Efficacy and safety of fibrin sealant for tissue adherence in facial rhytidectomy

Figures & data

Table 1 Nomenclature used for organizing fibrin sealants with the hemostat, sealant and adhesive groups

Group (All)	Category (All)	Class (Fibrin sealants only)	Brand (Fibrin sealants only)	Manufacturer (Fibrin sealants only)
Hemostats	Mechanical Active	Pooled human plasma liquid	Tisseel Evicel	Baxter, Westlake Village, CA Ethicon/J&J, Somerville, NJ
	Flowable Fibrin sealant	Individual human plasma liquid with bovine collagen and bovine thrombin	Vitagel	Orthovita, Malvern, PA
		Pooled human plasma and equine collagen patch	Tachosil	Baxter, Westlake Village, CA
Sealants	Fibrin sealant PEG polymer Albumin and glutaraldehyde Cyanoacrylate	Pooled human plasma liquid	Tisseel	Baxter, Westlake Village, CA
Adhesives	Cyanoacrylate Albumin and glutaraldehyde Fibrin sealant	Pooled human plasma liquid	Artiss	Baxter, Westlake Village, CA

Figure 1 Applicator for fibrin sealant product (Artiss; Baxter, Westlake Village, CA)²⁰ approved for use in rhytidectomy.

Figure 2 Placement of a split thickness skin graft using a thin layer of fibrin sealant application (top portion) without the need for staples or sutures (bottom portion).

Figure 3 Use of fibrin sealant to attach skin flaps to underlying tissue at the time of neck dissection (top portion) and placement of gentle pressure during adhesive polymerization (bottom portion).

Modified and used with permission of Peoples Medical Publishing House – USA (PMPH-USA) from Spotnitz WD, Burks SG, Prabhu R. Fibrin based adhesives and hemostatic agents. In: James V. Quinn, editor. Tissue Adhesives in Clinical Medicine, 2nd Edition. BC Decker; 2005: 94 (Figures 4–6).⁴⁵

Figure 4 Manufacturer supplied Artiss device (Baxter, Westlake Village, CA) to facilitate dissolving freeze dried fibrinogen and thrombin powders in saline solutions.

Figure 5 Some spray (top portion) and cannula (bottom portion) type applicators which can be used for application of fibrin sealant.

Table 2 Author’s suggestions provided for the proper use of fibrin sealant during rhytidectomy

Subject	Authors’ specific suggestions
Hemostasis	Assure meticulous hemostasis as fibrin sealant is most effective at sealing small vessels and will not prevent hemorrhage from vessels requiring suture or cautery
Pre sealant preparation	Cut all skin flaps and place all skin sutures in advance of fibrin sealant application Place fixation sutures and tie immediately after application of fibrin sealant Place lattice work of sutures for all suture lines which can be rapidly tightened after application of fibrin sealant Place drains if they are going to be used prior to fibrin sealant application Avoid clogging of drains with fibrin sealant Avoid drains altogether after gaining experience and confidence in the use of fibrin sealant
Sealant application	Apply fibrin sealant to all portions of flaps using appropriate length cannulas or spray devices Apply fibrin sealant as a thin layer and avoid excessive thickness which may contribute to additional granulation tissue formation and delayed flap healing as well as to skin graft necrosis by interfering with diffusion of nutrients from underlying tissues Position flaps quickly and efficiently and avoid manipulation of flaps after 60 second polymerization time
Post sealant application	Apply gently pressure to flaps for at least 3 minutes and consider the use of pressure dressings Avoid any further movement or manipulation of facial skin or flaps after application of pressure including placement of any additional sutures or lifting of tissues with forceps as disruption of initial fibrin sealant bonding will cause sealant to function as anti-adhesive and even stimulate seroma formation and fluid drainage
Postoperatively	Prevent arterial hypertension as well as prevent and treat nausea and vomiting to avoid any increases in venous pressure and minimize potential for additional bleeding

Package InsertArtiss, Baxter2011 http://www.fda.gov/downloads/biologicsbloodvaccines/bloodbloodproducts/approvedproducts/licensedproductsblas/fractionatedplasmaproducts/ucm073054.pdfAccessed April 18, 2012

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SpotnitzWDBurksSGPrabhuRFibrin based adhesives and hemostatic agentsQuinnJames VTissue Adhesives in Clinical Medicine2nd edBC Decker20051.94

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