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Eur J Cardiothorac Surg 2008;34:705. doi:10.1016/j.ejcts.2008.06.002
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Technique for combined application of fibrin sealant and bioabsorbable felt against alveolar air leakage

Tamami Isakaa, Masato Kanzakia,b,*, Takamasa Onukia

a The Department of Surgery I, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
b The Department of Surgery, Fuchu Hospital, 2-9-2 Musashidai Fuchu-shi, Tokyo 183-8524, Japan

Received 11 April 2008; accepted 2 June 2008.

* Corresponding author. Address: The Department of Surgery, Fuchu Hospital, 2-9-2 Musashidai Fuchu-shi, Tokyo 183-8524, Japan. Tel.: +81 3 3353 8111/42 323 5111; fax: +81 3 5269 7333/42 323 9205. (Email: yoshida{at}chi.twmu.ac.jp).

Key Words: Alveolar air leakage • Fibrin sealant • Polyglycolic acid (PGA) felt • Adhesion

We read the article by Itano titled ‘The optimal technique for combined application of fibrin sealant and bioabsorbable felt against alveolar air leakage’ with great interest [1]. Air leaks are frequently observed after pulmonary resection, while some air leaks can be avoided with careful surgical techniques. Therefore, the development of methods that enable an airtight closure of the lung parenchyma during pulmonary surgery is of importance. The ideal tissue adhesive should have an outstanding safety profile, be easily manipulated, and be approvable by regulatory agencies. Furthermore, the ideal tissue adhesive should be flexible enough to respond to contraction and relaxation during respiration. Fibrin glue, various other biological sealants, and synthetic sealants have been applied for intraoperative air leak and have been reported by many investigators. Fibrin based sealants have generally failed to show significant improvement. Fibrin glue can be easily absorbed and is frequently applied as an air leak sealant, immediate closure often does not occur, and in many cases postoperative recurrences can occur due to poor tissue-bonding strength. Therefore, the most effective technique may be the combined application of fibrin sealant and synthetic bioabsorbable sheet to control alveolar air leakage. However, it has been previously observed that the implantation of nearly all polymer materials, such as polyglycolic acid (PGA), polylactic acid, and polylactic-co-glycolic acid causes a non-specific inflammatory response. It has been observed that there is a negative effect of the acidic environment that is created by polymer degradation. It is believed that acidic pH is created at the sealing site [2,3]. As a result, the implanted PGA felt lead to pleural adhesion. We experienced the postoperative pneumothorax recurrence that performed the combined application of fibrin sealant and PGA felt for air leak 3 months ago. In our case, pleural adhesion existed in the areas of implanted PGA. Histological examination revealed chronic inflammation and thick pleura.

Thoracic re-interventions become the standard management practice in an increasing number of patients with lung diseases. We think that it is desirable for pleural adhesion not to happen. Therefore Itano's technique may be suitable for selective patients.

References

  1. Itano H. The optimal technique for combined application of fibrin sealant and bioabsorbable felt against alveolar air leakage. Eur J Cardiothorac Surg 2008;33:457-460.[Abstract/Free Full Text]
  2. Sung HJ, Meredith C, Johnson C, Galis ZS. The effect of scaffold degradation rate on three-dimensional cell growth and angiogenesis. Biomaterials 2004;25:5735-5742.[CrossRef][Medline]
  3. Isaka T, Kanzaki M, Yamato M, Okano T, Onuki T. Morphologic examination on surface of pleura after the pulmonary air leak sealing utilizing of tissue adhesives. Jpn J Chest Surg 2008;22:118–128.



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H. Itano
Reply to Isaka et al.
Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 706 - 706.
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