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  1. Xue YT, Chen MY, Cao JS, Wang L, Hu JH, Li SY, et al.
    Mil Med Res, 2023 Mar 23;10(1):15.
    PMID: 36949519 DOI: 10.1186/s40779-023-00451-1
    BACKGROUND: Reconstruction of damaged tissues requires both surface hemostasis and tissue bridging. Tissues with damage resulting from physical trauma or surgical treatments may have arbitrary surface topographies, making tissue bridging challenging.

    METHODS: This study proposes a tissue adhesive in the form of adhesive cryogel particles (ACPs) made from chitosan, acrylic acid, 1-Ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide (NHS). The adhesion performance was examined by the 180-degree peel test to a collection of tissues including porcine heart, intestine, liver, muscle, and stomach. Cytotoxicity of ACPs was evaluated by cell proliferation of human normal liver cells (LO2) and human intestinal epithelial cells (Caco-2). The degree of inflammation and biodegradability were examined in dorsal subcutaneous rat models. The ability of ACPs to bridge irregular tissue defects was assessed using porcine heart, liver, and kidney as the ex vivo models. Furthermore, a model of repairing liver rupture in rats and an intestinal anastomosis in rabbits were established to verify the effectiveness, biocompatibility, and applicability in clinical surgery.

    RESULTS: ACPs are applicable to confined and irregular tissue defects, such as deep herringbone grooves in the parenchyma organs and annular sections in the cavernous organs. ACPs formed tough adhesion between tissues [(670.9 ± 50.1) J/m2 for the heart, (607.6 ± 30.0) J/m2 for the intestine, (473.7 ± 37.0) J/m2 for the liver, (186.1 ± 13.3) J/m2 for muscle, and (579.3 ± 32.3) J/m2 for the stomach]. ACPs showed considerable cytocompatibility in vitro study, with a high level of cell viability for 3 d [(98.8 ± 1.2) % for LO2 and (98.3 ± 1.6) % for Caco-2]. It has comparable inflammation repair in a ruptured rat liver (P = 0.58 compared with suture closure), the same with intestinal anastomosis in rabbits (P = 0.40 compared with suture anastomosis). Additionally, ACPs-based intestinal anastomosis (less than 30 s) was remarkably faster than the conventional suturing process (more than 10 min). When ACPs degrade after surgery, the tissues heal across the adhesion interface.

    CONCLUSIONS: ACPs are promising as the adhesive for clinical operations and battlefield rescue, with the capability to bridge irregular tissue defects rapidly.

    Matched MeSH terms: Tissue Adhesives*
  2. Romano V, Cruciani M, Conti L, Fontana L
    Cochrane Database Syst Rev, 2016 12 02;12:CD011308.
    PMID: 27911983 DOI: 10.1002/14651858.CD011308.pub2
    BACKGROUND: Pterygium, a growth of the conjunctiva over the cornea, is a progressive disease leading in advanced stages to visual impairment, restriction of ocular motility, chronic inflammation and cosmetic concerns. Surgical removal is the treatment of choice, but recurrence can be a problem. Currently the best surgical option in terms of recurrence is conjunctival autograft. To date the most common surgical methods of attaching conjunctival autografts to the sclera are through suturing or fibrin glue. Each method presents its own advantages and disadvantages. Sutures require considerable skill from the surgeon and can be associated with a prolonged operation time, postoperative discomfort and suture-related complications, whereas fibrin glue may give a decreased operation time, improve postoperative comfort and avoid suture-related problems.

    OBJECTIVES: To assess the effectiveness of fibrin glue compared to sutures in conjunctival autografting for the surgical treatment of pterygium.

    SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2016), Embase (January 1980 to October 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 14 October 2016.

    SELECTION CRITERIA: We included randomised controlled trials (RCTs) in any setting where fibrin glue was compared with sutures to treat people with pterygium.

    DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, assessed trial quality, and extracted data using standard methodological procedures expected by Cochrane. Our primary outcome was recurrence of pterygium defined as any re-growth of tissue from the area of excision across the limbus onto the cornea. The secondary outcomes were surgical time and complication rate. We graded the certainty of the evidence using GRADE.

