Efficacy and safety of fibrin sealant for tissue adherence in facial rhytidectomy

Abstract

The purpose of this review is to clarify the present use of fibrin sealant in rhyditectomy procedures and help maximize the appropriate and safe application of this material. A set of terms and definitions for hemostats, sealants, and adhesives based on group, category, and class will be employed to highlight the specific capabilities of fibrin sealant. Fibrin sealant has now emerged as an example of maximizing the usefulness of a surgical agent and is the only product with Food and Drug Administration approval in all three groupings: hemostats; sealants; and adhesives. A variety of manufacturers' fibrin sealant products are available including multiple liquids and one patch. A single liquid product is now specifically indicated for skin flap adherence during rhytidectomy. The unique characteristic of this particular two component fibrin sealant adhesive agent is its slower polymerization rate as a result of a low thrombin concentration which when combined with fibrinogen permits adequate time for manipulation of flaps and tissues prior to final fixation. In addition to its flap adherence and potential space elimination capability, fibrin sealant is also an excellent blood clotting agent and can seal tissues to prevent lymphatic leak or serous fluid accumulation. Thus, it is almost ideally suited to reduce the occurrence of fluid accumulation, hematomas, ecchymoses, and swelling, as well as to possibly eliminate the need for drains following rhytidectomy. A literature review of fibrin sealant in rhytidectomy is included to help define the current state of its clinical use. The author's recommendations for the best use of this material during facial procedures are also provided.

Keywords: adhesives; blood; hemostats; lymph; sealants; serous fluid.

Figure 1

Applicator for fibrin sealant product (Artiss; Baxter, Westlake Village, CA) approved for use in rhytidectomy.

Figure 2

Placement of a split thickness skin graft using a thin layer of fibrin sealant application (top portion) without the need for staples or sutures (bottom portion).

Figure 3

Use of fibrin sealant to attach skin flaps to underlying tissue at the time of neck dissection (top portion) and placement of gentle pressure during adhesive polymerization (bottom portion). Modified and used with permission of Peoples Medical Publishing House – USA (PMPH-USA) from Spotnitz WD, Burks SG, Prabhu R. Fibrin based adhesives and hemostatic agents. In: James V. Quinn, editor. Tissue Adhesives in Clinical Medicine, 2nd Edition. BC Decker; 2005: 94 (Figures 4–6).

Figure 4

Manufacturer supplied Artiss device (Baxter, Westlake Village, CA) to facilitate dissolving freeze dried fibrinogen and thrombin powders in saline solutions.

Figure 5

Some spray (top portion) and cannula (bottom portion) type applicators which can be used for application of fibrin sealant.