Surgical application of tissue adhesives

Comparing intra-oral wound healing after alveoloplasty using silk sutures and n-butyl-2-cyanoacrylate

Objectives

The need for proper wound closure is of paramount importance after any intra-oral surgery. Various wound closure techniques have been described in literature using traditional non-absorbable suture materials. These include like synthetic absorbable sutures, surgical staples and tissue adhesives. Cyanoacrylates are among the most commonly used biocompatible tissue adhesives. To evaluate and compare intraoral wound healing using 3-0 silk sutures and n-butyl-2-cyanoacrylate after alveoloplasty.

Materials and Methods

A total of 20 patients requiring bilateral alveoloplasty in the same arch (upper or lower) were included in this study. Patients with any pre-existing pathology or systemic disease were excluded. After alveoloplasty was performed, the wound was closed using 3-0 braided silk sutures on one side, and using n-butyl-2-cyanoacrylate bio adhesive on the other side. Patients were evaluated based on the following parameters: time required to achieve wound closure; the incidence of immediate and postoperative hemostasis; the time to the use of the first rescue medication; the side where pain first arises; and the side where wound healing begins first.

Results

Compared to 3-0 silk sutures, cyanoacrylate demonstrated better hemostatic properties, reduced operative time, reduced postoperative pain and better wound healing.

Conclusion

These data suggest that cyanoacrylate glue is an adequate alternative to conventional sutures to close the surgical wound after alveoloplasty, and better than are 3-0 silk sutures.

A comparative study: efficacy of tissue glue and sutures after impacted mandibular third molar removal

OBJECTIVE

To compare the efficacy of cyanoacrylate (tissue glue) placement after surgical removal of impacted mandibular third molars.

MATERIALS AND METHODS

Thirty patients with bilaterally impacted mandibular third molars were studied in this controlled clinical trial. One side closure after surgical removal of third molar was done with conventional sutures and other side with cyanoacrylate.

RESULTS

The data analysis showed that postoperative bleeding with cyanoacrylate method was less significant than with suturing on the first and second day after surgery. There was no significant difference in the severity of pain between the two methods.

CONCLUSION

This study suggested that the efficacy of both, cyanoacrylate and suturing in wound closure were similar in the severity of pain, but use of cyanoacrylate showed better hemostasis.

Complications of transthoracic needle biopsy decreased with isobutyl 2-cyanoacrylate: a pilot study

To explore the possibility of performing percutaneous lung biopsy safely in patients mechanically ventilated with positive-end expiratory pressure (PEEP), transthoracic needle biopsy was performed in 16 anesthetized mongrel dogs mechanically ventilated with 10 cm H2O of PEEP. To obtain the biopsy sample, a 25-gauge "skinny needle" was passed through a 20-gauge sheath and placed up to 6.25 cm deep. After satisfactory samples were obtained, both needles were withdrawn in the control group, but in the treated group, the outer sheath was used to inject 0.5 ml of isobutyl 2-cyanoacrylate to seal the needle track. Pneumothorax was present in 7 (87.5%) of 8 dogs in the control group and in 2 (25%) of 8 dogs in the treated group (p = .0147). Lung tissue exhibited an apparent foreign-body granulomatous inflammatory reaction. This technique could extend the benefits of transthoracic needle biopsy to mechanically ventilated patients, but further studies to prove the safety of isobutyl 2-cyanoacrylate are necessary.

Fibrin seal--an alternative to suture repair in experimental pulmonary surgery

Fibrin seal (FS) a biological tissue adhesive was evaluated as a sealant of lung parenchyma. New Zealand White (NZW) rabbits underwent a right upper lobe wedge resection. The defect was repaired with FS, suture (S), or a combination of S and FS (SFS). Five rabbits from each treatment group were sacrificed on postoperative Days 1, 3, and 14. The ventilatory pressure required to produce air leak was measured and the wet weight of normal vs hemorrhagic lung tissue determined. Although leak pressure was lowest in FS on Day 1 (P less than 0.05), leak pressure was equal to S and SFS of Day 3 and highest on Day 14 (P less than 0.01). FS-treated lungs had less hemorrhagic tissue than S and SFS (P less than 0.0001). Microscopically S and SFS repairs had large areas of hemorrhagic necrosis while FS showed minimal changes. We conclude that FS is an effective sealant of lung parenchyma.

Combined application of heterologous collagen and fibrin sealant for liver injuries

Hemostasis in complex liver injuries remains a problem despite improvements in operative techniques including debridement, suturing or packing. To evaluate fibrin sealant (FS), a new biodegradable hemostatic agent in combination with porcine collagen for sealing of liver injuries, three series of experiments were performed in 132 rats. In series I, 18 rats had a 10-mm in diameter and 2-mm in depth punch defect to the left lateral lobe. In the FS group (n = 9), bleeding was treated by insertion of an FS-soaked piece of collagen of equal size which was firmly attached to a plastic disk with wire anchor. In the control group (n = 9), collagen alone was inserted. Fifteen minutes after the insertion the lobe was excised and pull-off experiments were performed with simultaneous script chart recording. There was a highly significant difference in the adhesion to the liver surface (85.6 +/- 7.1 in the FS group versus 24.8 +/- 2.6 g/cm2 in the control group, P less than 0.001). In series II, 42 anticoagulated rats (Coumadin, PT 27.5% +/- 1.3) with lobectomy or liver rupture were placed in three groups (n = 14). Group I was treated with FS, group II with FS and collagen, and group III with catgut sutures which served as controls. Fourteen days later 12 rats of group I, 13 of group II, and 7 of group III were alive yielding 85.7, 92.8, and 50% overall survival rates, P less than 0.05 groups I and II versus group III. In series III, 72 non-anticoagulated rats were treated identically to series II and examined morphologically at 1, 7, 28, and 56 days.(ABSTRACT TRUNCATED AT 250 WORDS)