hypertrophic scarring, and it now forms an important part of our facelift practice. [ABSTRACT FROM AUTHOR]

Background: Although fibrin sealants (FSs) and fibrin glues (FGs) are predominantly utilized to strengthen repairs of cerebrospinal fluid (CSF) fistulas (deliberate/ traumatic) during spinal surgery, they are also increasingly utilized to achieve hemostasis. Here, we investigated whether adding Tisseel (Baxter International Inc., Westlake Village, CA, USA), utilized to address increased bleeding during multilevel lumbar laminectomies with non-instrumented fusions, would reduce or equalize the time to drain removal and length of stay (LOS) without contributing to infections or prolonging time to fusion. Methods: Prospectively, 39 patients underwent multilevel laminectomies and 1-2 level non-instrumented (in situ) fusions to address stenosis/olisthesis; 22 who demonstrated increased intraoperative bleeding received Tisseel, while 17 without such bleeding did not. Results: The 22 receiving versus 17 not receiving Tisseel, with similar clinical parameters, underwent comparable average multilevel laminectomies (4.36 and 4.25) and 1-2 level fusions (1.4 vs. 1.29 levels). As anticipated, for those receiving Tisseel, the average intraoperative estimated blood loss (EBL), total postoperative blood loss, and total perioperative transfusion requirements [red blood cells (RBC), fresh frozen plasma (FFP), platelets] were higher. However, Tisseel had the added benefit of equalizing the time to postoperative drain removal [e.g. 3.41 days (with) vs. 3.38 days (without)] and LOS [e.g. 5.86 days (with) vs. 5.82 days (without)] without increasing the infection rates (e.g. one superficial infection per group) or average times to fusion (e.g. 5.9 vs. 5.5 months). Conclusions: Adding Tisseel for increased bleeding during multilevel laminectomies/in situ fusions contributed to hemostasis by equalizing the average times to drain removal/LOS compared to patients without increased bleeding and not requiring Tisseel. [ABSTRACT FROM AUTHOR]

Background Platelet inhibitors are commonly used to reduce the risk of atherothrombotic events. The aim of this study was to determine the impact of platelet inhibitors, specifically clopidogrel and aspirin, on clot kinetics, strength, and/or structure during the use of thrombin based gelatin matrices and fibrin sealants. Methods Blood was collected and heparinized from donors on clopidogrel (and aspirin) and age matched control donors. Blood component analysis, whole blood platelet aggregometry, and activated clotting time (ACT) were used to monitor compliance to therapy and identify any differences between donor groups. Clot kinetics and strength were analyzed using thrombelastography (TEG). Field Emission Scanning Electron Microscopy (FESEM) was used to analyze clot structure. Results Blood component profiles were similar for both donor groups. Aggregometry indicated that aggregation response to adenosine diphosphate (ADP) for clopidogrel donors was 12% of that for the controls (p = 0.0021), an expected result of clopidogrel induced platelet inhibition. However, blood from both donor groups had an elevated thrombin induced aggregation response. Heparinization of donor blood resulted in similarly elevated ACTs for both donor groups. TEG results indicated similar clot kinetics and strength between clopidogrel and control donor groups for blood alone and when clotting was induced using thrombin based gelatin matrices and fibrin sealants. FESEM images supported TEG findings in that similar morphologies were observed in ex vivo formed clots from both donor groups when thrombin based gelatin matrices and fibrin sealants were used. Conclusion These results suggest that platelet inhibitors do not negatively impact clot kinetics, strength, and structure when clotting is initiated with thrombin based gelatin matrices and fibrin sealants. [ABSTRACT FROM AUTHOR]

The present scenario in dentistry compels a dentist to aim for improvements and advancement in treatments rendered. With the increasing demands and expectations of patients and to enhance the convenience of the dentist, there is a need to replace the conventional suturing in surgeries. Fibrin glue is a biological tissue adhesive which is under study in this connection. An effort is made here to compare and evaluate the conventional suturing and fibrin glue adhesive through a series of case reports. The following case series describes the use of commercially available fibrin glue (TISSEEL) in periodontal flap surgeries in three patients and evaluation of its potential benefits. Fibrin glue treated cases showed improved and faster healing and significant improvements in clinical variables like gingival index, probing depth. Fibrin glue has potential benefits in healing with adhesive and haemostatic properties in surgical procedures. [ABSTRACT FROM AUTHOR]

