Treatment of corneal dermoid with lenticules from small incision lenticule extraction surgery:a surgery assisted by fibrin glue

AIM:To observe the clinical efficacy of the combined use of small incision lenticule extraction(SMILE)-derived lenticule patches in corneal dermoid excision,with fixation of the lenticule patches assisted by fibrin glue.METHODS:Seventeen eyes of 17 patients with corneal dermoid were treated with dermoid removal combined with SMILE-derived lenticule transplantation.All lenticule patches were fixed by fibrin glue.Ocular changes were assessed using slit lamp microscopy and anterior-segmental optical coherence tomography.The best-corrected visual acuity(BCVA)and ocular dioptric variations were examined preoperatively and postoperatively.Intraocular pressure(IOP)was also monitored in all visited time.RESULTS:Totally,18 lenticule patches were used on 17 eyes of 17 cornea dermoid patients.The mean follow-up time was 11.47±5.28mo.All lenticule patches we resuccessfullyg lued,kept on its location and maintained transparent during the follow-up time,with a consecutive epithelial cover for 1wk.Nine of the patients could coordinate visual and optometry exam well.Their preoperative BCVA is 0.60±0.35 in decimal,significantly improved to 0.80±0.26 in decimal at 6mo postoperatively(Z=-2.392,P=0.017),but the changes of their corneal astigmatism diopters showed no significance,with 2.22±1.91 D preoperatively,and 2.28±1.31 D at 6mo postoperatively(Z=-0.135,P=0.893).Limbal pannus formation occurred in 4(23.52%)cases and decreased with the application of tacrolimus eyedrops.IOP increased in 2(11.76%)cases,but well decreased by timolol maleate eyedrops.All the adult patients or guardians of minor patients were satisfied with the cosmetic improvement.CONCLUSION:Dermoid excision combined with transplantation of SMILE-derived lenticule patches using fibrin glue is a safe and effective novel tectonic keratoplasty procedure for corneal dermoid.

Common bile duct injury by fibrin glue: Report of a rare complication

Fibrin glue is widely used in clinical practice and plays an important role in reducing postoperative complications.We report a case of a 65-year-old man, whose common bile duct was injured by fibrin glue, with a history of failed laparoscopic cholecystectomy and open operation for uncontrolled laparoscopic bleeding.In view of thepersistent liver dysfunction, xanthochromia and skin itching, the patient was admitted to us for further management.Ultrasound, computed tomography, and magnetic resonance cholangiopancreatography(MRCP) revealed multiple stones in the common bile duct, and liver function tests confirmed the presence of obstructive jaundice and liver damage.Endoscopic retrograde cholangiopancreatography was unsuccessfully performed to remove choledocholithiasis, but a small amount of tissue was removed and pathologically confirmed as calcified biliary mucosa.This was followed by open surgery for suspicious cholangiocarcinoma.There was no evidence of cholangiocarcinoma, but the common bile duct wall had a defect of 8 mm × 10 mm at Calot's triangle.A hard, grid-like foreign body was removed, which proved to be solid fibrin glue.Subsequently, the residual choledocholithiasis was removed by a choledochoscopic procedure, and the common bile duct deletion was repaired by liver round ligament with T-tube drainage.Six months later, endoscopy was performed through the T-tube fistula and showed a well-repaired bile duct wall.Eight months later, MRCP confirmed no bile duct stenosis.A review of reported cases showed that fibrin glue is widely used in surgery, but it can also cause organ damage.Its mechanism may be related to discharge reactions.

Sealing of the hepatic resection area using fibrin glue reduces significant amount of postoperative drain fluid

AIM: To investigate whether the routine use of fibrin glue applied onto the hepatic resection area can diminish postoperative volume of bloody or biliary fluids drained via intraoperatively placed perihepatic tubes and can thus lower the complication rate.METHODS: Two groups of consecutive patients with a comparable spectrum of recent hepatic resections were compared: (1) 13 patients who underwent application of fibrin glue immediately after resection of liver parenchyma;(2) 12 patients who did not. Volumes of postoperative drainage fluid were determined in 4-h intervals through 24 h indicating the intervention caused bloody and biliary segregation.RESULTS: Through the first 8 h postoperatively, there was a tendency of higher amounts of fluids in patients with no additional application of fibrin glue while through the following intervals, a significant increase of drainage volumes was documented in comparison with the first two 4-h intervals, e.g., after 12 h, 149.6 mL +/-110 mL vs 63.2 mL +/-78 mL. Using fibrin glue, postoperative fluid amounts were significantly lower through the postoperative observation period of 24 h (851 mL +/-715 mL vs 315 mL +/-305 mL).CONCLUSION: For hepatic resections, the use of fibrin glue appears to be advantageous in terms of a significant decrease of surgically associated segregation of blood or bile out of the resection area. This might result in a better outcome.

