Chronic venous ulcers: a review on treatment with fibrin sealant and prognostic advances using proteomic strategies

Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.(AU)

Chronic venous ulcers: a review on treatment with fibrin sealant and prognostic advances using proteomic strategies

Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.(AU)

The effect of fibrin glue in preventing staple-line leak after sleeve gastrectomy. An experimental study in rats

Abstract Purpose To evaluate the effect of fibrin glue on staple-line leak after sleeve gastrectomy. Methods Fourteen adult wistar rats 300 gr were randomized into two groups: Control group (n=7) and study group (n=7). All the rats underwent sleeve gastrectomy using lineer stapler. In the study group, fibrin glue was used to reinforce the staple-line. The rats were sacrificed 7 days after surgery. The stomach was resected, submerged in saline and exposed to excess pressure to obtain a burst pressure value. The gastric staple line was evaluated histopathologically according to the Ehrlich Hunt scale. The results of the two groups were compared. Results The mean Ehrlich-Hunt scores for inflammation, fibroblastic activity and neo-angiogenesis were similar between the groups (p>0.05). Collagen deposition was significantly higher in study group (3.42±0.53) when compared with control group (2.57±0.78) (p=0.035). The mean burst pressure was 137.8±8.5 mmHg for control group and 135.0±8.1 mmHg for study group (p=0.536). Conclusion Reinforcement of the staple-line with fibrin glue has no effect on the burst pressure after sleeve gastrectomy. More studies are needed to evaluate the precautions against leak after sleeve gastrectomy.(AU)

Comparison of platelet rich plasma versus fibrin glue on colonic anastomoses in rats

Purpose: To compare platelet rich plasma (PRP) and fibrin glue about the effect of anastomotic healing. Methods: Thirty six Wistar-Albino male rats diveded into 3 groups according to control (Group1), PRP (Group 2) and fibrin glue (Tisseel VH) (Group 3). The colon was transected with scissor and subsequently an end to end anastomosis was performed using continuous one layer 6/0 vicryl sutures. Postoperative 7th day effect of anastomotic healing measuring with tissue hydroxyproline (TH) level and anastomotic bursting pressure (ABP); moreover comparison of cytokine (IL-6 and IL-10) and procalcitonin levels on 1st,3rd and 7th days. Results: There was no statistically significant difference of the ABP and hydroxyproline levels between PRP and fibrin glue on the 7th day. There was no statistically significant difference between levels of proinflammatory cytokine (IL-6) (P=0.41), anti-inflammatory cytokine (IL-10) (P=0.35), and procalcitonin levels (P=0.63) on 1, 3 and 7 days. Conclusion: Fibrin glue and platelet rich plasma are shown to be effective in healing intestinal anastomoses without superior to each other. (AU)

Multiple uses of fibrin sealant for nervous system treatment following injury and disease

Lesions to the nervous system often produce hemorrhage and tissue loss that are difficult, if not impossible, to repair. Therefore, scar formation, inflammation and cavitation take place, expanding the lesion epicenter. This significantly worsens the patient conditions and impairment, increasing neuronal loss and glial reaction, which in turn further decreases the chances of a positive outcome. The possibility of using hemostatic substances that also function as a scaffold, such as the fibrin sealant, reduces surgical time and improve postoperative recovery. To date, several studies have demonstrated that human blood derived fibrin sealant produces positive effects in different interventions, becoming an efficient alternative to suturing. To provide an alternative to homologous fibrin sealants, the Center for the Study of Venoms and Venomous Animals (CEVAP, Brazil) has proposed a new bioproduct composed of certified animal components, including a thrombin-like enzyme obtained from snake venom and bubaline fibrinogen. Thus, the present review brings up to date literature assessment on the use of fibrin sealant for nervous system repair and positions the new heterologous bioproduct from CEVAP as an alternative to the commercial counterparts. In this way, clinical and pre-clinical data are discussed in different topics, ranging from central nervous system to peripheral nervous system applications, specifying positive results as well as future enhancements that are necessary for improving the use of fibrin sealant therapy.(AU)

Multiple uses of fibrin sealant for nervous system treatment following injury and disease

