[The use of cyanoacrylate tissue adhesive in the pterygium excisions with amniotic membrane transplantation]

PURPOSE

To find the proper way to use the cyanoacrylate tissue adhesive (CTA) in the pterygium excisions with amniotic membrane transplantation and To evaluate the therapeutic effects of it.

METHOD

A prospective randomized clinical trial was carried out in 27 patients (32 eyes) who would have pterygium excision. They were divided into 2 groups randomly: 15 eyes in the CTA group, 17 eyes in the suture group. We evaluate the benefits of them with the respect to surgery time and postoperative sighs and symptoms.

RESULTS

Average surgery time was 15.8 minutes for CTA group and 23.7 minutes for sutures, P < 0.05. The postoperative sighs were much more light in CTA group. The average pain was significantly lower when CTA had been used, P < 0.05. And the amniotic membrane was attached much better. The two groups have no significant difference in the other aspects.

CONCLUSION

Using CTA instead of sutures when attaching the amniotic membrane in pterygium surgery shortens surgery time significantly and improve the postoperative sighs and symptoms. It's easy, safe and effective.

Effect of a Fibrin-Fibronectin Sealing System as a Carrier for Recombinant Human Bone Morphogenetic Protein-4 on Bone Formation in Rat Calvarial Defects

BACKGROUND

Bone morphogenetic proteins (BMPs) have been shown to play an important role in bone formation during development and wound healing. Despite there being good prospects for BMP applications, an ideal carrier system for BMPs has yet to be determined. The purpose of this study was to evaluate the possibility of a fibrin-fibronectin sealing system (FFSS) as a carrier for recombinant human BMP-4 (rhBMP-4) and to evaluate the genuine osteoconductive potential of the FFSS in a rat calvarial defect model.

METHODS

An 8-mm, calvarial, critical-size osteotomy defect was created in each of 30 male Sprague-Dawley rats. Three groups of 10 animals each received rhBMP-4 (0.025 mg/ml) in the FFSS, FFSS control, or sham-surgery control. The groups were evaluated using histologic and histometric parameters following 2- and 8-week healing intervals (five animals per group per healing interval).

RESULTS

Surgical implantation of rhBMP-4/FFSS resulted in enhanced local bone formation at 2 and 8 weeks. New bone formation was also evident in the FFSS control; however, the amount of defect closure, new bone area, and bone density was significantly greater in the rhBMP-4/FFSS group (P < 0.05). At 8 weeks, the quantity of the new bone was greater than that observed at 2 weeks, and the specimens showed a more advanced stage of remodeling and consolidation in both groups (P < 0.05). Only very limited bone formation was observed in the sham-surgery control.

CONCLUSION

The results of the present study indicated that the FFSS has osteoconductive potential and may be employed as a carrier for BMPs.

Prospective, multicenter evaluation of highly concentrated fibrin glue in the treatment of complex cryptogenic perianal fistulas

PURPOSE

The surgical management of complex perianal fistulas is challenging and may be associated with the risk of sphincter injury. Instillation of fibrin glue to the fistula tract is a simple procedure that does not involve any muscle division, and potentially results in healing of the fistula. This study was designed to assess the use of highly concentrated fibrin glue with intra-adhesive antibiotics in the treatment of complex cryptogenic perianal fistulas.

METHODS

Patients with complex perianal fistulas of cryptogenic origin were prospectively included in this multicenter study. Injection of the fibrin glue mixed with antibiotics was performed in a uniform fashion. After the procedure, patients were actively examined at fixed time intervals; in cases of recurrent fistula, reinjection of fibrin glue was offered.

RESULTS

Sixty patients were enrolled; complete healing of the fistula was achieved in 32 patients (53 percent). Eight of 28 patients (29 percent) who were not completely healed had significant symptomatic improvement. All patients resumed normal daily activity the day after surgery and none had any deterioration in continence related to the procedure. The majority of the 26 (43 percent) adverse events were considered mild and spontaneously resolved; 2 patients (3 percent) with perianal septic complications were successfully treated by drainage.

