Krishnan Lissy K, Mohanty Mira, Umashankar P R, Lal Arthur Vijayan
Biomedical Technology Wing Pojappure, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thrombosis Research Unit, Trivandrum, Kerala 695012, India.
Biomaterials. 2004 Nov;25(24):5557-63. doi: 10.1016/j.biomaterials.2004.01.013.
Bioactive hemostats and wound dressings consist of either inherently active materials or act as delivery vehicles which contain such materials. Fibrin is a natural hemostat and scaffold, guiding the direction of wound contraction and closure. In order to improve the ease of application of liquid fibrin glue, we have made a freeze-dried form of polymerized fibrin that supports hemostasis and wound healing. The bleeding from the middle ear artery of rabbits was found to be arrested instantaneously on application of fibrin sheets, even when the animal was heparinized systemically. As the fibrin sheet was found to be fragile, gelatin was incorporated to the sheet and thus the mechanical stability was improved without compromising the hemostatic effect. The efficacy of the fabricated fibrin and fibrin-gelatin sheets to seal traumatized rat liver was compared with commercially available hemostats, Abgel (cross-linked gelatin) and Surgicel (cross-linked cellulose). Tissue compatibility of all the hemostats was studied by analyzing the liver tissue 15 days after application. While the hemostatic effect was best with fibrin and fibrin-gelatin sheets, both Surgicel and Abgel were not capable of arresting the bleeding quickly. Gross analysis of tissue on the 15th day of application, visibly, Abgel was not only degraded but resulted in severe adhesions of internal organs and histologically capsule formation around the implant was evident. Though Surgicel was also seen as cream soft material on the site of application that joined two pieces of liver, there was no adhesion of other internal organs and histologically, immune reaction and foreign-body-type giant cells were present in large amounts. Fibrin was not found grossly on application site whereas fibrin-gelatin was seen as a small white spot. Granulation tissue formation and cell migration into the fibrin-based sheets were evident, and therefore, fibrin-based sheets are not only efficient hemostats but showed optimum degradation and wound healing.
生物活性止血剂和伤口敷料由本质上具有活性的材料组成,或者作为含有此类材料的递送载体。纤维蛋白是一种天然止血剂和支架,可引导伤口收缩和闭合的方向。为了提高液体纤维蛋白胶的应用便利性,我们制备了一种支持止血和伤口愈合的冻干聚合纤维蛋白形式。发现即使动物全身肝素化,在应用纤维蛋白片时,兔中耳动脉出血也能立即停止。由于发现纤维蛋白片易碎,因此在片中加入了明胶,从而在不影响止血效果的情况下提高了机械稳定性。将制备的纤维蛋白和纤维蛋白 - 明胶片对创伤大鼠肝脏的封闭效果与市售止血剂Abgel(交联明胶)和Surgicel(交联纤维素)进行了比较。在应用15天后通过分析肝脏组织研究了所有止血剂的组织相容性。虽然纤维蛋白和纤维蛋白 - 明胶片的止血效果最佳,但Surgicel和Abgel都不能迅速止血。在应用第15天对组织进行大体分析,明显可见,Abgel不仅降解,还导致内部器官严重粘连,并且在植入物周围明显形成组织学上的包膜。虽然在应用部位也可见Surgicel为连接两块肝脏的乳膏状柔软材料,但没有其他内部器官的粘连,并且在组织学上,存在大量免疫反应和异物型巨细胞。在应用部位大体上未发现纤维蛋白,而纤维蛋白 - 明胶被视为一个小白点。肉芽组织形成和细胞迁移到基于纤维蛋白的片中很明显,因此,基于纤维蛋白的片不仅是有效的止血剂,而且显示出最佳的降解和伤口愈合。