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

Abstract

The purpose of this review is to clarify the present use of fibrin sealant in rhyditectomy procedures and help maximize the appropriate and safe application of this material. A set of terms and definitions for hemostats, sealants, and adhesives based on group, category, and class will be employed to highlight the specific capabilities of fibrin sealant. Fibrin sealant has now emerged as an example of maximizing the usefulness of a surgical agent and is the only product with Food and Drug Administration approval in all three groupings: hemostats; sealants; and adhesives. A variety of manufacturers’ fibrin sealant products are available including multiple liquids and one patch. A single liquid product is now specifically indicated for skin flap adherence during rhytidectomy. The unique characteristic of this particular two component fibrin sealant adhesive agent is its slower polymerization rate as a result of a low thrombin concentration which when combined with fibrinogen permits adequate time for manipulation of flaps and tissues prior to final fixation. In addition to its flap adherence and potential space elimination capability, fibrin sealant is also an excellent blood clotting agent and can seal tissues to prevent lymphatic leak or serous fluid accumulation. Thus, it is almost ideally suited to reduce the occurrence of fluid accumulation, hematomas, ecchymoses, and swelling, as well as to possibly eliminate the need for drains following rhytidectomy. A literature review of fibrin sealant in rhytidectomy is included to help define the current state of its clinical use. The author’s recommendations for the best use of this material during facial procedures are also provided.

Low thrombin tissue sealant ARTISS (Baxter), in complex primary closure after Fournier’s gangrene

“…By virtue of their technical simplicity, fibrin sealants offer an attractive adjunct to a variety of reconstructive techniques where sutures or staples alone are expected to yield unsatisfactory results [7]. Artiss is unique in that its characteristic low concentration of thrombin (4.5IU) enables adequate time of up to 60 seconds for manipulation of tissue or flaps before polymerization and final fixation occurs [8]. In the following case report, we describe how Artiss works as a valuable tool for wound approximation during the reconstruction of FG sequelae.…”

A hospital cost analysis of a fibrin sealant patch in soft tissue and hepatic surgical bleeding

“…In some bleeding situations, conventional surgical methods (eg, sutures or clips) to control bleeding may be impractical or ineffective. 16 , 18 , 19 As a result, these situations often require the use of adjunctive agents, such as topical absorbable hemostats or fibrin sealants. 1 , 20 Although there are several products available, their efficacy in controlling bleeding can be limited, with uncontrolled bleeding remaining a prevalent problem.…”

Efficacy and Safety of Artiss Fibrin Tissue Sealant Use in Rhytidectomy: A Review of 120 Cases

“…Previous studies, reviews, and anecdotal reports have provided a wide range of results and conclusions on the use of fibrin tissue sealants in facelift. [5][6][7][8][9][10][11][12] Tisseel (Baxter) was approved by the U.S. Food and Drug Administration (FDA) in 1998 for use in hemostasis and wound sealing in surgery. 13 While not designed specifically for facelifts, surgeons learned to modify the mixing process of Tisseel to create a slow-setting sealant and allow for practical use during fixation of the skin flap.…”

“…13 While not designed specifically for facelifts, surgeons learned to modify the mixing process of Tisseel to create a slow-setting sealant and allow for practical use during fixation of the skin flap. 11 Increasing numbers of facial plastic surgeons using Tisseel behooved development of a fibrin tissue sealant designed specifically for facelifts. In 2011, Artiss (Baxter) was FDA approved as the first fibrin tissue sealant for use in facelifts.…”

“…14 The low concentration of thrombin (4.5 IU) makes Artiss an adhesive, not a hemostat, and provides the surgeon up to 60 seconds to position the skin flap prior to fixation. 11 In our practice, Tisseel was used in facelifts for more than a decade. We mixed the lyophilized thrombin powder with fibrinogen, aprotinin, and calcium chloride to create a tissue sealant well-suited for facelift flap adhesion.…”