Fibrin Glue Makes Septal Perforations Easier to Repair

MARCO ISLAND, FL—Doctors, faced with challenging problems of mending nasal septal perforations, suggested that the use of fibrin glue to hold into place an AlloDerm graft is effective and likely cost-saving.

“The use of fibrin glue for fixation of the acellular human dermal allograft in septal perforation repair is technically less difficult, reduces the length of the procedure, and we believe it reduces graft migration when compared to conventional suturing techniques,” said James R. Parry, DO, a resident in otolaryngology at the State University of New York, Upstate Medical Center in Syracuse.

Dr. Parry described the techniques of the procedure in an oral presentation at the meeting of the Triological Society here, noting that the head and neck surgeon is faced with a delicate procedure while attempting to eliminate the patient’s symptoms by restoring the normal nasal function.

James R. Parry, DO

He explained that septal perforations can cause significant morbidity. The symptoms associated with septal perforations include nasal congestion or obstruction, nasal crusting and drainage, recurrent epistaxis, and a whistling sound coming from the nose. In addition to the symptoms related to nasal septal perforations, manifestations of the disease process that caused the perforation also may carry significant morbidity.

Dr. Parry noted that the majority of surgical techniques employed today consist of two basic principles: “The use of internasal mucosal flaps for the insertion of a connective tissue interpostional graft. And that perforation repair can be performed either using a closed endonasal or open technique.”

He elected to use acellular human dermal allograft (AlloDerm) as an interpositional graft between mucoperichondrial flaps. He said previous work has suggested that the AlloDerm grafts have been shown to be effective in the repair of septal perforations.

AlloDerm is an acellular dermal matrix derived from donated human skin tissue supplied by US tissue banks utilizing the standards of the American Association of Tissue Banks and Food and Drug Administration guidelines. Since AlloDerm is regarded as minimally processed and not significantly changed in structure from the natural material, the FDA has classified it as banked human tissue.

Developed by LifeCell Corporation in Branchburg, NJ, AlloDerm is prepared in a multistep process that removes both the epidermis and the cells that can lead to tissue rejection and graft failure, without damaging the matrix. Once the dermal tissue has been decellularized, the final step is preservation. The processed tissue matrix is preserved with a patented freeze-drying process that prevents damaging ice crystals from forming. What remains is a matrix or framework of the natural biological components, ready to enable the body to mount its own tissue regeneration process.