Fibrin Sealant: Scientific Rationale, Production Methods, Properties, and Current Clinical Use

Abstract

Fibrin sealant is a complex plasma-derived product which is increasingly used as a biodegradable tissue adhesive or sealant to stop or control bleeding or provide air and fluid tightness in many surgical situations. This review describes the historical development of current fibrin sealant preparations and the scientific rationale behind the alleged physiological benefits of its major plasma-derived components. A comparison in the extraction methods and viral reduction treatments applied to current commercial products and autologous preparations, and their respective advantages and limits, are discussed. Application devices used for surgical applications are described. A survey of the major clinical applications in various surgical areas is presented. Current issues in terms of viral safety, definition of optimal fibrin sealant composition, and regulatory concerns, especially to demonstrate clinical efficacy, are also included.

Treatment of Fistulas-in-Ano With Fibrin Sealant in Combination With Intra-adhesive Antibiotics and/or Surgical Closure of the Internal Fistula Opening

“…[43][44][45][46] Fibrin sealant has been used to deliver cytokines, including TGF-␤, in experimental models. [47][48][49][50][51][52] The ultimate goal of treating fistulas-in-ano with fibrin sealant is fibrosis of the …”

Evaluation of mechanical closure resistance of sutureless vitrectomy sclerotomies after conjunctival cauterization with bipolar diathermy forceps

“…They can be synthetic glues (cyanoacrylate [30][31][32] and polyethylene glycol derived [33][34][35]) or biologic adhesives (such as fibrin-based glues [9,[36][37][38]). Although these preparations have proven to be effective in occluding sclerotomies, they also present a range of disadvantages, in addition to their high costs.…”

“…Synthetic adhesives have been related to ocular inflammation, foreign body sensation, conjunctival neovascularization, and tissue necrosis. The use of fibrin glue, which is derived from human thrombin, carries a small risk of infection from a contaminated donor pool as well as anaphylactic reaction [9,37,39,40].…”

Endoscopic Fibrin Sealant Injection with Application of Hemostatic Clips: A Novel Method of Closing a Refractory Gastrocutaneous Fistula

“…Fibrin sealant (also often referred to as fibrin glue) is an effective tissue adhesive that can help hemostasis and tissue adherence in many surgical situations (2). Indicated usage is for the control of bleeding when conventional surgical techniques (such as suture and cautery) are ineffective or impractical.…”

“…Viral inactivation by vapor heating and solvent-detergent treatment reduces viral load to negligible levels. There have been no reports of viral transmission from commercial fibrin sealants (2). The four separate vials in the fibrin sealant kit are designed to be reconstituted into two final components that, when mixed, will form the stable fibrin coagulum.…”