Fibrin adhesives

Side effects Side effects such as erosions, superficial ulceration or mucosal necrosis can be expected in > 80% of cases. Sucralfate, cimetidine, ranitidine and omeprazole (116) as well as fibrin adhesive have been used both for prevention and to promote healing. From a morphological viewpoint, these inflammatory tissue reactions are to a certain extent necessary to induce thrombosis and vessel wall fibrosis. Fever, leucocytosis, chest pain and tension occur as frequent yet usually insignificant concomitant reactions. Dysphagia or dysfunction of the oesophagus are of no clinical significance. The develop-... 

Direct fibrin adhesive injection during balloon inflation across neck [130]... 

Matson MB, Morgan RA, Belli AM (2001) Percutaneous treatment of pseudoaneurysms using fibrin adhesive. Br J Radiol 74 690-694... 

Dahlstrom, M.D., Weis-Fogh, U.S., Medgyesi, S., Rostgaard, J. and Sorensen. H. (1992) The use of autologous fibrin adhesive in skin transplantation. Plast. Recon.sti Siirg., 89, 968-972. 

In vivo, a complete coverage of the surface of nonwoven P3HB patches with endothelial-hke cells without any platelet or fibrin adhesions was reported from a 12-month study of closure of an atrial septal defect in sheep [ 144]. No platelet aggregates were seen and fibrin rarely observed on the patch surface in a 24-month study on the right ventricular outflow tract of sheep [145]. 

Fibrin adhesives have been used for longer than any other tissue adhesive, being first applied in the mid-twentieth century, although they were not sold commercially until 1978. Frequently referred to as fibrin sealants as their ability to seal leaks is more significant than their mechanical strength, they are widely used in a variety of surgical procedures, and more so in recent years after the approval by the US FDA of one product in 1998 for certain indications and a second product in 2003 (Spotnitz et al. 2005). 

Schematic of the formation of fibrin adhesive from its ingredients. This occurs in-situ at the time of use...

As a pure biological adhesive resembling blood clots, the fibrin adhesive is able to break down naturally in the body on a timescale resembling that for the tissue to heal (Lontz et al. 

Since the bond strength of fibrin adhesives to tissue is not very high (Chivers and Wolowacz... 

Akhtar has put forth contradictory studies regarding the toxicity and long-term effects of CA. He cites that Barbalinardo et al. compared relative effectiveness of isobutyl-2-cyanoacrylate, fibrin adhesive, and oxidized regenerated cellulose by the application of these hemostatic agents to sources of point bleeding. They found in the meantime that... 

Barbalinardo RJ, Citrin R Franco CD, Hobson II RW. A comparison of isobutyl 2 ecyanoacrylate glue, fibrin adhesive and oxidized regenerated cellulose for control of needle hole bleeding from polytetrafluoro-ethylene vascular prostheses. J Vase Surg. 1986 4 220-223. 

Fig. 2. Fibrin sealant spray application at site of left ventricular aneurysm repair to facilitate hemostasis (arrow points to adhesive).

Fig. 4. Application of fibrin sealant (arrow points to spray head for applying two-component adhesives) at the time of mastectomy and axillary dissection to reduce seroma formation.

The most extensive experience with tissue adhesive drug delivery exists in the fibrin sealant literature. This is clearly an off-label use of this agent as it is only currently approved for hemostasis in cardiac and splenic trauma surgery and for colon sealing at the time of colostomy closure. 

Levy, O.L.. Martinowilz, U., Oran, A., Tauber, C. and Horoszowski, H., The use of fibrin tissue adhesive to reduce blood loss and the need for blood transfusion after total knee arthroplasty a prospective, randomized, mullicenter study. J. Bone Joint Surg.. 81A. 1580 (1999). 

Siedentop, K., Harris, D., Ham, K. and Sanchez, B., Extended experimental and preliminary surgical findings with autologous fibrin tissue adhesive made from patient s own blood. Laryngoscope, 96, 1062-1064 (1986). 

MacPhee, M., Singh, M., Brady, R., Akhyani, N., Liau, G., Lasa, C., Hue, C., Best, A. and Drohan, W. Fibrin sealant A versatile delivery vehicle for drugs and biologies. In Sierra, D. and Sallz, R. (Eds.), Surgical Adhesives and Sealants. Current Technology and Applications. Technomic, Lancaster, PA, 1996, pp. 109-120. 

Figure 48-3. Schematic representation of fibronectin. Seven functional domains of fibronectin are represented two different types of domain for heparin, cell-binding, and fibrin are shown. The domains are composed of various combinations of three structural motifs (I, II, and III), not depicted in the figure. Also not shown is the fact that fibronectin is a dimer joined by disulfide bridges near the carboxyl terminals of the monomers. The approximate location of the RGD sequence of fibronectin, which interacts with a variety of fibronectin integrin receptors on cell surfaces, is indicated by the arrow. (Redrawn after Yamada KM Adhesive recognition sequences.

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