Adhesives Tissue

A complete discussion on adhesives and sealants for medical applications and sutureless surgery is not possible in this report, but the author recommends a review of the proceedings from the Surgical Applications of Tissue Sealants and Adhesives presented in New Orleans on October 6-7,2001 (see References Section). In addition, the Tissue Sealant and Adhesive 6th, 7 and 8th Annual Conferences sponsored by the Cambridge Healthtech Institute are excellent sources of information. 

The interactions of components of soft tissue within themselves as shown in Figs. 3.4 and 3.5 are indicative of the noncovalent bonds that must be formed between synthetic polymeric wound dressings and soft tissue in order to form a bond between tissues surfaces. 

Biocompatible Polymeric Materials and Tourniquets for Wounds, Topics in Applied Chemistry, DOI 10.1007/978-l-4419-6586-8 3, 

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The extent to which these new tissue adhesives and hemostats will influence surgical procedures can be seen in the following analogy. An effective carpenter cannot create a masterpiece without a saw to cut wood, nails to ensure local fixation of separate pieces of wood, and glue to cause broad surface apposition between wood surfaces. Similarly, the surgeon presently uses a scalpel to cut and divide tissues as well as a suture to create local fixation of tissues, but until... 

Presently approved new tissue adhesives and hemostatic agents... 

Components/ mechanism of action Light-activated polyethylene-glycol (PEG) polymer sealant for lung tissue. Monomeric (2-octyl cyanoacrylate) formulation tissue adhesive for skin closure. Bovine albumin cross-linked with gluteraldehyde tissue adhesive/sealant. 

In the following sections, a variety of different applications for tissue adhesives and hemostats will be reviewed and specific new agents presently available for clinical use will be discussed. 

At present there is only one commercially available tissue adhesive with approved on-label indications for skin closure. 2-Octyl-cyanoacrylate (Dermabond, Ethicon, Inc., Somerville, NJ) is presently indicated for skin closure in wounds which are not under extreme tension. This tissue adhesive is approved for topical skin application only. It is not indicated for internal use. The material is useful in closing traumatic skin lacerations [4,5] after wounds have been thoroughly cleaned as well as for minimally invasive surgical incisions and even larger surgical incisions in elective cases. The cyanoacrylate is applied while the skin... 

None of the other presently available tissue adhesives are approved for skin closure and their use in this setting is not presently recommended. 

There are a number of tissue adhesives currently approved as adjuncts to hemostasis. Each agent has specific properties which enhance intraoperative hemostasis in particular situations. All forms of surgical bleeding are not alike. Bleeding can be fast or slow, diffuse or punctate, arterial or venous, capillary or larger vessel. Thus one agent may be more efficacious than another in a specific clinical situation. 

This agent was approved by the FDA in May of 2000 and is the first tissue adhesive to be specifically approved for use on lung parenehyma. It is extremely strong and has excellent adherence strength on the surface of the lung. Approval... 

Meticulous care needs to be used in the application of this tissue adhesive. Only a very thin layer of adhesive should be used to assist with reapproximation of the intima and adventitia. It is important to remember that the material should not be allowed to drip into or onto critical areas such as the ostium of the coronary arteries. Inadvertent placement of this agent in such areas can result in blockage of a critical artery and a potentially fatal myocardial infarction. In addition. 

Substances which function as tissue adhesives have the unique ability to remain in contact with tissues in localized areas for prolonged periods of time. Not only does the tissue adhesive function as a glue but it has the capacity to serve as a slow release mechanism for drug delivery as it is biodegraded. 

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., History of tissue adhesives. In Sierra, D. and Saltz, R. (Eds.), Surgical Adhesives and Sealants, Current Technology and Applications. Technomic, Lancaster, PA, 1996, pp. 3-11. 

Quinn, J., Drzewiecki, A., Li, M., Stiell, I., Sutcliffe, T., Elmsiie, T. and Wood, W., A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Ann. Emerg. Med., 22, 1130-1135 (1993). 

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). 

The final section in this volume deals with applications of adhesion science. The applications described include methods by which durable adhesive bonds can be manufactured by the use of appropriate surface preparation (Davis and Venables) to unique methods for composite repair (Lopata et al.) Adhesive applications find their way into the generation of wood products (Dunky and Pizzi) and also find their way into the construction of commercial and military aircraft (Pate). The chapter by Spotnitz et al. shows that adhesion science finds its way into the life sciences in their discussion of tissue adhesives. 

Prior to immunohistochemical staining, paraffin sections must be properly mounted onto slides, and then deparaffinized and rehydrated. To help adherence to the glass and decrease the chances of sections dissociating from the slides, paraffin tissue sections should be mounted on tissue-adhesive-coated slides. The use of tissue-adhesive-coated slides is especially important for paraffin tissue sections undergoing heat-induced antigen retrieval (see Sect. 6.1.1). 

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