Search Results (8)

Rapid haemostasis during surgery is essential when one wants to reduce the duration of operations, reduce the need for transfusions, and above all when one wants to achieve better patient management. The use of haemostatic agents, sealants, and adhesives improves the haemostatic process by offering several advantages, especially in vascular surgery. These agents vary widely in their mechanism of action, composition, ease of application, adhesion to wet or dry tissue, immunogenicity, and cost. The most used are cyanoacrylate-based glues (Glubran 2) or polysaccharide hydrogel-microsphere powder (Arista^TMAH). This work is based on a retrospective study carried out on a sample of patients with different vascular diseases (FAV, pseudoaneurysm, and PICC application) in which two different haemostatic sealants were used. The aim was to assess the safety, the advantages, and the ability of both sealants to activate the haemostatic process at the affected site, also in relation to their chemical-physical characteristics. The obtained results showed that the application of Glubran 2 and Arista^TMAH as surgical wound closure systems is effective and safe, as the success achieved was ≥94% on anastomoses of FAV, 100% on stabilization of PICC catheters, and ≤95% on pseudoaneurysms. Full article

Background: The labial frenulum may be associated with traction on the marginal gingiva of the incisors with resulting gingival recession, a condition known as “pull syndrome”. In this case, performing a frenulectomy at least 6 months before root covering surgery is necessary. Recently, tissue adhesives have been studied as a good alternative to conventional sutures. Methods: A 34-year-old female affected by pull syndrome of the central lower incisors underwent frenulectomy, and an n-hexyl-cyanoacrylate tissue adhesive was used to ensure wound closure. Results: The patient was instructed in hygiene maneuvers and rinsed with 0.12% chlorhexidine-based mouthwash for 15 days. The glue was partially removed at 7 days, and for the remaining, natural disposal time was expected. The wound healing process was complete after 15 days with minimal postoperative discomfort. Conclusion: This n-hexyl-cyanoacrylate surgical glue could be proposed as a viable alternative to conventional sutures during surgical procedures involving wide flaps with the impossibility of first-intention healing. Moreover, it could be indicated to reduce operative time and patients’ discomfort, even if these hypotheses should be confirmed by future clinical studies. Full article

Background: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy caused by compression of the median nerve in the carpal tunnel. The presented study aimed to evaluate clinical outcomes by comparing two techniques of wound closure following carpal tunnel surgery in subjects randomized to the application of tissue adhesive or sutures. Methods: From April 2022 to December 2022, a single-center randomized prospective trial was conducted at the University Hospital of Split in Croatia. The study participants consisted of 100 patients (70 females) aged 61.56 ± 12.03 years, randomly assigned to suture-based wound closure (n = 50) or tissue adhesive-based wound closure (n = 50) with two-component skin adhesive Glubran Tiss 2^®. The outcomes were assessed postoperatively during the follow-up period at intervals of 2, 6, and 12 weeks. A scar assessment was performed using the POSAS (Patient and Observer Scar Assessment Scale) and cosmetic VAS (Visual Analog Scale). The VNRS (Verbal Number Rating Scale) was used to assess pain. Results: There were significant differences between glue-based wound closure and suture-based wound closure at 2-week and 6-week intervals after the surgery on the POSAS and cosmetic-VAS scales (better aesthetic effect with glue-based wound closure technique where noticed), with less postoperative pain at the same intervals. With the 12-week interval, differences in outcomes were insignificant. Conclusions: This trial demonstrated that cyanoacrylate-based adhesion mixtures might be possibly superior in the short term in terms of cosmetic appearance and discomfort compared to conventional skin suturing techniques for the closing of surgical wounds following open CTS decompression, but there was no difference between both procedures in the long term. Full article

Bone defects and complex fractures present significant challenges for orthopaedic surgeons. Current surgical procedures involve the reconstruction and mechanical stabilisation of complex fractures using metal hardware (i.e., wires, plates and screws). However, these procedures often result in poor healing. An injectable, biocompatible, biodegradable bone adhesive that could glue bone fragments back together would present a highly attractive solution. A bone adhesive that meets the many clinical requirements for such an application has yet to be developed. While synthetic and biological polymer-based adhesives (e.g., cyanoacrylates, PMMA, fibrin, etc.) have been used effectively as bone void fillers, these materials lack biomechanical integrity and demonstrate poor injectability, which limits the clinical effectiveness and potential for minimally invasive delivery. This systematic review summarises conventional approaches and recent developments in the area of bone adhesives for orthopaedic applications. The required properties for successful bone repair adhesives, which include suitable injectability, setting characteristics, mechanical properties, biocompatibility and an ability to promote new bone formation, are highlighted. Finally, the potential to achieve repair of challenging bone voids and fractures as well as the potential of new bioinspired adhesives and the future directions relating to their clinical development are discussed. Full article

