Tissue adhesives surgery

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. 

The alkylcyanoacrylates are biodegradable polymers which have been used as tissue adhesives in surgery (Woodward et al, 1965) and have been... 

Aveiy, B.S. and Ord, R.A. (1982) The use of butt lcyanoacrylate as a tissue adhesive in maxillo-facial and cranio-fadal surgery. British J. Oral Surg., 20, 84-95. 

Silver halide fibers are used by the Katzir group in a fiber-based laser welding system [33,34] used to weld tissue after surgery and intended to replace sutures. It can be water tight and less sensitive to infection. In this system one fiber is transmitting CO2 laser radiation to heat albumin, which plays the role of a biological adhesive, and another fiber collects the thermal radiation from the surface and records the temperature of the area. This is a feedback mechanism to keep the temperature at the right level. 

When the horn of the uterus, body tendons, and intestinal are damaged, tissue adhesion often results. (See Table 3 for data on adhesion preventative membranes for several types of surgery.) In order to prevent this phenomenon, a viscous polymer aqueous solution, sihcone sheet, poly(4-fluoroethylene) sheet, amnion, regenerated collagen membrane, and an oxidized cellulose cloth have all been used. However, none of these methods provide satisfactory results. Unsatisfactory results probably occur as a result of blood clot formation, tissue damage Ifom remaining materials, premature absorption by the body, lack of flexibility, and... 

Anti-adhesive materials have been developed to prevent tissue adhesion by providing a physical barrier between an injured site and the adjacent tissues. Although several non-absorbable synthetic materials such as silicone and PTFE have been shown to be effective, bioabsorbable materials are preferred because of the lack of necessity of secondary surgery to remove non-absorbable materials and the lack of need to consider long-term biocompatibihty such as encapsulation of the material, which will also evoke tissue adhesion. Moreover, non-absorbable synthetic materials have been shown to form adhesions on long-term application [99]. A wide variety of substances and materials have been used over the years. Commercially available anti-adhesive products are summarized in Table 8.7. 

Another commonly-used bioabsorbable sheet is Interceed for applications in gynecologic pelvic surgery. It is a knitted fabric of oxidized regenerated cellulose which slowly turns into a gel when placed on tissues. Unlike Seprafilm , Interceed is easy to handle and can be placed via laparoscopy. It has been reported that Interceed prevents tissue adhesion effectively when blood contamination is avoided during application of it [135]. However, as complete blood evacuation is not always possible in chnical situations, surgeons are not keen to use this product. Moreover, increased adhesion formation has been observed when Interceed is applied to areas where blood accumulation cannot be prevented [136]. 

Fibrin has a particular use in suture-less surgery. Reeent developments have established fibrin glue for tissue adhesives as attractive alternatives to sutures. The current available information on fibrin glue is discussed by Panda et... 

Bitton R, Bianco-Peled H (2008) Novel biomimetic adhesives based on algae glue. Macromol Biosci 8 393-400 Braunwald NS, Gay W, Tatooles CJ (1966) Evaluation of crosslinked gelatin as a tissue adhesive and hemostatic agent an experimental study. Surgery 60 857-861... 

Use of Tissue Adhesive for Skin Ciosure in Piastic Surgery... 

Yoo J, Chandarana S, Coshy R. Chnieal apph-eation of tissue adhesives in soft-tissue surgery of the head and neek. Curr Opin Otolaryngol Head Neck Surg. 2008 16 312-317. 

Roberts AC. The tissue adhesive indermil and its use in surgery. Acta ChirPlast. 1998 40 22-25. 

After the surgery, Maureen applies Indermil, which is a type of liquid bandage, to Robert s incision sites. Liquid bandages are tissue adhesives that seal surgical or wound incisions on a patient. Stitches and staples are not required and scarring is minimal. The polymer in a liquid bandage is typically dissolved in an alcohol-based solvent. The alcohol also acts as an antiseptic. 

Nahas FX, Solia D, Ferreira LM, Novo NF. The use of tissue adhesive for skin closure in body contouring surgery. Aesth Plast Surg 2004 28 165-9. 

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