Behaviour of the Biological Adhesives TachoSil®, GelitaSpon®, and a New Elastic Cyanoacrylate (Adhflex®) in Experimental Renal Trauma and Wound Healing

Abstract

Background: Renal injuries are relatively frequent in abdominal trauma. In some cases, adhesives and sealants can be used to repair and preserve injured organs. This paper describes the behaviour of three biomaterials - TachoSil®, GelitaSpon®, and a new elastic cyanoacrylate (CyA), Adhflex® - in standardized experimental renal injuries. Methods: Ninety male Wistar rats (300-350 g) were used. A Stiefel Biopsy Punch (8 mm diameter, 3 mm depth) was used to create injuries to the anterior kidney to evaluate wound healing. The animals were divided into five groups: (1) sham (n = 3); (2) control (n = 6), untreated, standard punch injury created on the anterior left kidney; (3) TachoSil® (n = 27), punch injury treated with TachoSil®; (4) GelitaSpon® (n = 27), punch injury treated with GelitaSpon®, and (5) Adhflex® (n = 27), punch injury treated with the new elastic CyA adhesive. The parameters studied were bleeding time, peritoneal adhesions, and histopathological evaluation of wound healing on days 2, 6, and 18, including measurements of the gap between wound edges, inflammatory reaction (CD68), and vascular neoformation (CD31). Results: The bleeding time was significantly shorter (27.7 ± 12.9 s) in the Adhflex® group than in the control (135.8 ± 11.6 s; p < 0.01), TachoSil® (77.5 ± 7.4 s; p < 0.05), and GelitaSpon® (82.5 ± 14.4 s; p < 0.05) groups. The incidence of intraperitoneal adhesions in the animals treated with Adhflex® was 3.6 times higher than in the non-treated group. It was also higher (p < 0.04) than in the groups treated with TachoSil® and GelitaSpon®. The time point with the largest gap between the wound edges and most abundant granulation tissue was at day 6. The largest gap after 18 days was reported for the Adhflex® adhesive. With regard to the markers CD31 and CD68, Adhflex® showed the largest areas 2 days after surgery, but no differences were found after 6 and 18 days versus the other treatments. The expression of the immunomarkers on the renal samples treated with Adhflex® was consistent with a normal healing process. Conclusions: In this experimental model of renal injuries, the new elastic CyA (Adhflex®) resulted in the shortest bleeding time. It offers rapid sealing of the bleeding produced by renal injuries, fixation to adjacent tissues, and reduced occurrences of relapse. The evolution of the scarring is similar to other procedures. Given that traumatic renal injuries are always an emergency due to haemorrhage, Adhflex® might offer additional benefits over conventional treatment methods in human clinical practice.

Tracking Healing Process of Experimental Liver Injuries Treated with Different Sealants and Adhesives Biomaterials. Matrix Metalloproteinase Evaluation

“…As has been described for renal injuries [14], the histological healing process of hepatic lesions in response to the three biomaterials was comparable. However, MMP expression varied depending on the sealant used.…”

“…[13] Some of the MMP-attributed roles in acute and chronic liver injury have been described, emphasizing the need for further experimentation to better understand their functions both in physiological conditions and during hepatic disease progression. [14] As a result of technological developments, the use of tissue adhesives and glues for tissue approximation and hemostasis has increased in surgery.…”

“…The superior adhesiveness and clotting speed of Adhflex® compared with conventional treatments in other organs suggests that Adhflex® could be considered a useful sealant substance. [14,15] Of the MMPs included in the Mosaic ELISA MMP Panel, only MMP1, MMP2, MMP8, MMP9 and MMP13 were sufficiently expressed to be quantifiable (Fig 1) Fig 1-D). …”

The effect of biological sealants and adhesive treatments on matrix metalloproteinase expression during renal injury healing

“…The degradation process of both TachoSil and GelitaSpon does not entails generation of non-physiologic toxic products. However, the superior adhesiveness and clotting speed showed by Adhflex in previous studies as compared to conventional treatments, suggest that this new elastic cyanoacrylate should be considered a useful sealant substance [19,20]. …”

“…In renal injuries, the renal surface is likely to be better protected if the adhesive being used is elastic, as is the case with Adhflex. In a previous experimental study on renal injuries, a significant reduction in bleeding time has been described using Adhflex as compared to other biological sealants [19]. Additionally, a peritoneal perilesional inflammatory reaction was observed, preventing possible bleeding recurrences in the early stages of healing [19].…”