Fibrin sealants

Product name (Generic, Trade Names, Manufacturer/ Distributor) Fibrin Sealant, Hemaseel APR, Haemacure, Tisseel VH, Baxter Healthcare Platelet Gel, Medtronic Harvest Technologies, and others Collagen Enhanced Fibrin Sealant, CoStasis, Cohesion Technologies, US Surgical Collagen -F Thrombin, FloSeal, Fusion Medical, Proceed Sulzer Medica... 

Fibrin sealant, thrombin and collagen, fibrin sealant plus collagen, and platelet gels... 

In 1998, the FDA approved fibrin sealant for three specific indications. These include hemostasis at the time of cardiac surgical operations [8] (Fig. 2) as well as at the time of operative procedures to treat splenic trauma. The application of the fibrin sealant which consists of normal biologic components in the body s clotting cascade creates a localized clot which further enhances inherent clotting ability. Although approved for these specific hemostatic indications only, fibrin sealant is useful as a hemostat in a wide variety of off-label clinical situations as well [9,10]. These include such applications as hemostasis for liver trauma or resection [11], vascular anastomoses [12], tonsillectomy [13], peripheral joint replacement [14], dental extractions [15], and bum debridement [16]. 

There is a learning curve associated with the use of fibrin sealant and the application devices which are used to apply the agent can significantly influence... 

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

Prior to May of 1998 when the commercial product was approved by the FDA in the United States, surgeons in this country formed fibrin sealant by using topical bovine thrombin, which is a commercially available product, together with concentrated fibrinogen most frequently obtained from the blood bank. Standard blood bank cryoprecipitate is a good source of concentrated fibrinogen. Also... 

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. 

Spotnitz, W.D., Falstrom, J.K. and Rodeheaver, G.T., The role of sutures and fibrin sealant in wound healing. In Barbul, A. (Ed.), Surgical Clinics of North America — Wound Healing. W.B. Saunders, London, 1997, pp. 1-19. 

Spotnitz, W.D., Fibrin sealant in the United Stales Clinical use at the University of Virginia. Thromb. Haemost., 74,482-485 (1995). 

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. 

Moore, M.M., Nguyen, D.H.D. and Spotnitz, W.D., Fibrin sealant reduces serous drainage and allows earlier drain removal after axillary dissection a randomized prospective trial. Am. Surg., 63, 97-102 (1997). 

Moore, M., Burak Jr., W., Nelson, E., Kearney, T., Simmons, R., Mayers, L. and Spotnitz, W., Fibrin sealant reduces the duration and amount of fluid drainage after axillary dissection A randomized prospective clinical trial. J. Am. Coll. Surg., 192. 591-599 (2001). 

Matthew, T.L., Spotnitz, W.D., Daniel, T.M. and Kion, I.L., Closure of small bronchopleural fistulas using fibrin sealant through the flexible fiberoptic bronchoscope. Chest, 94, 77S (1988). 

Wang, J., Neisley, H., Moody, D., Dobraz, J., Spotnitz, W.D. and Rodeheaver, G., Fibrin sealant delivery system increases the effectiveness of silver sulfadiazine. Surg. Forum L, 624-626(1999). 

Other Fibrin sealant TISSEEL VH Kit Four vials in different sizes IV NA... 

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