Lesions to the nervous system often produce hemorrhage and tissue loss that are difficult, if not impossible, to repair. Therefore, scar formation, inflammation and cavitation take place, expanding the lesion epicenter. This significantly worsens the patient conditions and impairment, increasing neuronal loss and glial reaction, which in turn further decreases the chances of a positive outcome. The possibility of using hemostatic substances that also function as a scaffold, such as the fibrin sealant, reduces surgical time and improve postoperative recovery. To date, several studies have demonstrated that human blood derived fibrin sealant produces positive effects in different interventions, becoming an efficient alternative to suturing. To provide an alternative to homologous fibrin sealants, the Center for the Study of Venoms and Venomous Animals (CEVAP, Brazil) has proposed a new bioproduct composed of certified animal components, including a thrombin-like enzyme obtained from snake venom and bubaline fibrinogen. Thus, the present review brings up to date literature assessment on the use of fibrin sealant for nervous system repair and positions the new heterologous bioproduct from CEVAP as an alternative to the commercial counterparts. In this way, clinical and pre-clinical data are discussed in different topics, ranging from central nervous system to peripheral nervous system applications, specifying positive results as well as future enhancements that are necessary for improving the use of fibrin sealant therapy.(AU)

Multiple uses of fibrin sealant for nervous system treatment following injury and disease

Abstract Lesions to the nervous system often produce hemorrhage and tissue loss that are difficult, if not impossible, to repair. Therefore, scar formation, inflammation and cavitation take place, expanding the lesion epicenter. This significantly worsens the patient conditions and impairment, increasing neuronal loss and glial reaction, which in turn further decreases the chances of a positive outcome. The possibility of using hemostatic substances that also function as a scaffold, such as the fibrin sealant, reduces surgical time and improve postoperative recovery. To date, several studies have demonstrated that human blood derived fibrin sealant produces positive effects in different interventions, becoming an efficient alternative to suturing. To provide an alternative to homologous fibrin sealants, the Center for the Study of Venoms and Venomous Animals (CEVAP, Brazil) has proposed a new bioproduct composed of certified animal components, including a thrombin-like enzyme obtained from snake venom and bubaline fibrinogen. Thus, the present review brings up to date literature assessment on the use of fibrin sealant for nervous system repair and positions the new heterologous bioproduct from CEVAP as an alternative to the commercial counterparts. In this way, clinical and pre-clinical data are discussed in different topics, ranging from central nervous system to peripheral nervous system applications, specifying positive results as well as future enhancements that are necessary for improving the use of fibrin sealant therapy.

Nerve growth factor with fibrin glue in end-to-side nerve repair in rats / Fator de crescimento nervoso em cola de fibrina no reparo término-lateral de nervos em ratos

PURPOSE: To determine the effects of end-to-side nerve repair performed only with fibrin glue containing nerve growth in rats. METHODS: Seventy two Wistar rats were divided into six equal groups: group A was not submitted to nerve section; group B was submitted to nerve fibular section only. The others groups had the nerve fibular sectioned and then repaired in the lateral surface of an intact tibial nerve, with different procedures: group C: ETS with sutures; group D: ETS with sutures and NGF; group E: ETS with FG only; group F: ETS with FG containing NGF. The motor function was accompanied and the tibial muscle mass, the number and diameter of muscular fibers and regenerated axons were measured. RESULTS: All the analyzed variables did not show any differences among the four operated groups (p>0.05), which were statistically superior to group B (p<0.05), but inferior to group A (p>0.05). CONCLUSION: The end-to-side nerve repair presented the same recovery pattern, independent from the repair used, showing that the addition of nerve growth factor in fibrin glue was not enough for the results potentiating.(AU)

OBJETIVO: Determinar os efeitos do reparo nervoso término-lateral realizado apenas com cola de fibrina contendo fator de crescimento nervoso em ratos. MÉTODOS: Setenta e dois ratos Wistar foram distribuídos em seis grupos: A - não submetido à secção nervosa; B - secção do nervo fibular (sem reparo); Os outros grupos tiveram o nervo fibular seccionado e então reparado na superfície lateral do nervo tibial intacto, com diferentes procedimentos: C - RNTL com suturas; D - RNTL com suturas e FCN; E - RNTL apenas com CF; F - RNTL com CF contendo FCN. A função motora foi acompanhada e a massa do músculo tibial, o número e o diâmetro das fibras musculares e axônios regenerados foram medidos. RESULTADOS: Não houve diferença entre as variáveis avaliadas nos quatro grupos operados (p>0,05), os quais foram superiores ao grupo B (p<0,05), mas inferiores ao grupo A (p>0,05). CONCLUSÕES: O reparo nervoso término-lateral mostrou o mesmo padrão de recuperação, independente do tipo de reparo utilizado, evidenciando que a adição de fator de crescimento nervoso na cola de fibrina não foi suficiente para a potencialização dos resultados.(AU)

