Fibrin sealants in surgical practice: An overview

The need to effectively manage hemostasis and tissue sealing during surgery has had a strong influence on the development of modern surgical technique s. A group of agents known as surgical tissue adhesives has been developed to promote hemostasis and tissue sealing during surgery, and these comprise both natural and synthetic agents. Fibrin sealants are the most effective tissue adhesives currently available, and they are biocompatible and biodeg radable. The fibrin sealants are comprised of purified, virus-inactivated h uman fibrinogen, human thrombin, and sometimes added components, such as vi rus-inactivated human factor XIII and bovine aprotinin. These agents mimic the final steps of the physiological coagulation cascade to form a fibrin c lot. The use of any plasma-derived product in the surgical setting carries a potential risk of viral transmission. In fact, it was the risk of viral t ransmission from fibrinogen and thrombin that halted development work on fi brin sealants in the United States. Since that time, new techniques for iso lating and concentrating plasma fractions have been developed, and national and international guidelines have been introduced to ensure the safety of all plasma products. All plasma donors are carefully selected and their pla sma units screened for viral contamination before processing. All plasma do nations and bovine tissue used in the production of commercial fibrin seala nts undergo rigorous viral reduction/elimination steps. As a result of this carefully controlled and monitored process, there have been no proven case s of viral transmission associated with the use of commercial fibrin sealan t. Fibrin sealants are currently used in a number of surgical specialties, including cardiovascular surgery, thoracic surgery, neurosurgery, plastic a nd reconstructive surgery, and dental surgery. The use of fibrin sealants h as a positive effect on surgical outcomes, such as improved time to hemosta sis, reduced blood loss, and reduced complications. This review describes t he development of fibrin sealants, the composition of currently available p roducts, and their use in surgical practice. (C) 2001 Excerpta Medica, Inc. All rights reserved.