Dr. Parry explained that when a patient receives an AlloDerm graft the material is typically sutured to the septum. “Because the AlloDerm is relatively thick, sewing AlloDerm into place to prevent graft migration can be technically difficult to perform,” he said. “To overcome the challenges presented by traditional suturing we adapted the use of fibrin glue for fixation of the AlloDerm graft.”
Explore This IssueMay 2007
Mechanisms of Fibrin Sealant
Fibrin glue has been available commercially in the United States since 1998, when the FDA approved the blood-derived products, also known as fibrin sealants, that are applied topically to help control bleeding. Fibrin sealants can be used to stop oozing from small, sometimes inaccessible, blood vessels during surgery when conventional surgical techniques are not feasible.
The main active ingredient of fibrin sealant is fibrinogen, a protein from human blood that forms a clot when combined with thrombin, another blood protein that facilitates blood clotting. The product works by forming a flexible material over the oozing blood vessel that can often control bleeding within five minutes. Although many surgeons have legally prepared their own fibrin sealants, these locally prepared products are not standardized or consistent, and the available sources of fibrinogen are not virally inactivated.
In his presentation at the Triological Society meeting, Dr. Parry illustrated with a series of drawings how the surgeons at Upstate performed a closed endonasal approach with an endoscopic assist. They used a unilateral, bipedicled internasal flap with AlloDerm as an interpositional graft, using fibrin glue for fixation of the AlloDerm graft.
One cubic centimeter of fibrin glue was applied to both sides of the interpositional graft. The graft was placed between the mucoperichondrial flaps and compressed for five minutes to allow for fixation.
Once the procedure was completed, the patients’ postoperative care involved the use of saline nose spray and antibiotics. Doctors performed endoscopic inspection of the repair site on days 7 and 14. The site was again endoscopically evaluated at six weeks and at three months postprocedure.
“Fibrin glue has been used in many areas of the body, so its success in treating septal perforation is not surprising,” said Robert Kern, MD, Professor of Medicine–Otolaryngology at Northwestern School of Medicine in Chicago. “Its use with AlloDerm in this type of procedure appears novel.” Dr. Kern moderated the session at which Dr. Parry presented his case series.
Dr. Parry reviewed six cases retrospectively in which fibrin glue was used to hold the AlloDerm graft in place in order to close the septal defect. The mean follow-up time for the procedure is three months. Three of the six patients had been involved in previous instances involving nasal trauma. And three of the six patients had previously undergone nasal surgical procedures.