Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy

Abstract

Background Pharyngocutaneous fistula is a major wound complication of total laryngectomy. Surgical sealants may be used to increase the strength and/or integrity of surgical repairs. The purpose of this study was to present our evaluation of the feasibility and utility of the application of sealant to the pharyngeal repair with the aim of reducing pharyngocutaneous fistula incidence. Methods This was a prospective single‐blind randomized controlled study; patients undergoing primary total laryngectomy for advanced carcinoma of the larynx were randomized into control and treatment (albumin‐polyaldehyde sealant applied to pharyngeal repair) groups. Relevant patient, disease, and management‐related factors were recorded. Results Forty‐five patients were included (23 controls and 22 who received treatments). No difference in the incidence of pharyngocutaneous fistula was observed between the 2 groups. No treatment‐related complications occurred. Conclusion Feasibility of application of an albumin‐polyaldehyde surgical sealant to the pharyngeal repair was demonstrated, however, a pharyngocutaneous fistula‐preventative effect was not observed. Larger animal and clinical studies are encouraged to clarify this finding.

Dual-Mode Cross-Linking Enhances Adhesion of Silk Fibroin Hydrogels to Intestinal Tissue

“…Figure 1 shows representative results from SDS PAGE, where the numbers below the gel images are a molecular weight that was calculated using protein standards and image analysis to generate a histogram, from which a peak was fitted, and molecular weight was calculated. This number is comparable to a number-averaged molecular weight, and the 5), (iii) SF (aq) (30), (iv) SF (IL) ( 5), (v) SF (IL) (30), (vi) cSF (IL) (5), and (vii) cSF (IL) (30); and (b) silk fibroin conjugates run on a 4−12% bis Tris gel: (i) MW marker, (ii) cSF (aq) (5), and (iii) cSF (aq) (30). Replicate experiments resulted in similar molecular weight values.…”

“…It was found that, for all of the silks except cSF (aq) , the samples successfully separated on Tris acetate gels (Figure 1a) but showed hindered migration through the bis Tris (Figure 1b) gels. In these figures, precursor silks for aqueous phase carboxylation are SF (aq) (5) and SF (aq) (30), and the precursor silks for organic phase carboxylation are SF (IL) (5) and SF (IL) (30), where the numbers in parentheses denote the fibroin extraction time.…”

“…3 Both GA-based and fibrin-based materials display two features that are required for internal adhesives: they are deliverable as an aqueous solution and display acceptable adhesion in wet environments. Fibrin-based adhesives may be regarded as more biocompatible because they do not contain glutaraldehyde (GA), a reagent that is regarded as potentially toxic, as made evident by the fact that adhesives employing GA have limited approval 4,5 for internal use in the United States. A significant disadvantage of using fibrin-based systems is that they use blood-derived products; thus, these materials must be virus inactivated, and there can be risk for thrombogenesis if components enter the circulation.…”

“…Figure 1. SDS PAGE images of (a) silk fibroin and its conjugates run on a 3−8% Tris acetate gel: (i) MW marker, (ii) SF (aq) (5), (iii) SF (aq)(30), (iv) SF (IL)(5), (v) SF (IL)(30), (vi) cSF (IL)(5), and (vii) cSF (IL)(30); and (b) silk fibroin conjugates run on a 4−12% bis Tris gel: (i) MW marker, (ii) cSF (aq)(5), and (iii) cSF (aq)(30).…”

Pharyngo-cutaneous fistula formation following total laryngectomy: management, sequelae and outcomes

“…Pre-operatively there is unfortunately often little time for "pre-habilitation". Intraoperatively, modifications of technique such as the use of barbed sutures 14 , stapler closure 15,16 , salivary bypass tubes 17 , sealants 18 or even transoral robotic total laryngectomy 19,20 have all been suggested. Reinforcing primary pharyngeal closure with a pectoralis major muscle-only overlay has also been suggested 21 .…”