Tulip bundle technique and fibrin glue injection:Unusual treatment of colonic perforation

We report a case of a 63-year-old male who experienced an iatrogenic sigmoid perforation repaired combining three endoscopic techniques.The lesion was large and irregular with three discrete perforations,therefore,we decided to close it by placing one clip per perforation,and then connecting all the clips with two endoloops.Finally we chose to use a fibrin glue injection to obtain a complete sealing.Four days after the colonoscopy the patient underwent a laparoscopic right hemicolectomy due to evidence of a large polyp of the caecum with high grade dysplasia and focal carcinoma in situ.Inspection of the sigma showed complete repair of the perforation.This report underlines how a conservative approach,together with a combination of various endoscopic techniques,can resolve complicated iatrogenic perforations of the colon.

Biocompatibility Studies on Fibrin Glue Cultured with Bone Marrow Mesenchymal Stem Cells in Vitro

Summary: By culturing bone marrow mesenchymal stem cells of rabbits with fibrin glue in vitro, the biocompatibility of fibrin glue was investigated to study whether this material can be used as scaffolds in bone tissue engineering. After 2-months old New Zealand rabbits had been anesthetized, about 4-6 ml of bone marrow were aspirated from rabbit femoral trochanter. The monocytes suspension was aspirated after bone marrow was centrifuged with lymphocyte separating medium and cultured primarily. Then the cells were divided into two groups: one was cultured with complete medium and the other with induced medium. The cells of the two groups were collected and inoculated to the culture plate containing fibrin glue. In the control group, cells were inoculated without fibrin glue. The implanted cells and materials were observed at different stages under a phase-contrast microscope and scanning electron microscope. MTT and alkaline phosphatase (ALP) were measured. Bone marrow mesenchymal stem cells grew on the surface of fibrin glue and adhered to it gradually. Cells light absorption value (A value) and the ALP content showed no significant difference. Fibrin glue had no inhibitory effect on cell morphology, growth, proliferation and differentiation. It has good biocompatibility and can be used as scaffold materials for bone marrow mesenchymal stem cells in bone tissue engineering.

A Heterologous Fibrin Glue Enhances the Closure Effect of Surgical Suture on the Repair of Annulus Fibrous Defect in a Sheep Model

Improving the closure effect of surgical suture for repair of annulus fibrosus defects remains an unsolved problem.A new type of porcine fibrin glue was reported for the repair of annulus fibrous defects in sheep models in this study.Continuous axial loading test showed that this glue could effectively improve the closure effect of surgical suture for annulus fibrous defect.Magnetic resonance imaging (MRI) of the lumbar spine confirmed that,compared with nonfibrin glue treated intervertebral discs,it contributed to preservation of the nucleus pulposus and maintained the physiological hydration of the intervertebral discs.Moreover,histomorphology evaluation showed that the porcine fibrin glue could partially reverse degeneration of the injured intervertebral discs.Taken together,porcine fibrin glue can effectively enhance the closure effect of surgical suture on annulus fibrosus,improve the repair effect and slow down the degeneration of the intervertebral disc,and provide a potential therapeutic strategy for degenerative intervertebral disc disease.

Endoscopic fibrin glue injection for closure of pancreatocutaneous fistula following transgastric endoscopic necrosectomy

Transgastric endoscopic necrosectomy has been recently introduced as the effective and alternative management of infected pancreatic necrosis and pancreatic abscess. However,up to 40% of patients who undergo endoscopic necrosectomy may need an additional percutaneous approach for subsequent peripancreatic fluid collection or non-resolution of pancreatic necrosis. This percutaneous approach may lead to persistent pancreatocutaneous fistula,which remains a serious problem and usually requires prolonged hospitalization,or even open-abdominal surgery. We describe the first case of pancreatocutaneous fistula and concomitant abdominal wall defect following transgastric endoscopic necrosectomy and percutaneous drainage,which were endoscopically closed with fibrin glue injection via the necrotic cavity.

