Document Detail


The potential utility of fibrin sealant dressing in repair of vascular injury in swine.
MedLine Citation:
PMID:  17215739     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: A previous study in which fibrin sealant dressing (FSD) secured hemostasis in major arterial hemorrhage for 96 hours suggested the applicability of this dressing in damage control operations after severe trauma. The objective of this study was to determine the effective duration of FSD hemostatic function in vivo and to examine its potential utility for definitive repair of a major arterial injury in swine. METHODS: High pressure bleeding in an infrarenal aortotomy was controlled by placing FSD on the wound with 4-minute compression (n = 15). If hemostasis was achieved, the abdominal cavity was closed. Surviving animals were killed at 2, 4, 6, and 8 weeks and aortotomy sites collected for histology. RESULTS: FSD stopped arterial hemorrhage after 4-minute compression in 14 of 15 (93%) pigs. Dressings failed in two pigs at 36 and 53 minutes after treatment. Twelve (80%) animals recovered and resumed normal activities. Of the remaining 12, two developed rebleeding at the aortotomy site on days 8 and 11 and were killed; another was killed because of idiopathic low hematocrit on day 10. Nine pigs survived until scheduled to be killed, maintaining hemostasis with stable hematological values. In the surviving animals, serial computed tomography scans showed formation of a pseudoaneurysm at the aortotomy site, which resolved after 2 to 3 weeks. The initial vascular defect and pseudoaneurysm were filled with fibroblast-myoblast collagen rich tissues covered by endothelium. CONCLUSION: FSD can seal an arterial injury, stop high pressure bleeding, and prevent rebleeding for at least 7 days. The dressing may be most beneficial in damage control operations. If combined with an elective interventional radiologic procedure (e.g. embolization or stenting), it may also offer an alternative to suture repair of vascular injuries in cases where profuse bleeding obstructs visualization.
Authors:
Bijan S Kheirabadi; Eric M Acheson; Rodolfo Deguzman; Jacqueline M Crissey; Angel V Delgado; Scot J Estep; John B Holcomb
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  62     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-11     Completed Date:  2007-02-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  94-103     Citation Subset:  AIM; IM    
Affiliation:
United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA. bijan.kheirabadi@cen.amedd.army.mil
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Animals
Aorta, Abdominal / injuries*,  pathology,  radiography
Female
Fibrin Tissue Adhesive / therapeutic use*
Hemorrhage / therapy*
Hemostatics / therapeutic use*
Occlusive Dressings*
Swine
Tomography, X-Ray Computed
Wound Healing
Chemical
Reg. No./Substance:
0/Fibrin Tissue Adhesive; 0/Hemostatics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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