    MAIN RESULTS: We included 14 RCTs conducted in Brazil, China, Egypt, India, Malaysia, New Zealand, Philippines, Saudi Arabia, Sweden and Turkey. The trials were published between 2004 and 2016, and were assessed as a mixture of unclear and low risk of bias with three studies at high risk of attrition bias. Only adults were enrolled in these studies.Using fibrin glue for the conjunctival autograft may result in less recurrence of pterygium compared with using sutures (risk ratio (RR) 0.47, 95% CI 0.27 to 0.82, 762 eyes, 12 RCTs; low-certainty evidence). If pterygium recurs after approximately 10 in every 100 surgeries with sutures, then using fibrin glue may result in approximately 5 fewer cases of recurrence in every 100 surgeries (95% CI 2 fewer to 7 fewer cases). Using fibrin glue may lead to more complications compared with sutures (RR 1.92; 95% CI 1.22 to 3.02, 11 RCTs, 673 eyes, low-certainty evidence). The most common complications reported were: graft dehiscence, graft retraction and granuloma. On average using fibrin glue may mean that surgery is quicker compared with suturing (mean difference (MD) -17.01 minutes 95% CI -20.56 to -13.46), 9 RCTs, 614 eyes, low-certainty evidence).

    AUTHORS' CONCLUSIONS: The meta-analyses, conducted on people with pterygium in a hospital or outpatient setting, show fibrin glue may result in less recurrence and may take less time than sutures for fixing the conjunctival graft in place during pterygium surgery. There was low-certainty evidence to suggest a higher proportion of complications in the fibrin glue group.

