SUTURELESS CARTILAGE GRAFT LARYNGOTRACHEAL RECONSTRUCTION USING FIBRIN SEALANT

Objective: To determine whether fibrin sealant can replace suture as a means of holding a cartilage graft securely in the trachea. Design: R andomized blinded control study comparing the use of Abrin sealant vs sutures in laryngotracheal reconstruction in ferrets. We compared resu lts at 7 and 30 days. Subjects: Forty ferrets randomized into 2 groups of 20. fibrin sealant and sutures, Within each group, half were studi ed at 7 days and the rest at 30 days. No ferrets were withdrawn from s tudy because of adverse effects of the intervention. Intervention: A c arved costal cartilage graft was placed in the anterior cricoid split incision, and was secured with either fibrin sealant or sutures. All a nimals were extubated after recovery from anesthesia. Specimens were e xamined grossly and histologically. Results: all animals survived unti l humanely killed. The pathologist, unaware of the groupings, measured lumen expansion in millimeters, cartilage graft migration, mucosal in -growth, degree of inflammation, graft integration, and graft viabilit y. The fibrin sealant group had statistically significant (P < .05) be tter results in mucosal in-growth. In no categories was the suture gro up better than the fibrin sealant group. In comparing 7-day with 30-da y results, the 30-day group had significantly better results in inflam mation and graft viability. Conclusions: Fibrin sealant can be used in place of sutures with improvement in mucosal growth in costal cartila ge laryngotracheal reconstruction in the experimental animal model. Us e of fibrin sealant (instead of sutures) may result in less surgical t rauma and edema, less surgical time, and faster recovery.