Comparative study between fibrin glue and platelet rich plasma in dogs skin grafts / Estudo comparativo entre a cola de fibrina e o plasma rico em plaquetas em enxertos cutâneos em cães

PURPOSE: Compare fibrin glue (Tissucol®) and platelet-rich plasma in full-thickness mesh skin grafts in dogs. METHODS: Eighteen dogs were used, divided into two groups: fibrin glue (FG) and platelet-rich plasma (PRP). In all the animals, a full-thickness 3x3 cm mesh skin graft was implanted. In the left limb, the biomaterial was place between the graft and the receptor bed, according to the group, while the right limb served as the control group. All the animals were evaluated clinically every 48 hours until the 14th day, using the variables of exudation, coloration, edema and cosmetic appearance. Three animals were evaluated histologically, on the third, seventh and tenth postoperative days, using the variables of fibroblasts, collagen, granulation tissue, microscopic integration-adherence and acute inflammation. RESULTS: Clinical evaluations showed that the group CF showed better scores for all variables compared to PRP group. On the histological evaluations PRP group had a higher presence of fibroblasts in the seventh and fourteenth days. CONCLUSION: The fibrin glue group was clinically superior to the platelet-rich group when used on full-thickness skin grafts in dogs.(AU)

OBJETIVO: Comparar a cola de fibrina (Tissucol®) e o plasma rico em plaquetas em enxertos cutâneos de espessura completa em malha em cães. MÉTODOS: Foram utilizados 18 cães, distribuídos em dois grupos, cola de fibrina (CF) e plasma rico em plaquetas (PRP). Em todos os animais foi realizado um enxerto cutâneo de 3x3 cm, em malha de espessura completa. No membro esquerdo foi colocado o biomaterial entre o enxerto e o leito receptor, cada qual em seu grupo, o membro direito serviu como grupo controle. Todos os animais foram avaliados clinicamente a cada 48 horas até o décimo quarto dia, através das variáveis: exsudação, coloração, edema e aspecto cosmético; histologicamente em três animais, no terceiro, sétimo e décimo quarto dia de pós-operatório através das variáveis: fibroblastos, colágeno, tecido de granulação, integração-aderência microscópica e inflamação aguda. RESULTADOS: Avaliações clínicas demonstraram que o grupo CF apresentou melhor escores em todas variáveis quando comparado com o grupo PRP. Nas avaliações histológicas o grupo PRP apresentou maior presença de fibroblastos ao sétimo e décimo quarto dia. CONCLUSÃO: A cola de fibrina foi clinicamente superior ao grupo plasma rico em plaquetas quando usados em enxertos cutâneos de espessura completa em cães.(AU)

The laparoscopy splenic injury repair: the use of fibrin glue in a heparinized porcine model / O reparo de lesão esplênica por laparoscopia: o uso da cola de fibrina em porcos heparinizados

PURPOSE: To investigate the effectiveness of fibrin glue (laparoscopic via) into promote the hemostasis of a spleen injury on a heparinized porcine model. METHODS: Eighteen Landrace porcine were submitted to laparoscopic spleen injury and randomly distributed: GHA (heparin plus adhesive), GH (heparin without adhesive) and GS (Sham - without heparin or adhesive). Ten minutes before the surgical procedures a single IV dose (200UI/kg) of heparin sodium was administrated only to groups GHA and GH. In the GHA, adhesive was applied after the mechanical injury and recorded the time until the polymerization and clot formation. RESULTS: No significant differences occurred among the groups (Fisher test) considering the weight and surgery time. The blood amount in the abdominal cavity on GH was significantly higher in comparison to the sham group and especially with the GHA (p<0.004). No significant differences were observed in the body temperature, heart rate, cardiac output, means arterial pressure, pulmonary artery pressure during the experiment. The activated partial thromboplastin time (APTT) was lower in the GHA in comparison to GH (p<0.003). CONCLUSION: The fibrin biological adhesive applied by laparoscopy is effective for hemostasis of minor spleen injury in a porcine model under the effect of anticoagulant drug.(AU)