CONCLUSIONS

Injection of fibrin glue for the treatment of perianal fistulas is safe, simple, and associated with early return to normal activity. Although moderately successful, it may preclude extensive surgery in more than one-half of these patients.

Bioadhesive tablets for controlled transdermal delivery of drugs

Transdermal bioadhesive tablets were formulated by the direct compression method and evaluated. Carboxyfluorescein (CF) was used as a model permeant. The compression parameters were kept consistent and the composition of the formulation was varied to alter the release rate of the drug from the formulations. The dosage form was evaluated for physicochemical, adherence, and in vitro diffusion parameters. The transdermal flux of the drug decreased with the increasing ratio of Ethyl cellulose (EC)/hydroxypropyl cellulose (HPC). The test formulations were subjected to pharmacokinetic studies in mice. The formulations were able to maintain a steady state plasma concentration up to 12 hours. They were found to be safe for transdermal use as interpreted from skin irritation studies carried out on rabbits.

Octylcyanoacrylate for the treatment of small, superficial, partial-thickness burns: a pilot study

BACKGROUND

Octylcyanoacrylate (OCA) is a tissue adhesive used to close wounds and to treat minor abrasions.

OBJECTIVE

To explore the use of OCA in patients with superficial, partial-thickness burns.

METHODS

A prospective, noncomparative, pilot study was conducted in an emergency department (ED) and burn center. Consecutive patients with early (< 6 hours), small (< 5% total body surface area [TBSA]), superficial, partial-thickness burns were enrolled. Burns were cleaned and any nonadherent necrotic epidermis was removed. Tense blisters were aseptically aspirated. Burns were then covered with a liquid OCA that was applied with a sponge brush. Pain of cleansing and OCA application was recorded, and physicians assessed ease of application. Burns were evaluated every one to two days until complete epithelialization for the presence of infection and exudation, and the OCA was reapplied as necessary. Main outcomes measured were the need for additional topical therapy, pain and ease of application, patient comfort, and satisfaction.

RESULTS

Ten patients were enrolled. Mean patient age (+/- standard deviation [SD]) was 23 (+/- 16) years, four were female, and nine were white. Burns were located on the hands (5), forearms (3), ankle (1), and back (1). Etiologies included contact (4), flame (4), and scald (2) burns. Mean (+/- SD) burn size was 71 (+/- 72) cm(2). Blisters were present on admission in all patients and remained intact in five. Application of OCA was very easy in all patients; it immediately relieved pain in four patients and had no effect in three patients, while three patients complained of a brief increase in pain on OCA application. Exudation was present in four of ten patients within one to two days, all of whom had ruptured blisters at initial presentation. OCA was reapplied in two of these patients, and two patients were changed to silver sulfadiazine due to excessive exudation. The OCA was removed in one patient due to accumulation of exudate. There was no infection, and all burns were epithelialized within five to ten days.

CONCLUSIONS

The results of this pilot study suggest that OCA may be useful for some, but not all, small, superficial, partial-thickness burns. Further studies may help clarify the indications and contraindications to proper usage of OCA in small, superficial burns.

A New Option in the Treatment of Skin Tears for the Institutionalized Resident: Formulated 2-Octylcyanoacrylate Topical Bandage

Skin tears are a common phenomenon in elderly institutionalized adults (EIAs). Incidence ranges from 0.92 to 2.5 per person/year. Little supportive literature exists regarding optimal treatment with many regimens reported. A convenience sample of 20 patients with Payne-Martin Category II and III skin tears of less than 8 hours' duration were prospectively evaluated with the use of a formulated 2-octylcyanoacrylate topical bandage. Patients were followed weekly until the tear healed. Complete healing occurred with 1 application of 2-OTB in 90% (18/20) of study subjects; 5% (n = 1) reported transient mild pain (less than 15 seconds), and 90% (n = 19) reported no pain. There were no incidents of cellulitis or infection. Shower and bathing routines were not interrupted. Cost averaged less than $1 per application. Clinician time averaged 1.5 minutes per application. Clinicians reported high satisfaction because repeated dressing changes were eliminated.

