25. Tissue Glues
Principles of the Perfect Tissue Adhesive
High bonding strength
Ease of operative applications
Reproducible outcomes
Nontoxic to tissue
Affordable cost
Fibrin Sealant
History
Fibrin powder used as hemostat and sealant by Bergel 1 in 1909
Described as an adhesive for skin grafts in 1940s 2 , 3
Approved by FDA in 1998 for use as a hemostatic agent and as a tissue sealant in liquid form; fibrin sealant patch approved in 2010 4
Artiss (Baxter) is the only fibrin sealant approved specifically for autologous skin grafting and flap adherence in rhytidectomy.
Fibrin sealant approved by the FDA as a hemostat, adhesive, and sealant
Mechanism of Action
Fibrin clot forms from a polymerized fibrin compound resulting from the reaction of fibrinogen and thrombin.
Thrombin cleaves larger subunits of fibrinogen, creating fibrin subunits, which in turn polymerize.
Factor XIII and calcium cause cross-linking and formation of a stable fibrin clot.
Fibrin clot will degrade in approximately 10-14 days.
Delivery System
Delivery systems consist of two separate components of fibrin and thrombin that combine on exiting the device through a double-barrel syringe with a Y-connector.
May be applied locally or aerosolized for larger surfaces
Commercially available products contain components from varied sources.
Fibrinogen from human pooled plasma or a patient’s own plasma
Thrombin of human or bovine origin
Aprotinin (antifibrinolytic protein)
Factor XIII and calcium (catalysts)
Equine collagen and cellulose matrix available for fibrin patch design
Pricing
Liquid form approximately $50/ml of fibrin sealant
Fibrin sealant patches range $600-$800/patch
Note:
Prices for these products may vary based on contracting
Complications
Commercial preparations of fibrin sealants have risk of bloodborne pathogens (viral, prions).
Products with bovine components can cause disseminated coagulopathy.
Aprotinin-containing products can cause anaphylaxis, rash.
Air emboli can occur with pressurized applications.
Thick layers of fibrin allowed to polymerize before tissue apposition can inhibit wound healing and act as an antiadhesive.
Applications
Conflicting studies exist for the outcomes of fibrin sealant used in cosmetic procedures.
Lower levels of thrombin (5 units/ml) allow the sealant to set at a slower rate, resulting in extended time for flap manipulation.
Multiple studies show statistically significant decrease in drain output with fibrin sealant versus control.
Varied reports in decreasing hematoma, edema, and ecchymosis formation.
Randomized controlled, blinded trial compared one side of the face without fibrin sealant and the addition of fibrin sealant on the other. The fibrin sealant side reduced average drainage volumes (20 ml without fibrin glue versus 7.7 ml with fibrin glue, p <0.0001) without increasing the incidence of hematoma or seroma.
Prospective, double-blind, randomized, controlled trial on the use of fibrin sealant in 20 consecutive patients undergoing facelifts by the same surgeon. Each patient was randomized for the use of fibrin sealant on either the right or the left side of the face with the contralateral side acting as the control. Total drainage was recorded on each side for 24 hours before drains were removed. The side treated with fibrin glue had a median drainage of 10 ml and the control side 30 ml (p <0.002).
Prospective, nonblinded, randomized, controlled trial in 30 patients undergoing facelifts. Patients were their own controls and were randomized to having glue on one side of their face. Drainage on glued side was 7.5 ml less than unglued in 24 hour output, but not thought to be clinically significant (p <0.05).
Senior Author Tip:
I have used tissue glues in all my facial rejuvenation procedures since 1991. They help to “seal” the space after SMAS treatment is completed. They appear to reduce swelling, bruising, and small seromas/hematomas.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