OBJETIVO: Investigar a eficácia da cola de fibrina (via laparoscópica) na hemostasia de uma lesão no baço de porco heparinizado. MÉTODOS: Dezoito suínos Landrace foram submetidos a lesão do baço e distribuídos aleatoriamente: GHA (heparina adesivo), GH (heparina sem adesivo) e GS (Sham - sem heparina ou adesivo). Dez minutos antes dos procedimentos uma dose única (200UI/kg) de heparina sódica (EV) foi administrada nos grupos GHA e GH. A fibrina (GHA) foi aplicada após a lesão e registrado o tempo até a polimerização e formação do coágulo. RESULTADOS: Não houve diferenças significativas entre os grupos (teste de Fisher), considerando o peso e o tempo de cirurgia. A quantidade de sangue na cavidade abdominal de GH foi significativamente maior em comparação ao GS e, especialmente, com o GHA (p<0,004). Não foram observadas diferenças significativas na temperatura corporal, frequência cardíaca, débito cardíaco, pressão arterial ou pressão da artéria pulmonar durante o experimento (20 minutos). O tempo de tromboplastina parcial ativada (TTPA) foi menor no GHA em relação ao GH (p<0,003). CONCLUSÃO: A cola de fibrina biológica aplicada por laparoscopia é eficaz para a hemostasia de lesões no baço menor em um modelo suíno sob o efeito de drogas anticoagulantes.(AU)

Ultrastructural evaluation of human keratinocyte growth and differentiation on a fibrin substrate / Avaliação ultraestrutural do crescimento e da diferenciação de queratinócitos sobre um substrato de fibrina

PURPOSE: In order to circumvent several difficulties that have been met in the routine use of the in vitro keratinocyte cultures using the standard procedure described by Rheinwald and Green, and obtain a more resilient and the least possible immunogeneic skin substitute for a future clinical application, this work studied a new keratinocyte culture system, which envisages the utilization of a fibrin substrate in association with high densities of human keratinocytes. METHODS: Through light and transmission electron microscopy and immunohistochemical assays, long-term proliferative and differentiative characteristics of keratinocytes cultured onto a fibrin gel under immerse and air-liquid interface culture conditions were evaluated. RESULTS: Despite the absence of a dermal substitute, the results demonstrated that the proposed composite was constituted of a transparent and elastic fibrin film covered by a well-attached, multistratified epithelium with morphological characteristics that resemble human epidermis, including the neoformation, albeit incomplete, of the basement membrane. CONCLUSIONS: Increased mechanical resistance due to the presence of an easy handling substrate, the delivery of nonclonfluent keratinocytes as well as the removal of animal-derived cells from the culture system suggest its potential use for future transplantation purposes.(AU)

OBJETIVO: Com o intuito de contornar diversas dificuldades encontradas no uso rotineiro de queratinócitos cultivados in vitro pela técnica descrita por Rheinwald e Green, e obter um substituto cutâneo mais resistente e o menos imunogênico possível para futuras aplicações clínicas, este trabalho avaliou um novo sistema de cultura de queratinócitos que prevê a utilização de um substrato de fibrina em associação com queratinócitos humanos em alta densidade. MÉTODOS: Através de microscopia óptica e eletrônica e análise imunohistoquímica, foram avaliadas as características proliferativas e de diferenciação em longo prazo de queratinócitos cultivados em condição imersa e na interface ar-líquido. RESULTADOS: Apesar da ausência de um substituto dérmico, foi demonstrado que o composto proposto constituiu-se de um substrato de fibrina transparente e elástico coberto por epitélio multi-estratificado, bem aderido, com características morfológicas semelhantes à epiderme humana, incluindo a neo-formação, embora incompleta, da membrana basal. CONCLUSÕES: A maior resistência mecânica com a presença de um substrato de fácil manuseio, a possível liberação de queratinócitos não-confluentes, e a remoção de células com origem animal dos sistemas de cultura sugerem que o composto proposto neste estudo apresenta grande potencial para uso clínico futuro.(AU)

End-to-side nerve repair using fibrin glue in rats / Anastomose nervosa término-lateral usando cola de fibrina em ratos