Fibrin glue has been widely used in a variety of surgical procedures to promote haemostasis and tissue bonding. It can also be used as a cell carrier for stem cells on tendons. However, the data about the effect of fibrin glue on flexor tendon healing is very limited. The present study examined the role of fibrin glue TISSEEL® in a rabbit model of flexor tendon injury. The rabbits were killed 3 or 8 weeks after the operation. The range-of-motion of the fingers and biomechanical properties of tendons were measured and compared between the control group and TISSEEL-treated group. The findings have shown that the range-of-motion in the TISSEEL-treated group was significantly different from that of the control group at 3 weeks after the operation. However, there is no significant difference in range-of-motion at 8 weeks after the operation. Moreover, there is no significant difference in biomechanical properties between the control group and TISSEEL-treated group. The results indicate that TISSEEL may attenuate adhesion formation at the early stage of flexor tendon repair. However, there is no significant effect on biomechanical features during tendon repair. In conclusion, this study has shown that it may be safe to use TISSEEL in tissue engineering applications for tendon regeneration and healing. [ABSTRACT FROM AUTHOR]

. Purpose: To assess the safety and efficacy of a fibrin tissue adhesive (Tissucol Duo®) used to close the conjunctiva in trabeculectomy. Methods: A nonrandomized prospective study including 57 patients with chronic simple glaucoma who underwent trabeculectomy surgery. All the trabeculectomies were conducted by the same surgeon using the same surgical technique with the exception that conjunctival closure was achieved by either running Nylon 10/0 suture ( n = 29) or using the fibrin glue ( n = 28). Preoperative and postoperative data were obtained on intraocular pressure (IOP), number of hypotensive medications used, self-reported discomfort and complications arising during and after surgery. Results: No differences were detected between the two patient groups regarding the intraocular pressure reduction achieved during follow-up. In the first 2 weeks of follow-up, reported discomfort assessed using a visual analogue scale was significantly lower in the Tissucol Duo® group. Two patients in the Tissucol Duo® group suffered conjunctival dehiscence and suturing was required at 24 hours postsurgery. Remaining complications were similar in the two groups. Conclusion: The use of Tissucol Duo® seems to be a safe and efficient option for conjunctival closure in trabeculectomy that simplifies the surgical procedure and reduces patient discomfort in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Background: Abdominal wall and inguinal hernia repair are the most frequently performed surgical procedures in the United States and Europe. However, traditional methods of mesh fixation are associated with a number of problems including substantial risks of recurrence and of postoperative and chronic pain. The aim of this systematic review is to summarize the clinical safety and efficacy of Tisseel/Tissucol fibrin sealant for hernia mesh fixation. Methods: A PubMed title/abstract search was conducted using the following terms: (fibrin glue OR fibrin sealant OR Tisseel OR Tissucol) AND hernia repair. The bibliographies of the publications identified in the search were reviewed for additional references. Results: There were 36 Tisseel/Tissucol studies included in this review involving 5,993 patients undergoing surgery for hernia. In open repair of inguinal hernias, Tisseel compared favorably with traditional methods of mesh fixation, being associated with shorter operative times and hospital stays and a lower incidence of chronic pain. Similarly, after laparoscopic/endoscopic inguinal hernia repair, Tisseel/Tissucol was associated with less use of postoperative analgesics and less acute and chronic postoperative pain than tissue-penetrating mesh-fixation methods. Other end points of concern to surgeons and patients are the risks of inguinal hernia recurrence and of complications such as hematoma formation and intraoperative bleeding. Comparative studies show that Tisseel/Tissucol does not increase the risk of these outcomes and may, in fact, decrease the risk compared with tissue-penetrating fixation methods. When used in the repair of incisional hernias, Tisseel/Tissucol significantly decreased both postoperative morbidity and duration of hospital stay. Conclusions: Clinical evidence published to date supports the use of Tisseel/Tissucol as an option for mesh fixation in open and laparoscopic/endoscopic repair of inguinal and incisional hernias. Guidelines of the International Endohernia Society recommend fibrin sealant mesh fixation, especially in inguinal hernia repair. Nonfixation is reserved for selected cases. [ABSTRACT FROM AUTHOR]