Fixation of a talar osteochondral fracture with cyanoacrylate glue

Cyanoacrylate glue was invented by Ardis in 1949 and was first used in surgery in 1959 by Coover. By further modifications, a nonhistotoxic form, butyl-2-cyanoacrylate, which had strong tissue binding properties even in nondry environments, was developed. Its use in the fixation of fractures and osteotomies is still under investigation and has had promising results in treatment of craniofacial and mandibular injuries. We fixed a talar osteochondral fracture with cyanoacrylate. After 3 months, magnetic resonance imaging showed an anatomically reduced and intact chondral surface. The clinical result was excellent. We believe cyanoacrylate glue may form an alternative means of fixation for osteochondral and, possibly, for chondral fractures.

Scalp electrode placement by EC2® adhesive paste in long-term video-EEG monitoring

OBJECTIVE

To evaluate the usefulness of an adhesive paste named EC2 (Grass-Telefactor) in comparison with collodion, for scalp electrodes placement in patients with drug resistant partial epilepsy monitored by long-term video-EEG.

METHODS

A total of 40 patients with drug resistant partial epilepsy participated in the study. In 20 patients, electrode placement on the scalp was made with collodion (group C) whereas in the remaining patients EC2 was used (Group P). After the electrode placement (T1) and after 24 h of recording (T2), the impedance of the electrodes was measured. Moreover, the time required to apply the electrodes and for their daily maintenance was calculated and recorded for all patients who entered the study.

RESULTS

At each observation, group C showed mean values of electrode impedance significantly higher that the group P (T1: 16.8 k omega; T2: 6.5 k omega vs T1: 2.4 k omega; T2: 4.0 k omega, respectively) (P < 1 x 10(-5)). The time required to make the montage and to provide its daily maintenance was significantly shorter in group P than in group C [20.8 and 10.5 min vs 44.3 and 19.7 min, respectively (P < 1 x 10(-5))].

CONCLUSIONS

We found that the use of EC2 paste in scalp electrode attachment is less time consuming, with better recording quality as a result of lower electrode impedance values, than the use of collodion.

SIGNIFICANCE

EC2 paste may substitute collodion in electrode placement for long-term video-EEG monitoring, with an optimal cost-benefit ratio in terms of recording performance, time consumption, and safety.

Mesothelial cell sheets cultured on fibrin gel prevent adhesion formation in an intestinal hernia model

In the present study, we examined a novel technique to prevent adhesion formation in a rat intestinal hernia model with mesothelial cell sheets cultured on fibrin gel. Mesothelial cells were obtained from isologous rats by enzymatic disaggregation of mesentery and cultured on fibrin gel. Electron microscopy revealed that these cultured cells form contiguous monolayer cell sheets with well-developed microvilli. These tissue-engineered constructs were grafted in vivo to an intestinal hernia model that results in regular surgical adhesions without treatment. Five days postgrafting, rats were sacrificed. Adhesion formation was not observed in rats grafted with the constructs, whereas severe adhesions were observed in all control rats. Constructs seeded with mesothelial cells isolated from EGFP-transgenic rats clearly revealed that grafted mesothelial cells remained at the host tissue site even after fibrin scaffold degradation. These cells developed more abundant microvilli in vivo than those in vitro. These results show that cultured mesothelial cell sheets are effective in preventing adhesion formation and should reduce postoperative complications caused by adhesion formation.

Fast-dissolving mucoadhesive microparticulate delivery system containing piroxicam