Purpose: To evaluate axonal regeneration after end-to-side nerve repair with fibrin glue in rats. Methods: Forty-five Wistar rats were divided into three groups: group A (n=15), were not submitted to surgery (control group); group B (n=15) were submitted to fibular transection without repair; and group C (n=15), were submitted to fibular transection with end-to-side nerve anastomosis using fibrin glue, in the lateral surface of an intact tibial nerve. The three groups were submitted to walking track (30 and 90 days) and posterior morphometrical analysis (90 days). Results: The functional tests demonstrated that there was no difference in the walking track during the study in group A (p>0.05). The group B had walking pattern impairment in the two tests (p>0.05). The group C had walking pattern impairment in the first test, with important recovery in the second test (p<0.05). The morphometrical assessment revealed significantly higher number of regenerated mielinates axons in group C, compared to group B (p<0.05). Conclusion: The end-to-side nerve repair with fibrin glue shows axonal recovery, demonstrated through functional and morphometrical ways in rats.(AU)

Objetivo: Avaliar a regeneração axonal após anastomose nervosa término-lateral (ATL) usando cola de fibrina em ratos. Métodos: Quarenta e cinco ratos Wistar distribuídos em três grupos: os animais do grupo A (n=15) não foram submetidos à secção nervosa (grupo controle); os animais do grupo B (n=15) foram submetidos apenas à secção do nervo fibular, sem posterior anastomose; e os animais do grupo C (n=15) foram submetidos à secção do nervo fibular e à ATL com cola de fibrina no nervo tibial. Posteriormente, os animais foram submetidos a dois testes de marcha (30 e 90 dias) e à análise morfométrica (90 dias). Resultados: A análise estatística dos testes de marcha demonstrou que o grupo A não apresentou alteração no padrão de caminhada durante o estudo (p>0,05). O grupo B apresentou prejuízo motor no primeiro e no segundo teste (p>0,05). O grupo C apresentou um padrão de atrofia no primeiro teste, com recuperação da marcha no segundo teste (p<0,05). Na análise morfométrica, o grupo C apresentou regeneração axonal significativamente superior ao grupo B (p<0,05). Conclusão: A ATL realizada com cola de fibrina resultou em regeneração axonal no rato, demonstrada tanto histologicamente quanto funcionalmente.(AU)

Fibrin adhesive and the vaginal vault synthesis on female rabbits abdominal hysterectomies / Adesivo de fibrina e a síntese da cúpula vaginal após histerectomia abdominal em coelhos fêmeas

PURPOSE: To investigate the effectiveness of fibrin glue in comparison with polyglycolic acid suture to promote the closure of rabbit's vaginal vault, after abdominal hysterectomy. METHODS: Twenty female, adults, New Zealand rabbits, were submitted to abdominal hysterectomy and randomly distributed to polyglycolic acid suture (G-PA / n=10) or fibrin glue closure of vaginal vault (G-FG / n=10). Radiograph study allowed identifying vault vaginal suture disrupter or fistulas to urinary bladder or rectum. Videovaginoscopy study allowed identifying the presence of cellulites, abscess formation, tissue granulation or granuloma. Vaginal cuff burst test allowed to identify by the escape of air bubbles and rupture pression record. Histological sections stained with Picrosirius red allowed the measure of fibrous tissue healing. RESULTS: The videovaginoscopy identified a significant difference (Fisher Test p<0.3142) of granulation tissue in the animals of G-PA (40 percent) in comparison with the G-FG (20 percent). The gross inspection showed the same relation in the granulation tissue occurrence (Fisher test p< 0.1749) with G-PA (50 percent) and G-FB (20 percent). The visceral adhesion to the vaginal vault wound was statistical significant (Fisher test p< 0.1749) with G-PA (50 percent) and G-FG (20 percent). The pressure of rupture (mm Hg) of the burst test was similar (p<0.0421) in the animals of G-PA (61.5±19.3) and G-FG (72.5±21.9). The collagen matrix of vault wound healing was similar (p< 0.0231) between the G-PA (31.63±15) and the G-FG (23.2±13.2). CONCLUSION: The vaginal vault closure using the fibrin glue is a safe and reliable procedure after abdominal hysterectomy in female rabbit model.(AU)