Endovascular glue embolization is a minimally invasive technique used to selectively reduce or block the blood supply to specific targeted vessels. Cyanoacrylate glues, mixed with radiopaque iodized oil, have been widely used for vascular embolization owing to their rapid polymerization rate, good penetration ability and low tissue toxicity. Nevertheless, in clinical practice, the selection of the glue–oil proportion and the manual injection process of mixtures are mostly based on empirical knowledge of operators, as the crucial physicochemical effect of polymerization kinetics has rarely been quantitatively investigated. In this study, the Raman spectroscopy is used for studying the polymerization kinetics of n-butyl-cyanoacrylate-based glues mixed with an iodized oil. To simulate the polymerization process during embolization, glue–oil mixtures upon contact with a protein ionic solution mimicking blood plasma are manually constructed and their polymerization kinetics are systematically characterized by Raman spectroscopy. The results demonstrate the feasibility of Raman spectroscopy in the characterization of polymerization kinetics of cyanoacrylate-based embolic glues. The polymerization process of cyanoacrylate-based mixtures consists of a fast polymerization phase followed by a slow phase. The propagation velocity and polymerization time primarily depend on the glue concentrations. The commonly used 50% mixture polymerizes 1 mm over ∼21.8 s, while it takes ∼51 min to extend to 5 mm. The results provide essential information for interventional radiologists to help them understand the polymerization kinetics of embolic glues and thus regulate the polymerization rate for effective embolization. Full article

N-butyl cyanoacrylate (NBCA) is a liquid monomer that undergoes an exothermic polymerization reaction to form a solid upon initiation with hydroxyl anions. Recently, EGpresto, a highly viscous NBCA-based adhesive, has been developed for vascular-occlusion purposes. In this study, we investigated the heat of polymerization of EGpresto and compared the results with those of a low-viscosity NBCA glue. Results show that EGpresto exhibited a lower heat of polymerization (64 ± 7 °C vs. 34 ± 1 °C). This was due to its high viscosity, which resulted in a delayed polymerization time. To investigate the efficacy and safety of EGpresto for intravenous embolization, a 14 d in vivo animal test was conducted using three pigs. Five cc of EGpresto was injected into the epigastric vein of each animal. Complete postoperative vein occlusion was confirmed at 7 and 14 d by ultrasonographic visualization. After the animals were sacrificed, the operated and unoperated veins were exposed, and the injected adhesive was found without migration. During the histology, the injected adhesive was not found in the inner or outer vein walls, and the immune reactions seemed to be the only foreign-body reaction, showing that EGpresto is a non-toxic and safe intravascular embolic agent. Full article

Aim: To compare the burst pressures of corneal wounds closed with a laser-activated, chitosan-based thin film adhesive against self-seal, sutures and cyanoacrylate. Methods: 2, 4 or 6 mm penetrating corneal wounds were created on 100 freshly enucleated bovine eyes. The wounds were closed using a laser-activated chitosan adhesive (n = 30), self-sealed (control) (n = 30), sutures (n = 20) or cyanoacrylate glue (Histoacryl^®) (n = 20). The corneoscleral rim was dissected and mounted onto a custom burst pressure testing chamber. Water was pumped into the chamber at 9ml/hr. The fluid pressure prior to wound leakage was recorded as the ‘burst pressure’. Results: The burst pressure for the 2, 4 and 6 mm wounds were 239.2 mmHg (SD = ±102.4), 181.7 mmHg (SD = ±72.8) and 77.4 mmHg (SD = ±37.4) (p < 0.00001), respectively, for chitosan adhesive. Burst pressure was 36.4 mmHg (SD = ±14.7), 4.8 mmHg (SD = ±4.9) and 2.7 mmHg (SD = ±1.3) (p < 0.00001), respectively, for the self-sealed group. For 4 and 6mm wounds, burst pressures with sutures were 33.0 mmHg (SD = ±19) and 23.5 mmHg (SD = ±17.4) (p = 0.0087), respectively. For cyanoacrylate, burst pressures for 2 and 4 mm wounds were 698 mmHg (SD = ±240.3) and 494.3 mmHg (SD = ±324.6) (p = 0.020087), respectively. Conclusion: This laser-activated chitosan-based adhesive sealed bovine corneal wounds up to 6 mm in length. Burst pressure was higher for the adhesive than sutured or self-sealed wounds, but lower than for cyanoacrylate. Full article

In situ forming hydrogels with catechol groups as tissue reactive functionalities are interesting bioinspired materials for tissue adhesion. Poly(ethylene glycol) (PEG)–catechol tissue glues have been intensively investigated for this purpose. Different cross-linking mechanisms (oxidative or metal complexation) and cross-linking conditions (pH, oxidant concentration, etc.) have been studied in order to optimize the curing kinetics and final cross-linking degree of the system. However, reported systems still show limited mechanical stability, as expected from a PEG network, and this fact limits their potential application to load bearing tissues. Here, we describe mechanically reinforced PEG–catechol adhesives showing excellent and tunable cohesive properties and adhesive performance to tissue in the presence of blood. We used collagen/PEG mixtures, eventually filled with hydroxyapatite nanoparticles. The composite hydrogels show far better mechanical performance than the individual components. It is noteworthy that the adhesion strength measured on skin covered with blood was >40 kPa, largely surpassing (>6 fold) the performance of cyanoacrylate, fibrin, and PEG–catechol systems. Moreover, the mechanical and interfacial properties could be easily tuned by slight changes in the composition of the glue to adapt them to the particular properties of the tissue. The reported adhesive compositions can tune and improve cohesive and adhesive properties of PEG–catechol-based tissue glues for load-bearing surgery applications. Full article