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Aprile V, Bacchin D, Calabrò F, Korasidis S, Mastromarino MG, Ambrogi MC, Lucchi M. Intraoperative prevention and conservative management of postoperative prolonged air leak after lung resection: a systematic review. J Thorac Dis 2023; 15:878-892. [PMID: 36910073 PMCID: PMC9992588 DOI: 10.21037/jtd-22-736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 02/06/2023] [Indexed: 02/28/2023]
Abstract
Background Prolonged air leak (PAL) due to an alveolar-pleural fistula (APF) is the most common complication after lung surgery. PAL is associated with an increased risk of morbidity and mortality, a longer chest tube duration, hence a prolonged hospitalization. Management of PAL may be challenging, and the thoracic surgeon should be aware of the possible therapeutic strategies. Methods A systematic literature review was performed in PubMed, Cochrane Library, EMBASE, Ovid and Google Scholar. Title, abstract and full-text screening was performed, followed by structured data extraction, methodological quality assessment and Cochrane risk of bias assessment. Inclusion criteria were: case-control studies/randomized controlled trials (RCTs) comparing the new tested method with the standard of care to manage PAL after lung surgery; PAL due to APF; at least 10 patients; English-written papers. Results A total of 942 initial papers from literature search, resulted in 43 papers after the selection. This systematic review found that the use of intraoperative measures as surgical sealants or pleural tenting, as well as a proper management of the chest drain and the use of blood patch or sclerosant agents seem to reduce postoperative air leaks incidence and/or duration and length of chest drain stay and hospitalization. Conclusions Different measures have been described in literature to manage or prevent postoperative PAL. Most of them seem to be safe and efficient if compared to the "wait and see" strategy, even if large comparative studies that standardize the intra- and post-operative management of APF after lung resection are lacking and, actually, hard to conceptualize. However, there is a large consensus on the value of a preoperative PAL-risk stratification and on the necessity of tailoring PAL management or prevention's strategy and its timing on each patient's features.
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Affiliation(s)
- Vittorio Aprile
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Diana Bacchin
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Fabrizia Calabrò
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Stylianos Korasidis
- Thoracic Surgery Unit, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | | | - Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Marco Lucchi
- Division of Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Thoracic Surgery Unit, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
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Gallyamov EA, Nikulin AV, Diduev GI, Malofei AM, Romanikhin AI, Surkov AI, Gvozdev AA, Fetlam DL. THE USE OF FIBRIN GLUE IN THE TREATMENT OF BRONCHIAL STUMP FAILURE AFTER LOWER LOBECTOMY ON THE RIGHT (A CLINICAL CASE). SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-3-49-55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite the constantly improving technique of operations, the use of modern suture materials and stitching-cutting devices, the problem of the occurrence of the failure of the bronchial stump remains unresolved. Many methods have been proposed for the treatment of bronchial stump failure, ranging from endoscopic mucosal coagulation and the installation of various types of occluders and ending with repeated surgical interventions. There are a huge number of publications devoted to the use of fibrin glue in various fields of medicine, for example, in neurosurgery, maxillofacial surgery, orthopedics, dentistry and thoracic surgery, fibrin glue is successfully used, including in the development of bronchial stump failure. This article presents a clinical observation of the use of fibrin glue in the treatment of bronchial stump failure after lower lobectomy on the right.