    Matched MeSH terms: Tissue Adhesives/adverse effects; Tissue Adhesives/therapeutic use*
  3. Chan RS, Vijayananthan A, Kumar G, Hilmi IN
    Med J Malaysia, 2012 Aug;67(4):424-5.
    PMID: 23082456
    Endoscopic injection of N-Butyl-2-cyanoacrylate is a widely accepted treatment for esophagogastric varices. This procedure is commonly associated with minor complications which include transient pyrexia and abdominal discomfort. Serious vascular complications secondary to systemic embolization of cyanoacrylate have rarely been reported. We describe the CT findings of extensive splenic infarction in a patient following cyanoacrylate injection for gastric varices.
    Matched MeSH terms: Tissue Adhesives/adverse effects*
  4. Liu J, Tan CSY, Scherman OA
    Angew Chem Int Ed Engl, 2018 07 16;57(29):8854-8858.
    PMID: 29663607 DOI: 10.1002/anie.201800775
    Supramolecular building blocks, such as cucurbit[n]uril (CB[n])-based host-guest complexes, have been extensively studied at the nano- and microscale as adhesion promoters. Herein, we exploit a new class of CB[n]-threaded highly branched polyrotaxanes (HBP-CB[n]) as aqueous adhesives to macroscopically bond two wet surfaces, including biological tissue, through the formation of CB[8] heteroternary complexes. The dynamic nature of these complexes gives rise to adhesion with remarkable toughness, displaying recovery and reversible adhesion upon mechanical failure at the interface. Incorporation of functional guests, such as azobenzene moieties, allows for stimuli-activated on-demand adhesion/de-adhesion. Macroscopic interfacial adhesion through dynamic host-guest molecular recognition represents an innovative strategy for designing the next generation of functional interfaces, biomedical devices, tissue adhesives, and wound dressings.
    Matched MeSH terms: Tissue Adhesives/chemistry*
  5. Salem SA, Hwei NM, Bin Saim A, Ho CC, Sagap I, Singh R, et al.
    J Biomed Mater Res A, 2013 Aug;101(8):2237-47.
    PMID: 23349110 DOI: 10.1002/jbm.a.34518
    The chief obstacle for reconstructing the bladder is the absence of a biomaterial, either permanent or biodegradable, that will function as a suitable scaffold for the natural process of regeneration. In this study, polylactic-co-glycolic acid (PLGA) plus collagen or fibrin was evaluated for its suitability as a scaffold for urinary bladder construct. Human adipose-derived stem cells (HADSCs) were cultured, followed by incubation in smooth muscle cells differentiation media. Differentiated HADSCs were then seeded onto PLGA mesh supported with collagen or fibrin. Evaluation of cell-seeded PLGA composite immersed in culture medium was performed under a light and scanning microscope. To determine if the composite is compatible with the urodynamic properties of urinary bladder, porosity and leaking test was performed. The PLGA samples were subjected to tensile testing was pulled until PLGA fibers break. The results showed that the PLGA composite is biocompatible to differentiated HADSCs. PLGA-collagen mesh appeared to be optimal as a cell carrier while the three-layered PLGA-fibrin composite is better in relation to its leaking/ porosity property. A biomechanical test was also performed for three-layered PLGA with biological adhesive and three-layered PLGA alone. The tensile stress at failure was 30.82 ± 3.80 (MPa) and 34.36 ± 2.57 (MPa), respectively. Maximum tensile strain at failure was 19.42 ± 2.24 (mm) and 23.06 ± 2.47 (mm), respectively. Young's modulus was 0.035 ± 0.0083 and 0.043 ± 0.012, respectively. The maximum load at break was 58.55 ± 7.90 (N) and 65.29 ± 4.89 (N), respectively. In conclusion, PLGA-Fibrin fulfils the criteria as a scaffold for urinary bladder reconstruction.
    Matched MeSH terms: Tissue Adhesives/chemistry
  6. Pulikkotil SJ, Nath S
    J Coll Physicians Surg Pak, 2013 Feb;23(2):164-5.
    PMID: 23374528 DOI: 02.2013/JCPSP.164165
    The trial compared wound healing clinically, histologically and morphometrically after the use of fibrin sealant and sutures for periodontal flap closure. Ten patients were selected for this split-mouth randomized controlled clinical trial. On the test site fibrin sealant (F) was applied for flap closure after periodontal flap surgery (n = 10) and on the control site sutures (S) were used (n = 10). Clinically wound healing was observed at 7, 14 and 21 days and biopsy was taken on the 8th day. At seventh day better healing was observed in fibrin sealant site. Histologically mature epithelium and connective tissue formation was seen in fibrin sealant site with increased density of fibroblasts (F = 70.45 ± 7.22; S = 42.95 ± 4.34, p < 0.001) and mature collagen fibers. The suture site had more number of inflammatory cells (S = 32.58 ± 4.29; F = 20.91 ± 4.46, p < 0.001) and more number of blood vessels (S = 11.89 ± 3.64; F = 5.74 ± 2.41, p = 0.005). Fibrin sealant can form a better alternative to sutures for periodontal flap surgery.