We have studied the feasibility of preparing fast-dissolving mucoadhesive microparticulate delivery systems containing amorphous piroxicam to improve drug residence time on sublingual mucosa and drug dissolution rate. Two new mucoadhesive carriers, Eudragit L100 (EuLNa) and Eudragit S100 (EuSNa) sodium salts, both characterized by a fast intrinsic dissolution rate, have been selected. Microparticles containing piroxicam and EuLNa (series 1) or EuSNa (series 2) in ratios from 15/85 to 85/15% (m/m) were prepared by spray drying. The morphology and physical state of the microparticles and the effect of the microparticle composition on the piroxicam release and mucoadhesion were investigated. Piroxicam loaded into the microparticles was found to be in the amorphous form at all drug/copolymer ratios. This feature was ascribed to the presence of an H-bond between the NH of piroxicam and a CO of the copolymers. The formation of solid solutions improved the dissolution rate and the apparent drug solubility. The mucoadhesive properties were affected by the drug/copolymer ratio and in series 2 the microparticles containing more than 50% (m/m) of piroxicam did not show mucoadhesive properties. The delivery system made of piroxicam and EuLNa in the ratio 70/30% (m/m) appears to be the most promising because it contains the lowest amount of polymer able to confer mucoadhesive properties and increase apparent drug solubility.

Effects of roller compaction settings on the preparation of bioadhesive granules and ocular minitablets

An experimental factorial design was employed to evaluate bioadhesive granules and bioerodible ocular minitablets (6 mg and Psi 2 mm). The purpose of this study was to compare minitablets prepared using roller compacted granules with an optimised minitablet formulation, manufactured on laboratory scale by direct compression. The formulation consisted of drum dried waxy maize starch, Carbopol 974P, and ciprofloxacin in a ratio of 90.5/5/3 (w/w/w). Three roller compactor parameters were varied, i.e. the roller speed, the horizontal screw speed and the compaction force, while the vertical screw speed was kept constant. Afterwards, the ribbons were milled to obtain granules suitable for compression. The friability, the flow properties, the bulk material characteristics (apparent and tap density and porosity) and the particle size distributions of two granule sieve fractions (90-125 and 125-355 microm) were investigated. The roller speed and the compaction force have the largest influence on the granule characteristics, followed by the horizontal screw speed. The physical properties of non- and gamma-irradiated minitablets were determined. From the tablet strength, friability and dissolution results, a low compaction force and a high roller speed were shown to be preferable to prepare granules which can be further tabletted into adequate ocular minitablets.

Short Scar Face-Lift with the Use of Fibrin Sealant

Fibrin sealants have been used in surgical procedures for decades. This article focuses on the short scar face-lift and the applicability of Tisseel fibrin sealant, or "tissue glue," in expediting the healing process in a series of consecutive patients undergoing face-lift surgery. The evolution of the face-lift incision into the short scar and the adjunctive use of the Tisseel fibrin sealant have both resulted in faster recovery.

The sealing effect of fibrin glue against alveolar air leakage evaluated up to 48h; comparison between different methods of application

OBJECTIVE

There is little experimental evidence to show how much positive airway pressure fibrin sealants can actually withstand, and in particular, how this effect changes over time. In the present study, we experimentally evaluated the sealing effect of fibrin glue against alveolar air leakage up to 48 h after application.

METHODS

Beagles were used (n = 48). Under thoracotomy, approximately 5 x 10 mm defects (2 mm depth) were made on the lung surface. Fibrin glue sealants were applied to this defect in three ways. In rubbing and spray method, fibrinogen was rubbed, followed by spraying of both fibrinogen and thrombin solutions. In double layer method, fibrinogen was dripped, followed by thrombin. Collagen fleece, coated with fibrinogen and thrombin (TachoComb) was also tested. The minimum positive airway pressure which produced air leakage was measured for each sealed defect (seal breaking pressure, cmH2O) at 0, 3, 6, 12, 24, and 48 h after application (n = 6 at each time point).

RESULTS

The seal-breaking pressure increased over time in all of the application methods. At 6 h, differences between methods were not significant but three defects in RS reached 70 cmH2O, the maximum pressure tested, compared with none in other two methods. At 12h, the seal-breaking pressure was significantly higher in RS compared with the other two methods (rubbing and spray method vs TachoComb; 66+/-3 vs 47+/-17, P = 0.047, rubbing and spray method vs double layer method; 66+/-3 vs 42+/-18, P = 0.024). Beyond 24 h, sealing pressure reached close to 70 cmH2O in all the methods.

CONCLUSIONS

The results show that the sealing effect of fibrin glue is relatively unstable up to 12h after its application. Rubbing and spray method may help the fibrin seal to reach its full strength faster compared with the other two methods.