Background: This is the first case-control study on the use of a fibrin sealant (Tisseel) on uterine suture during laparoscopic myomectomy (LM), with the primary endpoint to evaluate the intraoperative bleeding and postoperative blood loss. In addition, we evaluated the time required to achieve hemostasis using Tisseel and how much it can influence operative time. Methods: From December 2009 to January 2011, consecutive patients older than 18 years with symptomatic isolate intramural myoma with maximal diameter ≤6 cm and ≥4 cm and with a sonographically diagnosed free myometrium margin ≥0.5 cm were included in the study. We selected from our institute's database a group of consecutive patients with homogeneous features of the study group, who underwent laparoscopic myomectomy without Tisseel application. Results: Fifteen women with symptomatic myoma were enrolled in the study (group A). Regarding the control group (group B), we selected a homogenous group of 15 patients with the same preoperative characteristics of the study group. Mean operative time was 47.7 min and 62.1 min, for groups A and B respectively ( p < 0.05). Mean time required to achieve complete haemostasis was 195.5 s in group A and 361.8 in control group B ( p < 0.0001). Mean estimated blood loss was 111.3 mL and 230 mL in groups A and B, respectively ( p < 0.05). Mean hemoglobin decrease was 1.36 g/dL and 2.04 g/dL in groups A and B, respectively ( p < 0.05). Conclusions: The use of Tisseel during LM may represent a valid alternative solution for obtaining hemostasis, reducing intra- and postoperative bleeding. Furthermore, it may help the surgeon to obtain a rapid healing of the injured surfaces, probably reducing the use of electrocoagulation and traumatisms. [ABSTRACT FROM AUTHOR]

The article discusses the case of an 8-year-old boy with a macula-off, inferior bullous retinal detachment associated with morning glory syndrome that was first treated by a pneumatic retinopexy. Examinations revealed a total retinal detachment and subretinal gas. Treatment included a 25-gauge pars plana vitrectomy and fibrin sealant injection; the latter being useful in treating similar cases of retinal detachment with deep posterior peripapillary staphyloma and persistent residual traction.

Purpose: Comparison of conjunctival closure with fibrin glue and conventional closure in strabismus surgeries. Methods: Twenty-nine patients undergoing strabismus surgery were studied. Group 1 included twelve cases in whom Tisseel was used for closure and group 2 included seventeen cases in whom 7/0 Vicryl was used. Severity of redness, watering, pain, and discomfort in opening eyes were evaluated postoperatively. Results: In the first hour, severe pain was experienced in both groups without statistical significance; but in group 1, pain was less severe in the 12th and 24th hour ( P<.0001). After the first hour severity of watering was less in group 1 ( P<.0001). Discomfort in opening eyes was detected in fifteen patients in group 2 in the first 12 hours where only one case with fibrin glue had discomfort. In the second week, no differences in severity of complaints were seen. Conclusions: Conjunctival closure with Tisseel following strabismus surgery might be an alternative to suturing. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the use of Hemostatic Fibrin Glue in parotidectomy without the use of surgical drains. Study design: Prospective cohort study of 10 patients undergoing parotidectomy. Surgery as a one day admission without the use of surgical drains was planned. The complication and duration of the hospital stay were obtained. Methods: Parotidectomy was undertaken by one surgeon. Prior to wound closure, the skin flap and wound bed were approximated using Tisseel tissue sealant. Data regarding the incidence of any complication and the duration of the hospital stay were obtained. Patients were followed to assess surgical outcome and document any complications. The mean follow-up period was 8months (range 4–12months). Results: There were no major surgical complications. Two patients had facial nerve weakness due to adherence of the tumour in the facial nerve, in there was which complete recovery after few months. All patients were discharged the next day. None of the patients felt that the discharge had been premature. Conclusions: Parotidectomy can be undertaken safely without the need for surgical drains, therefore, allowing the patients to leave the hospital on the first postoperative day. [Copyright &y& Elsevier]