OBJETIVO: Investigar a eficácia da cola de fibrina e da sutura usando fio de ácido poliglicólico para promover o fechamento da cúpula vaginal de coelhas, após histerectomia abdominal. MÉTODOS: Vinte coelhos fêmeas, New Zealand, adultas foram submetidas à histerectomia abdominal e distribuídas para sutura da cúpula vaginal com fio de ácido poliglicólico (G-PA / n=10) ou cola de fibrina (G-FG / n=10). Estudo radiológico foi realizado para identificar deiscências ou fístulas vesicais ou retais. Videovaginoscopia foi realizada para identificar a presença de secreções, abscessos, tecido de granulação ou granuloma tipo corpo estranho. Teste in vitro de pressão de rompimento sob selo d'água foi realizado para identificar a perviedade da sutura. O tecido de cicatrização foi estudado pela coloração com picrosirius red para mensuração do tecido fibrótico. RESULTADOS: A videovaginoscopia mostrou uma diferença significante (Teste de Fisher p<0,3142) no tecido de granulação do grupo G-PA (40 por cento) em comparação com o grupo G-FG (20 por cento). A análise macroscópica mostrou a mesma relação com o tecido de granulação (Teste de Fisher p< 0.1749) com G-PA (50 por cento) e G-FB (20 por cento). A aderência visceral à cúpula vaginal foi estatisticamente significativa (Teste de Fisher p< 0.1749) com o G-PA (50 por cento) e G-FG (20 por cento). A pressão de rompimento (mmHg) foi similar (p<0.0421) nos animais do grupo G-PA (61.5±19.3) e G-FG (72.5±21.9). A matriz colagenosa do tecido de cicatrização teve resultados semelhantes (p< 0.0231) entre G-PA (31.63±15) e G-FG (23.2±13.2). CONCLUSÃO: O fechamento da cúpula vaginal usando cola de fibrina é um procedimento seguro e confiável após histerectomia abdominal em coelhos fêmeas.(AU)

The role of biological adhesive and suture material on rabbit hepatic injury / O papel da cola biológica e do fio de sutura na lesão hepática em coelhos

PURPOSE: To evaluate the performance of fibrin adhesive and absorbable suture thread in the repairing of hepatic injures in rabbits. METHODS: New Zealand albino rabbits (n=16), males and females, from 5 to 6 months old, average weight of 2500 g, were distributed randomly in Group A (n-8) - biological adhesive and Group B (n=8) - suture thread. After anesthesia with acepromazine (1mg/Kg), ketamine (50mg/Kg) and fentanyl EV (0,5ml/Kg), it was performed a supra-umbilical median laparotomy, the median hepatic lobe was isolated and subjected to severe standardized incision. In the group B the incision edges were sutured with simple 4-0 catgut, in separated stitches. It was evaluated the total time of the procedure, the hemostasis time and hemorrhage volume. In the 21st post-operative day it was evaluated the presence of adherences and signs of infection in the abdominal cavity, and it was followed by the resection of the median hepatic lobe for the histological evaluation. RESULTS: The calculated mean and standard deviation showed that the procedure time, hemostasis time and bleeding amount were significantly smaller in the group of animals subjected to the use of fibrin adhesive. The surgical abdominal incision was significantly more extensive in the animals of the suture group (average of 6,8 cm) in relation to the adhesive group (average of 3,8), as well as the number of occurrences of abscesses. The adherence of the intestinal ansas to the sutured incision (group B) occurred in five cases and the major omentum adhesion occurred in all animals. In the group A (adhesive) it occurred adherences of the major omentum in three cases. The microscopy of the hepatic incision repaired with the use of fibrin showed that the inflammatory infection is less intense, not associated with the formulation of secretion in the abscesses, and therefore has a more favorable later cicatricial aspect than a conventional suture with surgical thread. CONCLUSION: In agreement with other...(AU)