The effect of autologous fibrin tissue adhesive on postoperative cerebrospinal fluid leak in spinal cord surgery: a randomized controlled trial

STUDY DESIGN

A prospective randomized study evaluating the efficacy of autologous fibrin tissue adhesive for decreasing postoperative cerebrospinal fluid (CSF) leak in spinal cord surgery.

OBJECTIVE

To compare postoperative CSF leak in 3 groups (i.e., autologous fibrin tissue adhesive used, commercial fibrin glue used, and no fibrin tissue adhesive used) of patients undergoing spinal surgery who needed dural incision.

SUMMARY OF BACKGROUND DATA

Spinal cord operations, particularly when dural incision is inevitable, sometimes involve postoperative CSF leak. Because CSF leak is a serious complication, countermeasure is necessary to prevent it after dural suture. Commercial fibrin tissue adhesive was formerly used. Because the possibility of prion infection was widely noticed, commercial fibrin tissue adhesive containing animal components has been used less often.

METHODS

In 13 of 39 cases in which dural incision would be made, 400 mL whole blood was drawn, and autologous fibrin tissue adhesive was made of plasma. Cases were divided into 3 groups: (1) dural closure alone, (2) use of autologous fibrin tissue adhesive after dural closure, and (3) use of commercial fibrin tissue adhesive after dural closure. The primary outcome measure was determined as postoperative (3 days) volume of drainage fluid, and results were analyzed using the analysis of variance. The secondary outcome measure was general blood test, coagulation assay, and plasma fibrinogen, and these were analyzed also using the analysis of variance.

RESULTS

There was a significant difference in the primary outcome between the autologous and control groups. No complications such as infection or continuous CSF leak were observed in any case. The mean volume of drainage fluid was 586.2 mL in the group with autologous fibrin tissue adhesive and 1026.1 mL in the group without fibrin tissue adhesive. The volume of drainage fluid was significantly lower in the former group than that in the latter group. There was no statistical difference between the volumes of the group with autologous adhesive and with commercial adhesive (639.2 mL).

CONCLUSIONS

We used autologous fibrin tissue adhesive as a new sealant after dural closure instead of commercial fibrin tissue adhesive. No definitive CSF leak was observed, and the volume of drainage fluid was significantly lower in the group with autologous fibrin tissue adhesive than that in the group without fibrin tissue adhesive. The use of autologous fibrin tissue adhesive was superior to that of commercial fibrin tissue adhesive in cost.

[Tissue adhesive combined with amniotic membrane adhering in the treatment of ocular burns]

PURPOSE

To investigate the surgical technique and its usefulness of tissue adhesive combined with amniotic membrane adhering, a new surgical procedure for ocular burns.

METHODS

Thirty-four eyes from 29 patients with ocular burns participated in the study, grade II -III 9 eyes, grade IV 25 eyes . In 25 eyes with burn of grade IV, 7 eyes experienced complete (100%) limbal ischemia, 18 had partial (less than 100%) limbal ischemia, and 12 with severe conjunctival necrosis had sclera involved. Cyanoacrylate tissue adhesive combined with amniotic membrane adhering was applied after standard medical therapies failed in controlling the deterioration of patients' conditions. Our outcome measures included healing of the epithelial defect, resolution of the ulceration and inflammation, adhering of the tissue adhesive and amniotic membrane, and vision acuity.

RESULTS

outcome data were available for 33 eyes. For a follow-up of 2-6 months, All the 27 eyes showed epithelialization within 8-42 days, (23.9+/-8.0) days, including those with burns of grade II -Il , grade IV ( partial limbal ischemia). Corneal melting was arrested in 6 eyes with 100% limbal ischemia. Vision acuity was improved significantly in 29 eyes, had no change in the other 4 eyes.

CONCLUSION

Cyanoacrylate tissue adhesive combined with amniotic membrane adhering can rapidly restore both corneal and conjunctival surfaces, thus preventing effectively scarring sequelae in the late stage. In most severe burns, however, it arrests the corneosclera melting and restores the conjunctival surface and blood supply of the anterior segment, but does not restore the integrity of the corneal surface, which requires further limbal stem cell transplantation.

