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The adhesive strength of fibrin sealants has not been rigorously evaluated to date. The adhesive strength of six different concentrations of cryoprecipitated fibrinogen as well as the commercially available fibrin tissue adhesive Tissucol was tested under controlled conditions utilizing split-thickness skin grafts as the test adherand. This test configuration permitted the modeling of bonding strength for attachment of skin grafts as well as incorporate established engineering test standards for adhesives. An increase in fibrin concentration corresponded with an increase in shear adhesive strength. No significant increases in adhesive strength were attained after 5 min of bonding for all tested concentrations, except for the commercial adhesive, which attained the adhesive strength of an equivalent concentration of cryoprecipitated adhesive after 90 min. The adhesive strength, however, was an order of magnitude less than reported values of the tensile strength of fibrin material for similar concentrations. Therefore, it is important that the surgeon use a sufficiently high fibrinogen concentration for the specific clinical indication. The method of fibrin sealant preparation and/or the compounding adjuncts appear to have an effect on the development of adhesive strength.

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Various methods have been used for anastomosing, or attaching, two ends of a severed blood vessel together. The most common method, suturing, is tedious, can be time-consuming, and requires special training in microvascular surgery. Other methods, such as mechanical devices and lasers, have some problems as well. The use of fibrin adhesives for blood vessel anastomosis might eliminate some of the current problems by allowing a quicker, simpler, and more reliable method of attachment. Although mechanical studies have been conducted to determine fibrin glue properties in shear, tensile, and burst tests; most of these studies have used skin or intestinal tissue. Therefore, to evaluate the feasibility of using fibrin glue as an adhesive for blood vessel anastomosis, the mechanical properties of blood vessels joined with fibrin glue were examined using tensile and burst tests. High and low fibrinogen concentrations were tested after 5- or 45-min time periods. In addition, three clinical methods of attachment were compared: end-to-end anastomosis, vessel overlapping, and suturing. In this study, because the adhesive strength was not found to increase significantly after 5 min, setting times for fibrin glue may be short enough to make it a clinical option when compared to suturing. In addition, the higher fibrinogen concentration did not result in a significantly higher adhesive strength, indicating that the lower concentration fibrin adhesives may be of comparable strength to the higher concentrations for clinical applications.

These findings suggest that plastic surgeons, and especially those who are building young practices, must expand their offerings of nonsurgical cosmetic services to remain at the core of the cosmetic medicine field.

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Cryolipolysis is a nonsurgical body contouring procedure that involves cooling of fat cells to induce lipolysis while sparing surrounding structures. Plastic surgery practices are increasingly incorporating noninvasive aesthetic procedures (eg, cryolipolysis, fillers, radiofrequency, ultrasound) to offer their patients a wider range of aesthetic treatment options. Here, we report insights from 8 plastic surgeons with regard to cryolipolysis best practices from a clinical perspective and the impact of integrating this noninvasive body contouring procedure into a plastic surgery practice. The authors prefer cryolipolysis over liposuction for patients who are not amenable to surgery or those who desire to avoid downtime, also taking into consideration body mass index, skin laxity, comorbidities, and risk of contour irregularities. Patient counseling is critical for setting realistic expectations regarding outcomes and should focus on the efficacy of cryolipolysis, individual variability in results, potential side effects, time course of treatment response, and the need for multiple treatment cycles. Strategies for reaching new patients and expanding services among current cryolipolysis patients are discussed.