Chronic pain is a disturbing severe complication of mesh inguinal hernia repair. Its risk, incidence, severity and its aetiologies vary widely in the literatures. It is well established that laparoscopic repair has decreased the incidence of chronic pain, but only to a certain degree. The main source of pain with this approach is staple fixation. Different ways of fixation were sought to avoid this problem. A review of the data collected prospectively, the cohort included 233 consecutive patients who underwent totally extraperitoneal (TEP) inguinal hernia repair by a single surgeon who used fibrin glue (Tisseel) to fix the mesh in all cases. Patients were reviewed by the original surgeon at 2 weeks and 6-12 weeks post-operatively, but also at 6 months in the first year of the study, and selectively then after if pain was reported by the patient. Data was reviewed and analysed by the researcher as part of quality assurance. During the period from February 2005 to September 2008, 233 consecutive patients underwent 309 TEP inguinal hernia repairs. The mean age was 44.9 years. There was no conversion to open surgery. There was no mortality and only one major morbidity. In total, eight patients were complaining of mild intermittent discomfort (2 in the groins and 6 in the testicles) on their second post-operative review, but had no complaint at 6 months following their surgery. Chronic groin pain occurred in only one patient (0.43%). The use of fibrin glue is a safe and reliable way of mesh fixation in inguinal hernia repair, with very limited risk of developing chronic pain. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the acute and chronic fixation strength of fibrin sealant (FS) as an alternative method of fixation for laparoscopic ventral hernia repair (LVHR). Methods: Representative mesh types for LVHR included one nonabsorbable barrier mesh (Composix) and three absorbable barrier meshes (Sepramesh, Proceed, and Parietex composite). Macroporous polypropylene mesh (Prolite Ultra) served as the control mesh. Three methods of fixation were used, namely, 0-polypropylene suture + FS (ARTISS 4 IU), FS alone (ARTISS), and tacks alone, to secure 3 × 4-cm pieces of mesh (10 of each combination) to the peritoneal surface of New Zealand white rabbit abdominal wall. After 2 h of incubation at 37°C, specimens underwent acute testing. Subsequently, a chronic phase was completed using the aforementioned fixation methods (10 of each combination), in which two 4 × 4-cm pieces of mesh were secured intraperitoneally in each of 75 New Zealand white rabbits, which survived 8 weeks until they were sacrificed. A transparent grid overlay was used to measure the mesh and adhesion area. Adhesion tenacity was characterized using the Garrard adhesion scale. In both the acute and chronic samples, a 3 × 3-cm area of mesh-tissue interface underwent lap shear testing at a rate of 0.42 mm/s using a tensiometer (Instron 5542). The maximum load sustained by the mesh-tissue construct was recorded as the acute fixation strength in newtons (N). Data are given as means ± standard error of the mean. Statistical significance ( p < 0.05) was determined using a one-way analysis of variance (ANOVA) with Fisher's least significant difference (LSD) posttest or a nonparametric Kruskal-Wallis test (adhesion scores). Results: The acute fixation strength was significantly greater for all the meshes secured with either suture + FS or tacks alone than for FS alone ( p < 0.001 for all comparisons). All the meshes except Proceed demonstrated greater acute fixation strength with suture + FS than with tacks alone ( p ≤ 0.016). Composix achieved greater acute fixation with suture + FS than all the other meshes ( p ≤ 0.022). Acute fixation with suture + FS was greater for Parietex Composite and ProLite Ultra than for Proceed ( p ≤ 0.015). When the animals were sacrificed, 48 of 50 meshes fixed with FS alone were insufficiently affixed to the abdominal wall, which may have resulted in hernia recurrence in a hernia model. The chronic fixation strength was greater for all the mesh types with either suture + FS or tacks only than with FS alone ( p ≤ 0.0005). The chronic fixation strength was greater with suture + FS than with tacks for Proceed and ProLite Ultra ( p ≤ 0.013). Neither mesh area nor adhesion tenacity differed significantly with any mesh/fixation method combination. Conclusions: In a chronic rabbit model of LVHR, fixation strength with FS alone was inadequate for selected nonabsorbable and absorbable barrier-coated meshes. The acute and chronic fixation strengths of suture + FS were equivalent or superior to the fixation strength of tacks alone. Using a combination of suture and FS for mesh fixation in LVHR may provide adequate fixation while decreasing postoperative pain due to spiral titanium tacks. In this preclinical series, mesh secured to the peritoneal surface by FS alone may have led to early recurrence. [ABSTRACT FROM AUTHOR]

