Tissue Adhesives: Science, Products, and Clinical Use

Abstract

The field of tissue adhesives is a new and rapidly developing area of surgical technology. Since the approval of the first such agent, fibrin sealant in the Unites States in 1998, five distinct families of agents have emerged with a wide variety of Food and Drug Administration (FDA) approved indications. These indications include hemostasis, colon sealing, skin closure, lung sealing, vascular sealing and dural sealing. These materials are not only useful in many different surgical specialties including cardiac, thoracic, vascular, general, plastic, transplant, trauma and neurologic surgery, but can also be used in a variety of experimental applications such as drug delivery and tissue engineering. The object of this chapter is to review the five new families of tissue adhesives and hemostats with particular emphasis on the relevant chemistry, available products and clinical uses, as well as future experimental and clinical applications. The chemical reactions basic to these materials, commercially available products, clinical algorithms for use and potential future developments will be described.

The five families are fibrin sealants, cyanoacrylates, bovine gelatin and human thrombin, polyethylene glycol polymers and albumin cross-linked with glutaraldehyde. Multiple commercially approved products now exist within these families and represent novel additions to the traditional surgical armamentarium of ligatures, sutures, clips and staples. As the technical challenges of the modern surgical environment continue to increase with the widespread use of minimally invasive procedures, the need for surgical tissue adhesives will continue to grow and this remains an important area of future research and development.