Management of retrosternal adhesion after median sternotomy by controlling degradation speed of a dextran and ε-poly (l-lysine)-based biocompatible glue

Takai, Fumie; Takeda, Takahide; Yamazaki, Kazuhiro; Ikeda, Tadashi; Hyon, Suong‐Hyu; Minatoya, Kenji; Masumoto, Hidetoshi

doi:10.1007/s11748-020-01297-3

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…It is commonly used in clinical practice as a hemostat in digestive endoscopy [57][58][59]. It may also be used as an antiadhesion biomaterial providing deep wound healing while limiting progression of fibrosis [60][61][62]. It has adhesive and anti-microbial properties while being biocompatible [63].…”

Section: Discussionmentioning

confidence: 99%

Development of Experimental Animal Model and Methodology for Evaluation of a Seroma Prevention Approach

2023

J Surg

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Background: seroma is a frequent complication after routine procedures such as mastectomy or latissimus dorsi flap harvesting. Despite multiple attempts to find preventive and curative solutions, seroma remains a major surgical complication.No method of prevention is completely satisfactory at the present time.Objective: we aim to present an experimental animal model of seroma production after latissimus dorsi muscle and axillary nodes harvest and follow-up protocol to evaluate the efficacy and tolerability of seroma prevention methods.Methods: we performed a harvest of the right latissimus dorsi muscle and axillary lymph nodes, in 50 Wistar rats divided in 5 groups (n = 10 rats per group). In group I no seroma prevention was performed. Seroma prevention groups were the following: in group II Quilting Sutures (QS), group III Fibrin Glue (FG) application, group IV VENASEAL ® application and group V NEXPOWDER ® application. Follow-up included standard photographs, in vivo fluorescence imaging of flap perfusion, microCT-scan, seroma puncture and histological flap analysis at POD7, 30 and 90.Results: we developed a reliable surgical animal model of latissimus dorsi harvest to create seroma as observed in clinical practice. At POD7 the use of QS, FG and VENASEAL ® showed a significant decrease in seroma volume compared with control group (respectively p=0.0016, p=0.0005 and p<0.0001) in both microCT-scan and puncture measurements. At POD30 there was no difference between groups. POD7 flap vascularization was significantly lower in control group compared to QS (p<0.0001), FG (p< 0.0001), VENASEAL ® (p<0.0001) and non-operated (p=0.0289) groups as illustrated by fluorescence imaging. Histological analysis showed significant inflammation in the prevention methods and specifically when a TA was used. Conclusion:Our animal model and monitoring methodology allow for assessing methods of prevention of seroma as well as the potential associated complications. It may be used as a basic protocol for further studies of innovative tissue adhesives.

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Section: Discussionmentioning

confidence: 99%

Development of Experimental Animal Model and Methodology for Evaluation of a Seroma Prevention Approach

2023

J Surg

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“…Second, using a small right anterolateral thoracotomy incision before resternotomy, risky structures for injuries in the retrosternal area (i.e., adhesions in the aorta, patent coronary grafts, and right ventricles) can be removed from the retrosternal area. These strategies may be helpful to prevent catastrophic injuries in the major cardiovascular structures during resternotomy and to reduce mortality [ 21 ] . However, some authors argue that resternotomy-related injuries have no significant effect on perioperative mortality [ 22 ] .…”

Section: Discussionmentioning

confidence: 99%

Retrosternal Deformations after Coronary Artery Bypass Surgery Using Statistical Shape Analysis

Bademci

Ocakoğlu

Kocaaslan

et al. 2021

Braz J Cardiovasc Surg

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Introduction In this study, we aimed to evaluate the anatomical deformations of the major vascular structures in the retrosternal area caused by adhesions following coronary artery bypass grafting (CABG). Methods This single-center, retrospective study included a total of 40 patients with a previous CABG who were admitted to our emergency unit for any reason and underwent a contrast-enhanced chest computed tomography (patient group) and 40 patients without previous cardiac surgery (control group) between January 2018 and November 2019. The retrosternal area was compared between the groups using the statistical shape analysis method. The distance between the sternum and the ascending aorta and pulmonary artery was measured and anatomical deformations of the retrosternal area were examined. Results There was a statistically significant difference in the anatomical structures of the retrosternal area between the patient and control groups ( P <0.001). The distance from the midsternal line to the highest point of the pulmonary artery was statistically significantly shorter in the patient group, compared to the control group ( P =0.013). The distance from the sternum to the ascending aorta was also shorter in the patient group, although it did not reach statistical significance ( P >0.05). Conclusions Our study results showed narrowing of the retrosternal area following CABG and a shorter distance from the sternum to the pulmonary artery than the ascending aorta. Based on these findings, surgeons should be cautious about possible injuries in patients requiring cardiac surgery with repeated median sternotomy.

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“…[ 85 ] The aldehyded dextran can react with the ε‐PLL amine function to form medical adhesives. [ 86 ] These hydrogels can be used as adhesive and glue and to decrease the infection risk. [ 87 ] For example, the hydrogels developed by Hyon et al between aldehyded dextran and ε‐PLL showed low cytotoxicity on L929 mouse fibroblast cells due to the absence of cross‐linker and to the noncytotoxic polymers used for the development of the hydrogels.…”

Section: ε‐Pll For Hydrogel Synthesismentioning

confidence: 99%

The High Potential of ε‐Poly‐l‐Lysine for the Development of Antimicrobial Biomaterials

Lebaudy,

Guilbaud-Chéreau,

Frisch

et al. 2023

Advanced NanoBiomed Research

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ε‐poly‐l‐lysine (ε‐PLL) is a natural polypeptide/polycation originating from bacteria. Thanks to its antifungal and antibacterial properties, it is the subject of extensive research in the food and medical industries. ε‐PLL is also used to develop biomaterials in a broad range of applications, such as drug delivery, wound healing, or antimicrobial coatings. Indeed, loading ε‐PLL inside nanoparticles, functionalizing implant surfaces with ε‐PLL, or developing hydrogels based on reactions between ε‐PLL and other polymers can improve the materials properties, leading to biocompatible, antibacterial, and antifungal systems. These characteristics are necessary not only for the development of biomaterials, for their integrity in a biological environment, but also for improving the performances of medical devices. Moreover, ε‐PLL can be used as an alternative to antibiotics as its mechanism of action reduces the bacterial resistance risk compared with antibiotics. Finally, “smart” systems using ε‐PLL may be developed, with controllable material degradation or drug delivery via pH or temperature variations. This review sought to gather the latest research on the development of antimicrobial biomaterials based on the ε‐PLL polypeptide.

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Management of retrosternal adhesion after median sternotomy by controlling degradation speed of a dextran and ε-poly (l-lysine)-based biocompatible glue

Cited by 6 publications

References 18 publications

Development of Experimental Animal Model and Methodology for Evaluation of a Seroma Prevention Approach

Development of Experimental Animal Model and Methodology for Evaluation of a Seroma Prevention Approach

Retrosternal Deformations after Coronary Artery Bypass Surgery Using Statistical Shape Analysis

The High Potential of ε‐Poly‐l‐Lysine for the Development of Antimicrobial Biomaterials

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