Approximately one million spinal surgeries are performed in the United States each year. The risk of an incidental durotomy (ID) and resultant persistent cerebrospinal fluid (CSF) leakage is a significant concern for surgeons, as this complication has been associated with increased length of hospitalization, worse neurological outcome, and the development of CSF fistulae. Augmentation of standard dural suture repair with the application of fibrin glue has been suggested to reduce the frequency of these complications. This study examined unintended durotomies during lumbar spine surgery in a large surgical patient cohort and the impact of fibrin glue usage as part of the ID repair on the incidence of persistent CSF leakage. A retrospective analysis of 4,835 surgical procedures of the lumbar spine from a single institution over a 10-year period was performed to determine the rate of ID. The 90-day clinical course of these patients was evaluated. Clinical examination, B-2 transferrin assay, and radiographic imaging were utilized to determine the number of persistent CSF leaks after repair with or without fibrin glue. Five hundred forty-seven patients (11.3%) experienced a durotomy during surgery. Of this cohort, fibrin glue was used in the dural repair in 278 patients (50.8%). Logistic models evaluating age, sex, redo surgery, and the use of fibrin glue revealed that prior lumbar spinal surgery was the only univariate predictor of persistent CSF leak, conferring a 2.8-fold increase in risk. A persistent CSF leak, defined as continued drainage of CSF from the operative incision within 90 days of the surgery that required an intervention greater than simple bed rest or over-sewing of the wound, was noted in a total of 64 patients (11.7%). This persistent CSF leak rate was significantly higher ( P < 0.001) in patients with prior lumbar surgery (21%) versus those undergoing their first spine surgery (9%). There was no statistical difference in persistent CSF leak between those cases in which fibrin glue was used at the time of surgery and those in which fibrin glue was not used. There were no complications associated with the use of fibrin glue. A history of prior surgery significantly increases the incidence of durotomy during elective lumbar spine surgery. In patients who experienced a durotomy during lumbar spine surgery, the use of fibrin glue for dural repair did not significantly decrease the incidence of a persistent CSF leak. [ABSTRACT FROM AUTHOR]