Cardiac Device Implant Wound Closure with 2-Octyl Cyanoacrylate

2-Octyl Cyanoacrylate (2-OCA) is a tissue adhesive developed for skin laceration closure that has not been previously evaluated for cardiac device implant wound closure. We reviewed 460 consecutive device implants with 475 incisions between November 1993 and May 2001. From November 1993 to December 1998, all patients (n 335) had a 3-layer reabsorbable suture closure with the application of topical bacitracin and dressing material. They were advised to avoid exposure to moisture for 10 days. From January 1999 to May 2001, the superficial suture layer was replaced with 2-OCA (n=125). No topical bacitracin or dressing was applied and patients were allowed to shower within 72 hours. The two groups did not differ significantly with respect to age (69 +/- 12 vs 70 +/- 13 years, P=NS), sex (59% vs 62% male, p=NS) or device type (77% vs 68% pacemakers/loop recorders, p=NS). All incisions were evaluated at 24 hours, 7-14 days, and 6-12 weeks postprocedure. The 2-OCA and suture groups did not differ significantly with respect to allergic reaction (0% vs 1.4%, P=NS), cellulitis (0% vs 0.9%, P=NS), and infection requiring explant (0.8% vs 0.3%, P=NS), respectively. Total adverse events occurred in 1 of 125 (0.8%) of the 2-OCA group versus 9 of 350 (2.6%) of the suture group (P=NS). In cardiac device implant closure 2-OCA obviated the need for topical antibiotics and dressing materials while facilitating wound care without increased complications.

Biomaterials Used in Injectable Implants (Liquid Embolics) for Percutaneous Filling of Vascular Spaces

The biomaterials currently used in injectable implants (liquid embolics) for minimally invasive image-guided treatment of vascular lesions undergo, once injected in situ, a phase transition based on a variety of physicochemical principles. The mechanisms leading to the formation of a solid implant include polymerization, precipitation and cross-linking through ionic or thermal process. The biomaterial characteristics have to meet the requirements of a variety of treatment conditions. The viscosity of the liquid is adapted to the access instrument, which can range from 0.2 mm to 3 mm in diameter and from a few centimeters up to 200 cm in length. Once such liquid embolics reach the vascular space, they are designed to become occlusive by inducing thrombosis or directly blocking the lesion when hardening of the embolics occurs. The safe delivery of such implants critically depends on their visibility and their hardening mechanism. Once delivered, the safety and effectiveness issues are related to implant functions such as biocompatibility, biodegradability or biomechanical properties. We review here the available and the experimental products with respect to the nature of the polymer, the mechanism of gel cast formation and the key characteristics that govern the choice of effective injectable implants.

Intralesional Injection of Tisseel Fibrin Glue for Resection of Lymphangiomas and Other Thin-Walled Orbital Cysts

PURPOSE

Surgical removal of orbital lymphangiomas is often difficult because the capsule of these lesions is fragile, and, once violated, it tends to collapse, making identification of residual tumor difficult and dissection often incomplete. A surgical technique combining partial controlled decompression of the lesion with intralesional injection of Tisseel fibrin glue is evaluated to determine its effectiveness in resecting the lesion and preventing recurrences.

METHODS

This is a retrospective interventional case series. Three young patients, two with lymphangiomas and one with congenital hydrocystoma, underwent surgical resection of their thin-walled cystic lesions of the orbit with the use of intralesional injection of Tisseel fibrin glue. Resolution of the signs and symptoms, complications of the surgery, and recurrence of bleeding are the parameters studied.

RESULTS

All 3 patients had improvement of their signs and symptoms. None had complications related to the surgery, and no recurrence of bleeding occurred during the follow-up period.

CONCLUSIONS

Our study suggests that this surgical technique with intralesional injection of Tisseel fibrin glue is an effective treatment modality for the resection of lymphangiomas and other orbital thin-walled cystic lesions.