Fibrin glue repair leads to enhanced axonal elongation during early peripheral nerve regeneration in an in vivo mouse model

Microsurgical suturing is the gold standard of nerve coaptation. Although literature on the usefulness of fibrin glue as an alternative is becoming increasingly available, it remains contradictory. Furthermore, no data exist on how both repair methods might influence the morphological aspects（arborization; branching） of early peripheral nerve regeneration. We used the sciatic nerve transplantation model in thy-1 yellow fluorescent protein mice（YFP; n = 10）. Pieces of nerve（1cm） were grafted from YFP-negative mice（n = 10） into those expressing YFP. We performed microsuture coaptations on one side and used fibrin glue for repair on the contralateral side. Seven days after grafting, the regeneration distance, the percentage of regenerating and arborizing axons, the number of branches per axon, the coaptation failure rate, the gap size at the repair site and the time needed for surgical repair were all investigated. Fibrin glue repair resulted in regenerating axons travelling further into the distal nerve. It also increased the percentage of arborizing axons. No coaptation failure was detected. Gap sizes were comparable in both groups. Fibrin glue significantly reduced surgical repair time. The increase in regeneration distance, even after the short period of time, is in line with the results of others that showed faster axonal regeneration after fibrin glue repair. The increase in arborizing axons could be another explanation for better functional and electrophysiological results after fibrin glue repair. Fibrin glue nerve coaptation seems to be a promising alternative to microsuture repair.

Successful management of chylous ascites with total parenteral nutrition,somatostatin,and fibrin glue

Chylous ascites, an uncommon disease usually caused by obstruction or rupture of the peritoneal or retroperitoneal lymphatic glands, is defined as the accumulation of chyle in the peritoneal cavity. It is a difficult management problem due to the serious mechanical, nutritional, and immunological consequences of the constant loss of protein and lymphocytes. Most investigators believe that the incidence of chylous ascites is increasing because of more aggressive thoracic and retroperitoneal surgery and also because of the prolonged survival of patients with cancer. Although the incidence of chylous ascites has increased in recent years, treatment remains unsatisfactory. The standard conservative treatments include paracentesis, a medium chain triglyceride （MCT） based diet, total parenteral nutrition （TPN）, and recently recommended somatostatin, are preferable in most cases, but usually need several weeks to cure chyloperitonum. Open or laparoscopic ligation of ruptured lymph ducts, a commonly used procedure for persistent chylous ascites, may fail in patients without visible chylous leak. Fibrin glue, a widely used approach to treat various kinds of fistulae, has recently been reported to seal chylous leak during operation. Here we present two cases of chylous ascites who were successfully treated with fibrin glue in different settings.

Perivenous application of fibrin glue prevents the early injury of jugular vein graft to arterial circulation in rabbits

Background Placement of an external support has been reported to prevent intimal hyperplasia of vein grafts. However, it is limited by potential complications. In the present study, we investigated the effect of fibrin glue on preventing vein graft failure as perivenous application. Methods Twenty-four rabbits were divided into non-supported group （n=12） and fibrin glue group （n=12）. All animals underwent unilateral jugular vein into common carotid artery interposition grafting and then fibrin glue was applied as perivenous support. Samples of tissues were harvested after 4 weeks. Results The vein grafts with fibrin glue demonstrated a statistically significant decrease in proliferating cell nuclear antigen in the medial/intimal region [13.38% （11.26%-15.11%）] compared with non-supported vein grafts [31.22% （27.15%-35.98%）] （P〈0.001）. Light microscopy showed remarkable attenuation of endothelial cell loss and numerous microvessels in neoadventitia in the fibrin glue group compared with the non-supported group. The smooth muscle cells migrated into adventitia significantly in fibrin glue group, whereas the smooth muscle ceils migrated into intima in non-supported group. Conclusion Perivenous support of vein graft with fibrin glue in vivo can attenuate the severe injury encountered in the non-supported vein grafts exposed to artery.

Biocompatibility, biodegradation, and neovascularization of human single-unit platelet-rich fibrin glue： an in vivo analysis

Background The clinical applications of fibrin glue span over several surgical modalities.The aim of this study was to evaluate the biocompatibility and biodegradation of different formulations of platelet-rich fibrin glue in vivo and examine its effects on the neovascularization of wound sites.Methods Human-derived single-unit fibrin glue was prepared.Incisions were made on the backs of rats,and these were coated with homemade glues containing different concentrations of aminomethylbenzoic acid （Groups A-F） or commercial adhesives （Group G）.A sham control group was included （Group H）.The wounds were examined by histological analysis and immunohistochemistry at several time points.Results Successful wound closure was achieved in all groups by day 12.Acute inflammation occurred during the first six days,but gradually disappeared.The longest sealant duration was achieved using the lowest concentration of antifibrinolytic agent in a 1：10 volume ratio with cryoprecipitate.Expression levels of the platelet endothelial cell adhesion molecule-1 were significantly higher in Groups A and C compared to the control groups （Groups G and H） on day 3 （P ＜0.05）.Conclusions Single-unit platelet-rich fibrin glue has excellent biocompatibility and is associated with the upregulation of neovascularization.The addition of aminomethylbenzoic acid could prevent the degradation of fibrin glue.

