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Fibrin sealants

Authors
Arthur J Silvergleid, MD
Elizabeth Peralta, MD
Section Editors
Steven Kleinman, MD
Hilary Sanfey, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Various electrosurgical instruments are available and are used for dissection and sealing vascular structures, while topical hemostatic agents, including fibrin sealants, are used to manage bleeding from surfaces or cavities that are not amenable to suturing, electrosurgery, or other specialized instruments (eg, argon plasma coagulator).

Fibrin sealants are two-component systems that are approved for use as hemostatics, tissue sealants, and tissue adhesives. These can be used in a variety of surgical situations. However, there are no reliable guidelines about when fibrin sealants are best used or which products are optimal for specific indications.

The use of fibrin sealants is reviewed here. The use of other topical hemostatic agents and tissue adhesives or sealants, including topical thrombin as a single-component topical agent, is discussed separately (table 1) [1,2]. (See "Overview of topical hemostatic agents and tissues adhesives".)

BACKGROUND AND PHYSIOLOGY

The search for the perfect operative sealant began in the first decade of the 20th century. By the 1940s, fibrinogen and thrombin were combined in operative settings. Once Cohn fractionation led to the ability to generate highly concentrated fibrinogen preparations (in the 1960s), fibrin sealants were used to promote wound healing, skin grafting, and dural sealing; to provide hemostasis in microvascular surgery and parenchymal injury; and to serve as a matrix for bony chips and fragments in the repair of bone defects [3].

Fibrin sealants simulate the final stage of the clotting cascade (figure 1 and figure 2 and figure 3). (See "Overview of hemostasis".)

                    
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Literature review current through: Oct 2017. | This topic last updated: May 12, 2017.
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