OBJETIVO: Avaliar o desempenho do adesivo de fibrina e do fio de sutura absorvível no reparo de lesões hepáticas provocadas em coelhos. MÉTODOS: Coelhos (n=16),Nova Zelândia, albinos, machos e fêmeas, 5 a 6 meses de idade, peso médio de 2500 gramas, foram distribuídos aleatoriamente em Grupo A(n = 8) - adesivo biológico e Grupo B(n=8) - fio de sutura. Após anestesia com acepromazina (1mg/Kg), quetamina (50mg/Kg) e fentanylEV (0,5ml/Kg), realizou-se laparotomia mediana supra-umbilical, o lobo hepático médio foi isolado e submetido a uma lesão padronizada grave. No grupo A foi aplicado o adesivo de fibrina. No grupo B as bordas da lesão foram suturadas com categute 4-0 simples, em pontos separados. Avaliou-se o tempo total de procedimento, tempo de hemostasia e volume da hemorragia. No 21º dia de pós-operatório avaliou-se a presença de aderências e sinais de infecção na cavidade e procedeu-se a ressecção do lobo hepático médio para a avaliação histológica. RESULTADOS: A média e desvio-padrão calculados mostraram que o tempo de procedimento, tempo de hemostasia e quantidade de sangramento foram significantes menores no grupo de animais submetidos ao uso do adesivo de fibrina. A extensão da ferida operatória foi significativamente maior nos animais do grupo sutura (média de 6,8cm) em relação ao grupo adesivo (média de 3,8cm) assim como o número de vezes da ocorrência de abscessos. A aderência de alças intestinais à lesão suturada (grupo B) ocorreu em 5 casos e adesão do omento maior ocorreu em todos os animais. No grupo A (adesivo) foram observadas aderências do omento maior em três casos. A microscopia da lesão hepática reparada com o uso de fibrina mostrou que a reação inflamatória é menos intensa, não está associada à formação de secreção ou abscessos e com isso tem um aspecto cicatricial tardio mais favorável que uma sutura convencional com fio cirúrgico. CONCLUSÃO: Em concordância com outros trabalhos da literatura biomédica, o adesivo de fibrina é uma opção...(AU)

Estudo comparativo do uso de cola de fibrina e cianoacrilato em ferimento de fígado de rato

PURPOSE: To determinate the role of cianoacrilate and fibrin glue in the repair of the hepatic wound, to evidence the hemostatic capacity of the adhesives and their respective integration to the hepatic tissue. METHODS: 30 rats Wistar-EPM1 were separate in 2 groups and submitted to the anesthesia with tiopental in the concentration of 40mg/kg EV. Laparotomy was made with exhibition of the liver. A punch of 3mm was made in the hepatic right lobe. The animals of group A were treated with the placement of fibrin glue in the wounds, the animals of group B had the wounds treated with cianoacrilate. In the 7th of post-operative period, under anesthesia, the animals suffered the resection of the right hepatic lobe and samples were collected for the histology study procedures (HE and Picro-Sirius). They were appraised for optical microscopy, the inflammatory response (qualitative criteria of the neutrofiles presence, giants cells, granuloma, neovascularization) and for polarization microscopy, the quantification of collagen (I-young Type and III-matureType). RESULTS: The two adhesives had hemostatic effects in similar times.The wounds treated with fibrin glue showed larger amount of young and mature collagen and a larger amount of neovascularization, while the wounds treated with cianoacrilate showed larger reaction of granuloma. CONCLUSION: Fibrin glue and cianoacrilate have similar hemostatic effects.The wound treated with fibrin glue present larger neovascularization and larger percentage of collagen type I and type III showing tendency to a better tissue repair without formation of granuloma.

OBJETIVO: estudar comparativamente o uso de cianoacrilato e cola de fibrina no reparo do ferimento hepático, para evidenciar suas respectivas capacidades de integração aos tecidos à curto prazo. MÉTODOS: 30 ratos Wistar-EPM1 foram separados em 2 grupos e submetidos à anestesia com tiopental na concentração de 40mg/kg EV. Realizada laparotomia com exposição do fígado. Usando um "punch" dermatológico de 3mm foi produzido um ferimento padronizado em lobo direito hepático. Os animais do grupo A foram tratados com a colocação de cola de fibrina nos ferimentos, os animais do grupo B tiveram os ferimentos tratados com adesivo de cianoacrilato. No 7º de PO, sob anestesia, os animais sofreram a ressecção do lobo hepático direito e foram coletadas amostras para os procedimentos de estudo histológicos (HE e Picro-Sirius). Foram avaliados, por microscopia óptica, os processos inflamatórios (critérios qualitativos da presença de neutrófilos, células gigantes, granuloma tipo corpo estranho, neovascularização) e, por microscopia de polarização, a quantificação de colágeno (Tipo I-jovem e Tipo III-maduro). RESULTADOS: Os dois adesivos levaram ao efeito hemostático em tempos semelhantes. Os ferimentos tratados com cola de fibrina mostraram maior quantidade de colágeno jovem e maduro e uma maior quantidade de neovascularização, enquanto os ferimentos tratados com cianoacrilato mostraram maior reação de granuloma tipo corpo estranho. CONCLUSÃO: O ferimento tratado com a cola de fibrina apresentou maior neovascularização e maior porcentagem de colágeno tipo I e tipo III demonstrando tendência a uma melhor reparação tecidual, sem formação de granuloma tipo corpo estranho.