Treatment of grade 4 renal stab wounds with absorbable fibrin adhesive bandage in a porcine model

PURPOSE

In a porcine model we evaluated the efficacy of the absorbable fibrin adhesive bandage and other novel fibrin products for treating major renal stab wounds.

MATERIALS AND METHODS

In commercial swine we produced an almost lethal, grade 4 renal stab wound via a 3.5 cm. sagittal, centrally located, through-and-through laceration. Each pig then received treatment in random fashion, including conventional oversewing of capsular defects with absorbable gelatin sponge and horizontal mattress sutures in 6, external absorbable fibrin adhesive bandage that was pressure held for 60 seconds in 6, external and internal absorbable fibrin adhesive bandage that was applied externally, inserted into the renal defect and pressure held for 60 seconds in 6, liquid fibrin sealant that was placed in the laceration and held for 60 seconds in 8, fibrin foam that was applied in the same manner as liquid fibrin in 5 and closing of the peritoneum over the lacerated kidney without further treatment in 6. Blood loss and time to hemostasis were recorded. Animals were sacrificed at 6 weeks to evaluate the injured renal unit.

RESULTS

Compared with conventional therapy the absorbable fibrin adhesive bandage applied externally alone or externally and internally resulted in significantly less bleeding and significantly less time to hemostasis (p <0.001). Liquid fibrin and fibrin foam did not reliably achieve hemostasis. Postoperatively computerized tomography and histological sectioning suggested that the absorbable fibrin adhesive bandage results in a stable, durable clot and healing is at least as successful as with conventional treatment.

CONCLUSIONS

The absorbable fibrin adhesive bandage appears to be a safe, rapid means of renal salvage after injury.

Does the absorbable fibrin adhesive bandage facilitate partial nephrectomy?

PURPOSE

To evaluate the ability of the absorbable fibrin adhesive bandage (AFAB), a prototype product comprising lyophilized fibrinogen and thrombin on a VicrylTM mesh backing, to seal the collecting system and control bleeding after partial nephrectomy.

MATERIALS AND METHODS

Growing female pigs (n = 18) underwent left nephrectomy and a 40% (by length) right lower pole partial nephrectomy. One of three treatments was immediately applied: Conventional-closure of the collecting system, ligation of visible segmental vessels, application of SurgicelTM with bolstering sutures to the renal capsule; AFAB-application of up to two 4 x 4-inch AFABs held under pressure for 60 seconds; Placebo-application of a hemostatically inert VicrylTM bandage, visually identical to the AFAB. Blood loss and ischemic and total operative times were recorded, and abdominal computerized tomography (CT) was performed on postoperative day 6. Animals were sacrificed at 6 weeks to evaluate the remaining renal mass histologically.

RESULTS

Compared with conventional therapy, use of the AFAB resulted in significantly less bleeding (13 versus 68 ml., p <0.001) and lower operative (7.2 versus 16.3 minutes, p <0.001) and ischemic times (3.4 versus 7.8 minutes, p <0.001). Estimated blood loss in the placebo bandage group was dramatically higher (357 ml., p <0.001). Postoperative CT and histological sectioning suggested that the AFAB produces a stable, durable clot and that healing is at least as successful as with conventional treatment.

CONCLUSION

Use of the AFAB facilitated performance of partial nephrectomy by reducing blood loss and ischemic and total operative times. The AFAB appears equivalent to conventional surgery in its ability to seal the collecting system.

Role of cytokines in the restoration of the delayed-type hypersensitivity reaction of anergic patients

Soluble mediators from peripheral blood lymphocytes activated either by skin test antigens or by alloantigens restored the delayed type hypersensitivity (DTH) reaction in the majority of anergic surgical patients who are at increased risk for sepsis and mortality. Antigen had to be injected together with the mediators and the individual had to be reactive to the antigen for restoration. These results suggest that restoration of the DTH response depends on the ability of cytokines produced and acting in a non-specific manner to promote the response of the anergic patients' specific antigen-sensitive cells to antigen.