Many strategies have been investigated to provide an ideal substitute to treat a nerve gap injury. Initially, silicone conduits were used and more recently conduits fabricated from natural materials such as poly-3-hydroxybutyrate (PHB) showed good results but still have their limitations. Surgically, a new concept optimising harvested autologous nerve graft has been introduced as the single fascicle method. It has been shown that a single fascicle repair of nerve grafting is successful. We investigated a new approach using a PHB strip seeded with Schwann cells to mimic a small nerve fascicle. Schwann cells were attached to the PHB strip using diluted fibrin glue and used to bridge a 10-mm sciatic nerve gap in rats. Comparison was made with a group using conventional PHB conduit tubes filled with Schwann cells and fibrin glue. After 2 weeks, the nerve samples were harvested and investigated for axonal and Schwann cell markers. PGP9.5 immunohistochemistry showed a superior nerve regeneration distance in the PHB strip group versus the PHB tube group (>10 mm, crossed versus 3.17 ± 0.32 mm respectively, P < 0.05) as well as superior Schwann cell intrusion (S100 staining) from proximal (>10mm, crossed versus 3.40 ± 0.36 mm, P < 0.01) and distal (> 10 mm, crossed versus 2.91 ± 0.31mm, P < 0.001) ends. These findings suggest a significant advantage of a strip in rapidly connecting a nerve gap lesion and imply that single fascicle nerve grafting is advantageous for nerve repair in rats. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate VH fibrin sealant''s influence on lower extremity lymphedema after inguinal lymphadenectomy in vulvar cancer patients. Methods: Patients undergoing an inguinal lymphadenectomy during the management of vulvar malignancy were randomized to receive sutured closure (SC) vs VH fibrin sealant sprayed into the groin followed by sutured closure (FS). Leg measurements were taken preoperatively and during postoperative encounters when surgical outcomes were assessed. Grade 2 or 3 lymphedema was defined as circumferential measurement increases of 3–5 cm and >5 cm, respectively. Results: 150 patients were enrolled. 137 patients were evaluable for lymphedema analysis with 67 and 70 patients in the SC arm and FS arm, respectively. The incidence of grade 2 and 3 lymphedema was 67%(45/67) in the SC arm, and 60% (42/70) FS arm (p =0.4779). The incidence of lymphedema was strongly associated with inguinal infection (p =0.0165). Lymphedema was not statistically increased in those who received adjuvant radiation. 139 patients remained evaluable for a descriptive analysis of their surgical complications. The overall incidence of complications was 61%(43/70) and 59% (41/69) for SC and FS arms, respectively. There was no statistically significant difference in duration of drains, drain output or incidence of inguinal infections, wound breakdowns or seromas. There was an increased incidence of vulvar infections in the FS arm (23/69) vs (10/70) (p =0.0098). The utilization of a Blake drain was associated with an increase in vulvar (p =0.0157) and inguinal wound breakdown (p =0.0456). Conclusion: VH fibrin sealant in inguinal lymphadenectomies does not reduce leg lymphedema and may increase the risk for complications in the vulvar wound. [Copyright &y& Elsevier]

Reliable laparoscopic fixation of meshes prior to their fibrous incorporation is intended to minimize recurrences following transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal repair (TEP) repair of inguinal hernias. However, suture-, tack- and staple-based fixation systems are associated with postoperative chronic inguinal pain. Initial fixation with fibrin sealant offers an atraumatic alternative, but there is little data demonstrating directly whether fibrin-based mesh adhesion provides adequate biomechanical stability for repair of inguinal hernia by TAPP and TEP. Using a newly developed, standardized simulation model for abdominal wall hernias, sublay repairs were performed with six different types of commercially available hernia mesh. The biomechanical stability achieved, and the protection afforded by the mesh–hernia overlap, were compared for three different techniques: nonfixation, point-by-point suture fixation, and fibrin sealant fixation. Mesh dislocation from the repaired hernia defect was consistently seen with nonfixation. This was reliably prevented with all six mesh types when fixed using either sutures or fibrin sealant. The highest stress resistance across the whole abdominal wall was found following superficial fixation with fibrin sealant across the mesh types. There was a highly statistically significant improvement in fixation stability with fibrin sealant versus fixation using eight single sutures ( p = 0.008), as assessed by the range of achievable peak pressure stress up to 200 mmHg. To ensure long-term freedom from recurrence, intraoperative mesh–hernia overlap must be retained. This can be achieved with fibrin sealant up to the incorporation of the mesh – without trauma and with biomechanical stability. [ABSTRACT FROM AUTHOR]

Matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) are important in regulating tissue remodeling of extracellular matrix. Dysregulation of MMPs is considered to be important to postoperative adhesion development. To examine whether Tisseel, a fibrin sealant, exerts an effect on expression of MMPs from human peritoneal mesothelial cells, normal peritoneal fibroblasts, and adhesion fibroblasts, a tissue culture study was conducted for 6, 12, 24, and 48 h under normoxic conditions. A multiplex reverse transcriptase–polymerase chain reaction technique using β-actin as a housekeeping gene was used to determine relative change in MMP-1, MMP-2, and TIMP-1 mRNA levels under six conditions (five fibrin sealant preparations and a control). Our results demonstrate that MMP-1, MMP-2, and TIMP-1 are all expressed by human peritoneal mesothelial cells and fibroblasts. All fibrin sealant compositions increased MMP-1 mRNA levels by all cell types, although the time course and pattern varied. The fibrin sealant compositions had variable effects on MMP-2 mRNA expression. Interestingly, in mesothelial cells, TIMP-1 mRNA levels were reduced by fibrin-sealant-containing aprotinin at both concentrations, while being further reduced by fibrin sealant without aprotinin, particularly at 6 and 12 h. In adhesion fibroblasts, there was generally no effect, while in normal fibroblasts, expression of TIMP-1 increased after 24 h. These results suggest that fibrin sealant, in addition to assisting in the achievement of hemostasis, exerts biological effects on human peritoneal mesothelial cells and fibroblasts and modulates MMP expression. Thus, fibrin sealant may influence tissue remodeling and may thereby be able to alter postoperative adhesion development. [ABSTRACT FROM AUTHOR]

Background: Tisseel (Baxter Corp. Ontario, Canada) is a fibrin-based tissue glue that has been widely used to reduce wound drainage, achieve hemostasis, and decrease surgical complications. To date, Tisseel has not been evaluated in a randomized prospective trial for use in parotid surgery. Objectives: To determine whether the use of Tisseel in parotidectomy decreases postoperative wound drainage, the duration of percutaneous drainage, the length of hospital stay, and the frequency of complications. Methods: Sixty consecutive parotidectomy patients were randomized into two groups: a group treated with 2 cc of Tisseel prior to wound closure and a control group. Postoperative wound drainage was measured for all patients by blinded hospital staff. The duration of percutaneous drainage, duration of hospital stay, and incidence of complications at the 3-week follow-up were assessed. Results: A statistically significant difference in total drainage volume (p < .02) and frequency of postoperative seroma (p < .05) was demonstrated between patients treated with Tisseel prior to wound closure and the control group. Conclusion: The use of Tisseel in parotidectomy patients prior to wound closure significantly decreases total drainage volume and the frequency of postoperative seroma. [ABSTRACT FROM AUTHOR]

Objective: This randomized, blinded, controlled study examines the effects of fibrin sealant (Tisseel, Laboratoire de production Baxter AG, Vienna, Austria) on wound drainage following thyroidectomy. Methods: Fifty-six consecutive patients were enrolled in the study. Patients were randomized into Tisseel and non-Tisseel treatment groups. Wound drain output was tallied in 8-hour increments by observers blinded to the treatment groups. Results: Fifty-six patients completed the study. Significant decreases in wound drainage were found in the first 8 hours in the Tisseel group. Eight hours postoperatively, wound output in the Tisseel group was reduced by 44% compared with the non Tisseel group. A significant decrease in the total drainage over the 64-hour time period of 43% was noted between the treatment and control groups. Post-thyroidectomy wound drainage was reduced and trended to earlier drain removal. No significant changes in the length of hospital stay were noted, nor were postoperative complications encountered in either treatment group. Conclusions: Fibrin sealants offer a unique opportunity to safely decrease post-thyroidectomy wound drainage. This investigation furthers the evidence that fibrin sealants could safely enable the implementation of drain-free thyroidectomies. [ABSTRACT FROM AUTHOR]

