Saltz R, Sierra D, Feldman D, Saltz M B, Dimick A, Vasconez L O
Department of Biomedical Enginnering, University of Alabama, Birmingham.
Plast Reconstr Surg. 1991 Dec;88(6):1005-15; discussion 1016-7.
A 2-year experience with laboratory and clinical applications of fibrin glue is presented. An autologous technique, which eliminates the danger of multidonor preparations, has been developed in our blood bank. While one can obtain different fibrinogen concentrations from the same amount of a patient's blood, in vitro mechanical testing demonstrated that at higher fibrinogen concentrations there is an increase in shear adhesive strength. Evaluation of skin-graft take in 16 Sprague-Dawley rats did not demonstrate significant differences in healing when adhesive use was compared with suture technique. In a clinical study, four different groups of patients (facial burns, hand burns, difficult graft sites, and miscellaneous surgical applications) benefited from autologous or single-donor fibrin glue for a total of 82 cases. There are several distinct advantages to the use of fibrin adhesive: The autologous technique eliminates the risk of transmissible viral diseases (AIDS, hepatitis); it can be used as a sealant in the treatment of seromas, dural leaks, and lymphoceles; and it improves hemostasis and early graft adherence. Face and hands are resurfaced with sheet grafts in a single procedure, obtaining a better aesthetic result with complete graft take and immediate start of physical therapy. Neither sutures nor pressure dressings are required. The minimal postoperative care associated with early return to normal activities seems to increase the satisfaction of patients and nurse personnel.
本文介绍了纤维蛋白胶在实验室和临床应用方面的两年经验。我们血库开发了一种自体技术，消除了多供体制剂的风险。虽然从相同量的患者血液中可以获得不同浓度的纤维蛋白原，但体外力学测试表明，在较高纤维蛋白原浓度下，剪切粘合强度会增加。对16只Sprague-Dawley大鼠的皮肤移植成活情况进行评估时，将粘合剂使用与缝合技术进行比较，未发现愈合方面的显著差异。在一项临床研究中，四组不同的患者（面部烧伤、手部烧伤、难植皮部位和其他外科应用）共82例受益于自体或单供体纤维蛋白胶。使用纤维蛋白粘合剂有几个明显的优点：自体技术消除了传染性病毒疾病（艾滋病、肝炎）的风险；它可用作治疗血清肿、硬脑膜漏和淋巴管囊肿的密封剂；它还能改善止血和早期移植物粘连。面部和手部可通过单次手术用片状移植物进行表面修复，获得更好的美学效果，移植物完全成活并可立即开始物理治疗。既不需要缝合也不需要加压包扎。与早期恢复正常活动相关的术后护理最少，这似乎提高了患者和护理人员的满意度。