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Affiliation(s)
- E. A. Gallyamov
- City Clinical Hospital No. 23 named after I. V. Davydovsky of the Department of Health of the City of Moscow
| | - A. V. Nikulin
- City Clinical Hospital No. 23 named after I. V. Davydovsky of the Department of Health of the City of Moscow
| | - G. I. Diduev
- City Clinical Hospital No. 23 named after I. V. Davydovsky of the Department of Health of the City of Moscow
| | - A. M. Malofei
- City Clinical Hospital No. 23 named after I. V. Davydovsky of the Department of Health of the City of Moscow
| | - A. I. Romanikhin
- City Clinical Hospital No. 23 named after I. V. Davydovsky of the Department of Health of the City of Moscow
| | - A. I. Surkov
- City Clinical Hospital No. 23 named after I. V. Davydovsky of the Department of Health of the City of Moscow
| | - A. A. Gvozdev
- City Clinical Hospital No. 23 named after I. V. Davydovsky of the Department of Health of the City of Moscow
| | - D. L. Fetlam
- City Clinical Hospital No. 23 named after I. V. Davydovsky of the Department of Health of the City of Moscow
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Taniguchi Y, Matsubayashi Y, Ikeda T, Kato S, Doi T, Oshima Y, Okazaki H, Tanaka S. Clinical Feasibility of Completely Autologous Fibrin Glue in Spine Surgery. Spine Surg Relat Res 2022; 6:388-394. [PMID: 36051679 PMCID: PMC9381088 DOI: 10.22603/ssrr.2021-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Fibrin glue is widely used in spine surgery. Nevertheless, no report has demonstrated the feasibility of completely autologous fibrin glue (CAFG) in spine surgery. This study aims to investigate the safety, efficacy, and effect of bone fusion of CAFG on spine surgery. Methods We retrospectively extracted data of patients who underwent primary spine surgery with preoperatively prepared CAFG. Primary outcomes were the incidence of wound-related unplanned reoperations within 90 days following primary surgery and the occurrence of reoperation for the management of cerebrospinal fluid (CSF) leakage in patients who had been treated with CAFG used as dural sealants. The effect of CAFG on bone fusion was also assessed by detecting implant failure at one year postoperatively in patients aged 25 years or less undergoing primary fusion for idiopathic scoliosis. Results We identified 131 eligible patients (47 males and 84 females) with a mean age of 32.3 years. CAFG was used most frequently as an adhesive for fixation of graft bone (110 patients), followed by as a dural sealant for CSF leakage in 17 patients, and as a local hemostatic agent in four patients. Wound-related reoperations were identified in four patients (3.1%), which included three for surgical site infection, and one for postoperative epidural hematoma. There was no reoperation required for the management of CSF leakage among 17 patients with dural incision or incidental durotomy. Compared with the control cohort, the use of CAFG was not associated with early wound-related reoperations or implant failure in patients with spinal deformity. Conclusions We demonstrated the clinical feasibility of CAFG in spine surgery. The use of CAFG was not associated with the incidence of reoperations for wound-related complications. CAFG worked effectively as a dural sealant for preventing CSF leakage. CAFG had no beneficial or adverse effect on spinal bone fusion.
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Affiliation(s)
- Yuki Taniguchi
- Department of Orthopedic Surgery, The University of Tokyo Hospital
| | | | - Toshiyuki Ikeda
- Department of Blood Transfusion, The University of Tokyo Hospital
| | - So Kato
- Department of Orthopedic Surgery, The University of Tokyo Hospital
| | - Toru Doi
- Department of Orthopedic Surgery, The University of Tokyo Hospital
| | - Yasushi Oshima
- Department of Orthopedic Surgery, The University of Tokyo Hospital
| | - Hitoshi Okazaki
- Department of Blood Transfusion, The University of Tokyo Hospital
| | - Sakae Tanaka
- Department of Orthopedic Surgery, The University of Tokyo Hospital
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Montazerian H, Davoodi E, Baidya A, Baghdasarian S, Sarikhani E, Meyer CE, Haghniaz R, Badv M, Annabi N, Khademhosseini A, Weiss PS. Engineered Hemostatic Biomaterials for Sealing Wounds. Chem Rev 2022; 122:12864-12903. [PMID: 35731958 DOI: 10.1021/acs.chemrev.1c01015] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hemostatic biomaterials show great promise in wound control for the treatment of uncontrolled bleeding associated with damaged tissues, traumatic wounds, and surgical incisions. A surge of interest has been directed at boosting hemostatic properties of bioactive materials via mechanisms triggering the coagulation cascade. A wide variety of biocompatible and biodegradable materials has been applied to the design of hemostatic platforms for rapid blood coagulation. Recent trends in the design of hemostatic agents emphasize chemical conjugation of charged moieties to biomacromolecules, physical incorporation of blood-coagulating agents in biomaterials systems, and superabsorbing materials in either dry (foams) or wet (hydrogel) states. In addition, tough bioadhesives are emerging for efficient and physical sealing of incisions. In this Review, we highlight the biomacromolecular design approaches adopted to develop hemostatic bioactive materials. We discuss the mechanistic pathways of hemostasis along with the current standard experimental procedures for characterization of the hemostasis efficacy. Finally, we discuss the potential for clinical translation of hemostatic technologies, future trends, and research opportunities for the development of next-generation surgical materials with hemostatic properties for wound management.
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Affiliation(s)
- Hossein Montazerian
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States.,California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States.,Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Elham Davoodi
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States.,California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States.,Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States.,Multi-Scale Additive Manufacturing Lab, Mechanical and Mechatronics Engineering Department, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| | - Avijit Baidya
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Sevana Baghdasarian
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Einollah Sarikhani
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States
| | - Claire Elsa Meyer
- Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Reihaneh Haghniaz
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Maryam Badv
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States.,Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States.,Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Nasim Annabi
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States.,Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Paul S Weiss
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, California 90095, United States.,California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States.,Department of Chemistry and Biochemistry, University of California, Los Angeles, Los Angeles, California 90095, United States.,Department of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
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