    Matched MeSH terms: Tissue Adhesives/therapeutic use*
  7. Teoh MK, Bucknall TE
    Med J Malaysia, 1989 Jun;44(2):122-8.
    PMID: 2696870
    The use of tissue adhesives has been widely studied since the 1960s. Since then they have found use in specialties like plastic surgery, neurosurgery, ENT surgery and dental surgery. Several papers have reported their safe use, both clinically and experimentally, particularly of the newer homologue n-butyl/2-cyanoacrylate (Histoacryl). In this study 43 patients (46 wounds) whose operations involved a groin incision were randomised into two groups for skin closure either with Dexon subcuticular suture (23 wounds) or Histoacryl glue (23 wounds). We found that both sets of wounds healed well with no wound infections or excessive inflammation when assessed at one week and four weeks. However the glued wounds had consistently better cosmesis scores (mean score 4.71 at four weeks) compared to the subcuticular Dexon wounds (mean score 4.00 at four weeks) and P value of less than 0.05. We feel that there is a place for tissue adhesives in skin closure for some general surgical wounds.
    Matched MeSH terms: Tissue Adhesives/therapeutic use*
  8. Mourougayan V
    Cleft Palate Craniofac J, 2006 Nov;43(6):656-8.
    PMID: 17105330
    To study the quality of scars following the use of butyl cyanoacrylate to close the skin during cleft lip repair.
    Matched MeSH terms: Tissue Adhesives/therapeutic use*
  9. Dasrilsyah RA, Kalok A, Ng BK, Ali A, Teik Chew K, Lim PS
    J Obstet Gynaecol, 2021 Feb;41(2):242-247.
    PMID: 32530340 DOI: 10.1080/01443615.2020.1740917
    This was a prospective randomised controlled trial comparing the effects of first-degree perineal tear repair using adhesive glue versus conventional suturing in terms of pain score, wound complication and patient's satisfaction. One hundred and twenty one women were randomised. The skin adhesive group had a significantly lower pain score at rest as well as during sitting, walking and micturition during the first week of delivery compared to the suture group. The time taken to become pain free was significantly shorter in the tissue adhesive group (3.18 vs. 8.65 days, p < .001). Only two patients who had skin glue experienced wound gaping. No significant difference was observed in the level of satisfaction between the adhesive and suture groups. Tissue adhesive is better than subcuticular suture for repairing first-degree perineal tear as it causes less pain and has shorter recovery time.Impact statementWhat is already known on this subject. First- and second-degree tears following vaginal delivery are common and involved a third of women. Suturing of these tears is advocated to avoid wound gaping and poor healing.What the results of this study add. For first-degree tear repair, tissue adhesive is better than conventional suture in terms of pain reduction and recovery time.What the implications are of these findings for clinical practice and/or further research. Skin adhesive is an ideal method for first-degree perineal tear repair especially in out of hospital settings such as home birth or midwifery-led centre. A larger scale study is needed to establish its feasibility for second- and third-degree tears repair.
    Matched MeSH terms: Tissue Adhesives/therapeutic use*
  10. Teoh LY, Chong SS, Hoh SY, Teoh MS, Ng KL
    Asian J Surg, 2019 May;42(5):634-640.
    PMID: 30446424 DOI: 10.1016/j.asjsur.2018.09.014
    OBJECTIVES: Monofilament sutures, both absorbable and non-absorbable, have been used for wound closure. Tissue adhesive has been used in closure of clean, low tension wounds. However, there have been very few published studies on the aesthetic outcomes in neck surgeries. The aim of this study is to compare the patients' and doctors' satisfaction scores in the aesthetic outcome between both methods of closure of thyroidectomy wounds using validated scoring systems.

