Application of fibrin glue in microvascular anastomosis: comparative analysis with the conventional suture technique using an experimental free flap model / Aplicação da cola de fibrina em microanastomoses vasculares: análise comparativa com a técnica de sutura convencional utilizando um modelo experimental de retalho microcirúrgico

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

INTRODUCTION: Microvascular anastomosis is an important component of the free flap surgical procedure. Currently, the conventional suture is still considered the gold standard technique. However, it presents some problems for being technically demanding, time consuming and with a long learning curve. In looking for an easier and faster technique, alternative methods of anastomosis were studied including the fibrin glue. Despite the good results reported in the literature, its acceptance in the clinical setting is still small Controversies regarding its thrombogenicity and mechanical resistance create some concerns about its safeness. The absence of a more realistic experimental model has not allow a full aprecciation of its potencial benefits in clinical use. The aim of this study is clarify these controversies and demonstrate the advantages of fibrin glue application in an environment that can reproduce the clinical practice. METHODS: A free inguinal flap transfer to the anterior cervical region was used as experimental model. The circulation of the flap was restored by means of microvascular anastomosis between the femoral and carotid arteries (end-to-side) and between the femoral and jugular veins (end-to end). The procedures were performed in 20 rabbits that were divided into two groups (n= 10) according to the anastomosis technique: Group I (conventional) and Group II (fibrin glue). RESULTS: The application of fibrin glue significantly reduced the amount of sutures required to complete the anastomoses: 4 less sutures in the arteries and 4,5 less sutures in the veins. In Group I, the mean arterial anastomosis time was 17,21 minutes against 12,72 minutes in Group II. In the veins, the mean anastomosis time in Group I was 22,93 minutes against 16,57 minutes in Group II. The application of fibrin glue also reduced the flap ischemic time and the total operative time by 11,5 minutes and 15,67 minutes, respectively. The flapssurvival rate was 90% in both groups. CONCLUSIONS: The application of fibrin glue in microvascular anastomoses was reliable and effective in this study.

ASSUNTO(S)

adesivo tecidual de fibrina anastomosis surgical disease models animal fibrin tissue adhesive reconstructive surgical rocedures procedimentos cirúrgicos reconstrutivos surgical flaps modelos animais de doenças microsurgery microcirurgia anastomose cirúrgica retalhos cirúrgicos

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