Effect of Fibrin Adhesive Application in Microvascular Anastomosis: A Comparative Experimental Study

Abstract

The application of fibrin adhesive did not result in any harmful effects in the microvascular anastomosis. The authors encourage the clinical application of fibrin adhesive in more complex cases, when more than one microvascular anastomosis is required.

Two-Suture Fish-Mouth End-to-Side Microvascular Anastomosis With Fibrin Glue

“…33Y35 The tensile strength of fibrin glueYassisted anastomosis is shown to be less than that of conventional anastomosis, which may result in high aneurysm formation rates. 8 We used 2 stay-sutures to provide adequate initial strength and observed aneurysm formation at 1 case in the experimental group on the 21st day. At this point, combination of least possible number of sutures and fibrin glue application appears to obtain optimal results.…”

“…8 By mimicking the last steps of the coagulation cascade, thrombogenicity is intentionally induced by fibrin adhesives, to prevent any leakage and hemorrhage at the lumen periphery. Our results confirm several previous studies proving there is no increased thrombogenicity with fibrin glue application in microvascular anastomosis.…”

Application of fibrin glue in microvascular anastomoses: Comparative analysis with the conventional suture technique using a free flap model

“…The possibility of minimizing the number of sutures required per anastomosis was also evidenced in other studies, where 33-50% of suture reduction was successfully achieved. 1,8,12,13 On the other hand, Sagi et al 6 and Moskovitz et al 9 tried to perform anastomoses in the femoral and inferior epigastric arteries using only fibrin glue, without any suture, but the results were catastrophic due to acute anastomosis disruption and high rate of aneurysm formation. A common issue of these two studies was that they relied solely on the fibrin glue to support the anastomoses.…”

“…Since the first experiments with fibrin glue application in microvascular anastomoses by Pearl et al 1 and Matras et al 2 in 1977, several authors reported its use to minimize the number of sutures and to decrease the surgery time required to perform microvascular anastomosis. [3][4][5][6][7][8][9][10][11][12][13] Most of them achieved very satisfactory results, with significant reduction of sutures and anastomosis time, yet maintaining adequate patency rates. Despite the supporting evidences in the experimental literature, the clinical application of fibrin glue in microvascular anastomoses is still limited to a few case series.…”

Technology‐assisted and sutureless microvascular anastomoses: Evidence for current techniques

“…[52][53][54][55][56][57] However, concerns regarding the inherent thrombogenicity of these products and the potential for triggering intraluminial thrombosis exist. 58 Although promising animal studies have been published, [59][60][61][62][63][64] few clinical series exist. At least one large series of free tissue transfers in breast reconstruction (n 5 349) reports use of thrombin-based glues with no apparent increase in anastomotic failure.…”