Which microflap closure technique is stronger, fibrin glue or microsuture?
Background: The use of a microsuture for closing vocal fold defects allows for healing by primary intention and aligns the incision with the leading edge of the vocal fold. More expeditious alternative closure methods, including fibrin glue, novel sutures, and bioabsorbable microscopic clips, have been sought. The efficacy of any wound closure, including its ability to remain intact, is dependent on its ability to maintain its strength in the face of mechanical stress.
Study design: Basic research done on bovine and porcine vocal fold models.
Setting: Department of Otolaryngology, Center for Voice, Airay and Swallowing, Medical College of Georgia at Georgia Regents University, Augusta.
Synopsis: Six excised bovine vocal folds were tested on the universal testing system. Model failure occurred at an average extension of 22.6 mm, corresponding to mean force of 11.61 N. Microflap closure with fibrin glue demonstrated no appreciable tension resistance, with closure failing on initial tension application. Five excised porcine vocal folds were used for each condition in further testing. No significant difference was found in the tensile load of the control (no closure performed) and fibrin glue cohorts at all measured distraction levels. The microsuture group was able to achieve higher tensile loads at increased distraction, reaching significance at 10 mm. Because this was an ex vivo study, histologic examination of the vocal fold at various points during the healing process was not possible. Limitations included study of only one fibrin sealant type, unknown interaction between fibrin glue and animal tissue, testing of the entire closure rather than the fibrin clot itself, and the model’s ability to apply force in only one vector, although this is the most common method for testing tensile strength.
Bottom line: Despite study limitations, there is no significant difference in tensile strength of microflaps closed with fibrin glue or not closed, while suture microflap closure provides a significantly stronger mechanical closure compared to no closure.
Reviewed by Amy E. Hamaker