[HSF] Bioglue

Nasser F. Abou'Seada nfaabouseada at gmail.com
Wed Nov 8 04:23:30 EST 2006 

don ... I echo your opinion .....
another question .... what is "no pull" ?? 

NFA

> From: Donald Ross
> Wow!
> Surely we need another wiki for little gems like this, and 2000 cases
> without sternal infection etc.  The sort of stuff which is difficult
> and not "scientific" enough to publish in regular journals. And
> because it is a wiki the peer review can be accomplished by anyone
> who wants to rubbish or praise it.
> Also Prasanna wouldn't be able to claim he doesn't have time to write
> papers!
> In Australia we would call such a wiki "No bull"
> What do the rest of you bull or nad artists think?
> Don
> On 08/11/2006, at 12:48 PM, prasannasimha wrote:
> 
> > I have done this in a total of 6 cases . The first case was in 1996
> > when I was in another teaching hospital . That patient was actually
> > a patient of my senior colleague when I suggested it to him and the
> > patient agreed.The last one I did was 2 months back. All 6 cases
> > had a satisfactory union.
> > The last case was a case of CABG who had a papillary carcinoma of
> > the thyroid and had previous radiation therapy. His sternum
> > appeared stable post op but dehisced and was mobile when he came at
> > 3 months follow up. We  managed him conservatively for another 12
> > months  as the dehiscence appeared minimal.
> > He cam e back to us after that time with a grossly dehisced sternum
> > with fibrous union and the sternal edges were very mobile. We did
> > an Onco consult who said that there was no recurrence of the
> > tumour. He was also not interested in "reficing" the sternum with a
> > plate etc. So I glued his sternum. Basically took cyanoacrylate
> > glue (under fluoro control) and injected the intervening space
> > between the sternum with cyanoacrylate glue and placed a chest
> > binder. (initally gave a local infiltration, waited for 10 minutes
> > and then injected it. The first injection reduced the mobility but
> > did not stop it totally (there was one "free fragment" and I
> > repeated it in another two sessions with the sternum getting
> > "fixed"  NSAID's given in the interim.
> > Prasanna
> > Donald Ross wrote:
> >> Prasanna,
> >> I know you don't have time to publish and I can understand that
> >> and judging by your operating load and HSF dedication I wonder you
> >> have time to sleep.
> >> Can you however , expand a little more on this gluing of chronic
> >> unstable sternums?
> >> I understand that this is  a rare and usually benign sternal
> >> complication but I am fascinated by the concept and from whose in
> >> fertile brain the idea germinated. ( I hope they had ethics approval)
> >> Success rate for example? Any experience with obese patients? How
> >> many treated?
> >> Don
> >>
> >>
> >>
> >>
> >> On 07/11/2006, at 11:45 PM, psimha wrote:
> >>
> >>>
> >>> Yes. Absolutely not for acute ones !!
> >>> Prasanna
> >>> Donald Ross wrote:
> >>>> Do we hear correctly?
> >>>> You can inject cyanoacrylate percutaneously  to fix an unstable
> >>>> sternum? I presume these are chronic cases?
> >>>> Don
> >>>> On 07/11/2006, at 5:34 AM, prasannasimha wrote:
> >>>>
> >>>>> Giulio,
> >>>>> I have used cyanoacrylate glue (basically super glue )
> >>>>> extensively. The one thing that is important is to have a dry
> >>>>> field. This may involve clamping or even a short period of circ
> >>>>> arrest. If the area is not dry and blood free then the blood
> >>>>> congeals on the glue  instead of two ends sticking.
> >>>>> I t works well to sterilize meshes and also for postoperative
> >>>>> sinuses too. I have even glued percutaneously unstable sternums
> >>>>> with and without fibrous union. It  works well in them too.
> >>>>> Prasanna
> >>>>> Giulio Rizzoli wrote:
> >>>>>>
> >>>>>> Thank You Ben for the nice summarization.
> >>>>>> I will add that among the adhesives there are the acrylic
> >>>>>> glues. Their use was proposed in this  forum as a lifesaving
> >>>>>> maneuver in cases of bleedings located in not reachable areas.
> >>>>>> I experienced one of these cases in an aortic root replacement
> >>>>>> that was successfully solved, as proposed by Levinson (I
> >>>>>> think) on this forum by clamping both caval veins followed by
> >>>>>> clamping of the aortic prosthesis and applying the acrylic
> >>>>>> glue on the blood deprived field. The advantage of the glue in
> >>>>>> this case was in the rapidity of action so the heart tolerated
> >>>>>> without problem the maneuver.
> >>>>>> I don't use the commercially available acrylic glue but a
> >>>>>> modification of it commercialized with the name "Glubran" (you
> >>>>>> can search it in the internet).
> >>>>>> The advantage is that doesn't prohibit the stitching with
> >>>>>> needles because doesn't produce a very hard surface. If You
> >>>>>> use it on a dry suture line you can be sure that you will not
> >>>>>> loose a single drop of blood from that suture line.
> >>>>>>
> >>>>>>         Giulio Rizzoli
> >>>>>>
> >>>>>>
> >>>>>>
> >>>>>>
> >>>>>> One needs to look at such things as glues or adhesives and
> >>>>>> hemostatic agents.
> >>>>>>
> >>>>>> GRF and BioGlue are adhesives. They form a firm layer that
> >>>>>> allows 2 surfaces to adhere - ie layers of a dissection. The
> >>>>>> 'curing' that happens with the glutaraldehyde or formalin
> >>>>>> cures the other components which glue the surfaces together.
> >>>>>> They are hemostatic in that they provide a firm layer, not
> >>>>>> that they encourage hemostasis (rather they probably
> >>>>>> discourage it with their toxic nature).
> >>>>>> We have then the biological sealants. These are the various
> >>>>>> fibrin glues Tisseel for one. These rely on naturally
> >>>>>> occurring fibrinogen being converted to fibrin in an area of
> >>>>>> bleeding. If you can keep the layer from floating away it can
> >>>>>> help. They are naturally absorbed.
> >>>>>> There are the substances that provide a substrate for
> >>>>>> clotting  e.g. Surgicel (oxidised cellulose). Topical thrombin
> >>>>>> is often used with this.
> >>>>>> There are a series of similar products such as Tachosil,
> >>>>>> Tachocomb etc. These are not so much as adhesives but sealants.
> >>>>>> There are now a wealth of other synthetic substances. These
> >>>>>> include Hemaderm or Medafor (a starch based compound that
> >>>>>> absorbs blood and promotes clotting as well as providing a
> >>>>>> degree of tamponade). CoSeal and related substances act as
> >>>>>> sealants with no mechanical strength.
> >>>>>>
> >>>>>> There are also the devices Tomas mentioned a couple of weeks ago.
> >>>>>>
> >>>>>> These all are topical. I have not mentioned any of the drugs
> >>>>>> that can be given internally (lysine analogues and aprotinin
> >>>>>> etc.)
> >>>>>>
> >>>>>> So, as far as Bioglue goes, not good for stopping bleeding,
> >>>>>> but useful in VSD and LV rupture etc.
> >>>>>> It has a drawback - it solidifies and thus can embolise.
> >>>>>>
> >>>>>> So, there are horses for courses.
> >>>>>> (Sorry for the lecture it is part of a talk on such things)
> >>>>>
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