Fibrin glue-assisted for the treatment of corneal perforations using glycerin-cryopreserved corneal tissue

AIM: To evaluate the outcomes and safety of lamellar keratoplasty(LK) assisted by fibrin glue in corneal perforations. ·METHODS: Six eyes of 6 patients affected by different corneal pathologies(2 posttraumatic corneal scar and 3 bacterial keratitis) underwent LK procedures by using fibrin glue. The mean corneal perforation diameter was 1.35 ±0.64mm(range,0.7-2.5mm),and the greatest diameter of the ulcerative stromal defect was 2.47 ± 0.77mm in average(range,1.5-3.5mm). The donor corneal lamella diameters were 0.20-mm larger and thicker than the recipient to restore a physiologic corneal thickness and shape: mean donor diameter was 8.34 ± 0.28mm(range,8.2-8.7mm) and mean thickness was 352±40.27mm(range,220-400mm). Mean follow-up was 7.33±1.97 months(range,6-11 months). Postoperatively,the graft status,graft clarity,anterior chamber response,the visual prognosis,intraocular pressures,and postoperative complications were recorded. ·RESULTS:Allthecornealperforationsweresuccessfully healed after the procedure. The best-corrected visual acuity(BCVA) ranged from 20/1 000 to 20/50 in their initial presentation,and from 20/100 to 20/20 in their last visit,showed increase in all the patients. No major complications such as graft dislocation and graft failure were noted. Neovascularization developed in the superficial stroma of donor graft in 1 case. High intraocular pressure developed on day 2 after surgery,while was remained in normal range after application of anti-glaucomatous eyedrops for 1 week in 1 case. ·CONCLUSION: Fibrin glue-assisted sutureless LK is valuable for maintaining the ocular integrity in the treatment of corneal perforations.

腰大池引流联合生物蛋白胶黏贴肌瓣治疗骶管囊肿的疗效分析

目的探讨腰大池引流联合生物蛋白胶黏贴肌瓣治疗骶管囊肿的疗效分析.方法回顾性分析2018年1月至2023年6月收治的82例症状性骶管囊肿患者的资料,均行腰大池引流联合生物蛋白胶黏贴肌瓣治疗骶管囊肿.结果所有患者均顺利完成手术并完成随访,随访时间6-14个月,平均10个月.采用日本骨科学会(JOA)和疼痛视觉模拟评分(VAS)评估患者术后3、6个月的神经功能改善情况,JOA评分术前(16.09±1.91)分,术后升至(23.09±1.77)分,差异具有统计学意义(t=-40.75,P<0.05).VAS评分术前(5.52±1.28)分,术后降至(2.22±0.83)分,差异有统计学意义(t=31.023,P<0.05).疼痛消失38例(46.34%),改善36例(43.90%),无变化5例(6.10%);感觉障碍消失19例(23.17%),改善26例(31.71%),无变化6例(7.32%);下肢无力消失2例(2.44%),改善5例(6.10%),无变化2例(2.44%);排便障碍消失6例(7.32%),改善15例(18.29%),无变化4例(4.88%);排尿障碍消失6例(7.32%),改善13例(15.85%),无变化4例(4.88%);性功能障碍消失0例(0.00%),改善2例(2.44%),无变化3例(3.66%).结论腰大池引流联合生物蛋白胶黏贴肌瓣是治疗骶管囊肿有效、复发率低、并发症少的治疗方式.

纤维蛋白胶在处理破裂腹主动脉瘤腔内隔绝术中Ia型内漏的疗效

目的观察应用纤维蛋白胶填塞技术处理破裂腹主动脉瘤腔内隔绝术中Ia型内漏的疗效,评价其可行性、安全性及有效性。方法2010年10月至2022年1月腹主动脉瘤破裂患者47例,完成腹主动脉瘤腔内隔绝术45例,其中男36例,女9例;年龄28~93岁(70±4)岁,13例术中应用纤维蛋白胶填塞术治疗Ⅰa型内漏。术后3、6、12个月复查患者主动脉CT血管造影(CTA)。结果13例术中使用纤维蛋白胶填塞治疗,术中造影提示内漏均消失,患者病情稳定出院。随访1年,13例患者,3例非主动脉因素死亡,其余10例术后3、6、12个月复查主动脉CTA结果均未发现内漏。结论纤维蛋白胶填塞在治疗破裂腹主动脉瘤腔内隔绝术中的Ⅰa型内漏中是安全有效的。