Abstract Background: Bio-Oss® is a deproteinized bovine mineral used in bone augmentation procedures. The particles are often mixed with a protein product (Tisseel® ) to form a mouldable graft material. Aim: The aim of the present experiment was to study the healing of self-contained bone defects after the placement of Bio-Oss® particles alone or mixed with Tisseel® in cylindrical defects in the edentulous mandibular ridge of dogs. Material and methods: In 4 labrador dogs, the 2nd, 3rd and 4th mandibular premolars were extracted bilaterally. 3 months later, 3 cylindrical bone defects, 4 mm in diameter and 8 mm in depth, were produced in the right side of the mandible. Following a crestal incision, full thickness flaps were raised and the bone defects were prepared with a trephine drill. The defects were filled with Bio-Oss® (Geistlich Biomaterials, Wolhuser, Switzerland) particles alone or mixed with Tisseel® (Immuno AG, Vienna, Austria), or left “untreated”. A collagen membrane (Bio-Gide® , Geistlich Biomaterials, Wolhuser, Switzerland) was placed to cover all defects and the flaps were sutured. 2 months later, the defect preparation and grafting procedures were repeated in the left side of the mandible. After another month, the animals were sacrificed and biopsies obtained from the defect sites. Results: Bio-Oss® -treated defects revealed a higher percentage of contact between graft particles and bone tissue than defects treated with Bio-Oss® + Tisseel® (15% and 30% at 1 and 3 months versus 0.4% and 8%, respectively). Further, the volume of connective tissue in the Bio-Oss® treated defects decreased from the 1 to the 3 month interval (from 44% to 30%). This soft tissue was replaced with newly formed bone. In the Bio-Oss® + Tisseel® treated... [ABSTRACT FROM AUTHOR]

Fibrin glue has been promoted for use in many neuro- and orthopaedic surgical procedures. At present, some surgeons make routine use of the adhesive in augmentation of bone grafting operations. However, there is controversy about its effectiveness in augmenting bone graft healing. This study investigated the use of two-component fibrin sealant (Tisseel®, Immuno AG, Vienna, Austria) as an adjunct to graft material in fusion surgery. Twenty-four cats were fused with corticocancellous bone graft, which was taken from a separate cat, across the disc space in the anterior cervical region. In the present experiment, the authors carried out cervical interbody fusions in 24 cats, divided into two groups, to test the usefulness of fibrin glue in fixation of allograft fusions. At surgery, a piece of corticocancellous allograft was placed into the intervertebral disc space at the C5–C6 region, either untreated or locally treated with fibrin adhesive (Tisseel). Fusion mass formation was examined 6 months after the experimental fusion procedure by radiography and computed tomography (CT) scanning and the new bone formed was evaluated histologically. The authors observed that the allograft fusion mass area is more voluminous in the untreated animals in Group I than in the ones augmented with Tisseel, as illustrated by CT measurement (section area and bone density) (p=0.038). Accordingly, histopathological studies demonstrated a reduced vascularization of the graft as well as diminished new bone formation in the animals treated with Tisseel in Group II. The present investigation demonstrates that local fibrin sealing significantly retards the osteogenic fusion in a model of corticocancellous bone grafting in cats. In view of our results it seems that fibrin sealant is not suitable for fixation of bone fragments in anterior cervical fusion. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate and to compare the effects of microsuturing to that of tissue adhesives (Tisseel®) on the healing of anastomosing peripheral nerve incisions. Forty-five Wistar-Albino rats were placed in special cages and separated into three groups (n = 15). In the control group, biliteral sciatic nerves were explored but no incision was made. In the first experimental group, bilateral sciatic nerves were incised and end-to-end anastomosing was performed by microsuturing the epineurium. In the second experimental group, tissue adhesive (Tisseel®) was used alone in anastomosing the sciatic nerve cuts. Assessments of the healing processes were demonstrated by 1. electromyography (EMG), 2. measuring the electrical responses of the anastomosed nerves after electrical stimuli, 3. histopathological examination. Statistical analysis of the EMG findings showed that the Tisseel group was the closest in the healing process to the control group. After applying electrical stimuli to the dissected nerves, the resistance value of the Tisseel group was nearest to those of the control group. The histopathological examinations showed highly degenerative nervebundles and prominent foreign body granuloma at the anastomosed sites of the microsutured group. The granulomatous inflammation was observed to be much less in the Tisseel group. We conclude that the healing effect of Tisseel was found to be superior to that of microsmuring as demonstrated by the findings of EMG, electrical responses of the anastomosed nerves, and histopathological examination. [ABSTRACT FROM AUTHOR]