    METHODS: A double-blinded randomised controlled trial comparing the aesthetic outcome between tissue adhesive and conventional suture was conducted among patients undergoing thyroid and parathyroid surgeries. Ninety-six patients were randomised into two treatment groups. Patients' wounds were scored by an independent observer using the SBSES score at 6 weeks postoperatively and observer component of the POSAS score at 3 months.

    RESULTS: Forty-nine patients were randomised to the tissue adhesive group while forty-seven patients received the conventional method. There was no statistical difference in the aesthetic outcome using the patient's scoring system between both arms, with a median score of 9 (p = 0.25, SD ± 6.5). The observer's satisfaction score using POSAS was also not statistically significant (median score of 14 (p = 0.77, SD ± 6.2)). No significance was found in the observer's median score using the SBSES scoring system either (score 3, p = 0.12, SD ± 1.3). However, there was significant reduction in the duration of closure using glue (4.42 mins vs 6.36 mins, p 

    Matched MeSH terms: Tissue Adhesives*
  11. Pulikkotil SJ, Nath S
    Aust Dent J, 2014 Jun;59(2):156-64.
    PMID: 24861389 DOI: 10.1111/adj.12178
    Fibrin sealant (FS) is a biologically derived tissue adhesive for securing flaps. The aim of the present randomized controlled clinical trial was to compare early wound healing by assessing interleukin-1β (IL-1β) and interleukin-8 (IL-8) levels from gingival crevicular fluid (GCF) after using FS and suture for periodontal flap closure.
    Matched MeSH terms: Tissue Adhesives/administration & dosage*
  12. Ratnalingam V, Eu AL, Ng GL, Taharin R, John E
    Cornea, 2010 May;29(5):485-9.
    PMID: 20308876 DOI: 10.1097/ICO.0b013e3181c29696
    To evaluate the recurrence rate, surgical time, and postoperative pain between conjunctival autografting with sutures and with fibrin adhesive in pterygium surgery.
    Matched MeSH terms: Tissue Adhesives/therapeutic use*
  13. Tan HL, Nah SA, Budianto II, Sehat S, Tamba R
    J Pediatr Surg, 2012 Dec;47(12):2294-7.
    PMID: 23217892 DOI: 10.1016/j.jpedsurg.2012.09.022
    Octyl cyanoacrylate has been used for many years for simple skin closure, but its use in hypospadias repair and as a urethral stent fixator has not been previously reported. We report our experience.
    Matched MeSH terms: Tissue Adhesives/therapeutic use*
  14. Liew W, Wai YY, Kosai NR, Gendeh HS
    Hernia, 2017 08;21(4):549-554.
    PMID: 28417279 DOI: 10.1007/s10029-017-1611-1
    PURPOSE: Laparoscopic hernioplasty has become a popular choice for inguinal hernia repair since its advent in 1990s. Postoperative pain is an undesirable clinical outcome impairing daily activity of 22.5% of patients. The aim of this study is to evaluate postoperative acute and chronic pain via inflammatory markers as an objective assessment following tacks or glue mesh fixation in TEP repair.

    METHODS: Sixty-six (66) patients with unilateral uncomplicated inguinal hernia were randomized into 34 patients in the tacker and 32 patients in cyanoacrylate glue mesh fixation in TEP repair. The extent of surgical trauma was evaluated by measuring inflammatory markers of C-reactive protein, white blood cell count at 48 h, and ESR at 3 months postoperatively. Postoperative acute and chronic pain was assessed by recording the visual analogue scale scores and surgical complications were recorded over 3 months of the study period.

    RESULTS: The median CRP and WBC levels at postoperative 48 h in both groups raised significantly from the baseline values (p  0.05). The median ESR level increased significantly at 3 months postoperatively from baseline in the glue mesh fixation group only (p  0.05). There was no significant difference for VAS scores at all timelines between the tacker and glue mesh fixation group (p > 0.05).

    CONCLUSION: Cyanoacrylate glue mesh fixation technique as an alternative method to mechanical fixation in TEP repair is comparable to tacker and can be considered to be safe and feasible.

    Matched MeSH terms: Tissue Adhesives/therapeutic use*
  15. Nadarajah G, Ratnalingam VH, Mohd Isa H
    Cornea, 2017 Apr;36(4):452-456.
    PMID: 27941383 DOI: 10.1097/ICO.0000000000001106
    PURPOSE: To evaluate graft stability and recurrence rate between fibrin glue and autologous blood in pterygium conjunctival autograft surgery.

    METHODS: A prospective, randomized, single-blinded clinical trial to assess the efficacy of autologous blood in place of fibrin glue in pterygium surgery. A total of 120 eyes of 111 patients were randomized according to pterygium morphology, to undergo pterygium surgery with autografting using either autologous blood or fibrin glue. All patients were operated by a single surgeon; 58 eyes were operated using fibrin glue and 62 eyes had a conjunctival autograft with autologous blood. Patients were seen on postoperative day 1, 1 week, 1 month, 6 months, and 1 year after surgery. Graft stability and pterygium recurrence were graded by an independent observer who was masked to the method of treatment.

    RESULTS: All 120 eyes completed the 1-year follow-up. Graft loss was seen only in the autologous blood group. Of the 62 eyes in this group, a total of 15 (24.2%) grafts dislodged. Recurrence was calculated after excluding grafts that were dislodged. Of the 105 patients, there were a total of 7 recurrences, 2 (3.4%) from the fibrin adhesive method and 5 (10.6%) from the autologous blood method. This was not statistically significant (P = 0.238).

    CONCLUSIONS: Autologous blood does not exhibit similar graft stability seen with fibrin glue. Although the recurrence rate may not be significant, careful patient selection and a standard method needs to be laid out before the use of this method is widely accepted.

    Matched MeSH terms: Tissue Adhesives/therapeutic use*
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