胶原基复合止血材料的研究进展及展望

胶原蛋白可用于多种止血场景,并凭借优越的性能和易于获取的特点逐渐取代传统止血材料。然而,不同剂型的胶原止血剂都存在各自的缺陷,如力学性能差、粘附性差等。虽然提纯或交联改性胶原能在一定程度上获得改善,但作用有限,临床应用仍深受限制。天然生物及其衍生物材料是来源丰富的止血剂,具有生物相容性和良好的吸收和降解性能。广泛使用的材料包括壳聚糖、纤维蛋白胶、藻酸盐和氧化纤维素,以及近年来逐渐受到重视的传统中药材。因此,胶原蛋白与天然生物及其衍生物材料交联而成的胶原蛋白基复合止血材料,有望成为极具前景的生物医用止血材料。本文综述了不同类型胶原基复合止血材料的研究进展,总结了各自的优缺点,最后对胶原基复合止血材料的未来发展方向进行了探讨。

外胚间充质干细胞条件培养基冻干粉复合纤维蛋白胶修复大鼠皮肤损伤

背景:近来多数研究将组织工程材料与干细胞或细胞因子复合来改善动物模型皮肤损伤。鼻黏膜来源的外胚间充质干细胞条件培养基冻干粉可以长期保存,用于修复皮肤损伤具有独特的优势。目的:观察外胚间充质干细胞条件培养基冻干粉复合纤维蛋白胶修复大鼠皮肤缺损的效果。方法:体外培养SD大鼠鼻黏膜来源的外胚间充质干细胞,第3代细胞的培养基透析后冷冻干燥制成冻干粉。将30只皮肤缺损SD大鼠按治疗方法分为3组(n=10):损伤对照组,不接受特殊治疗作为对照;纤维蛋白胶组,局部应用纤维蛋白胶;条件培养基冻干粉复合纤维蛋白胶组,局部应用含有外胚间充质干细胞条件培养基冻干粉的纤维蛋白胶。治疗后动态观察创面愈合情况,测量创面面积,对皮肤组织切片进行苏木精-伊红染色和CK8、P63免疫组化染色。结果与结论:条件培养基冻干粉复合纤维蛋白胶组创面愈合速度高于纤维蛋白胶组和损伤对照组(P<0.001)。条件培养基冻干粉复合纤维蛋白胶组创面表皮和真皮在21 d全部再生修复;纤维蛋白胶组再生皮肤较薄;单纯创伤组皮肤再生不完全。在大鼠模型中,外胚间充质干细胞条件培养基冻干粉复合纤维蛋白胶联合使用可以促进损伤皮肤的伤口愈合。

气管食管瘘临床诊疗研究进展

气管食管瘘是指气管或支气管与食管之间的病理性瘘道,包括气管-食管瘘和支气管-食管瘘,临床以气管-食管瘘较多见。气管食管瘘致病原因较多,可引起严重的并发症,影响生活质量,是一种治疗困难、病死率较高的疾病。气管食管瘘目前治疗方式较多,但多数疗效欠佳,对新兴治疗手段的需求迫切。胸腹部X线摄影检出鼻胃管滞留是气管食管瘘诊断的金标准,其主要治疗方法包括外科手术治疗、支架置入、局部生物胶水封闭、干细胞治疗等。本文综述近年气管食管瘘诊断与治疗的主要研究进展,旨在为该病的临床诊治提供参考。

可注射用合成水凝胶在手术患者伤口的应用与护理探讨

为探究可注射水凝胶在肝移植手术患者创面应用的效果,采用随机分配的原则将患者分为A、B、C组,A组注射可注射水凝胶,B组注射0.9%氯化钠注射液,C组注射纤维蛋白胶,观察患者的出血量和出血时间、7 d后的血常规、体质量及凝血等指标。结果表明,采用的可注射水凝胶组的平均出血时间是(34.8±1.30)s,显著缩短(P<0.01);术后7 d的血常规、体质量及凝血等指标基本一致,只有在PLT、HCT二项指标上的差异显著,其中可注射水凝胶组的PLT水平最高;在腹腔内粘连程度方面,各组间无统计学意义(P>0.05)。采用可注射水凝胶的止血效果大致等同于纤维蛋白胶,但出血时间和出血量优势明显。