Fibrin glue

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Fibrin glue or glue (also tissue glue ) is a physiological two-component glue of biological origin. It has the following uses in medicine :

A fundamental advantage of the fibrin glue - compared to conventional surgical sutures - is the protection of particularly sensitive tissue and the formation of less noticeable scars, since no stitches are made with needle and thread. In fact, the fibrin glue permanently sticks the tissue at the wound edges together until the body's own wound healing has repaired the damage.

Components

Component 1 Component 2
Fibrinogen and factor XIII Thrombin
Aprotinin Calcium chloride

functionality

If components 1 and 2 are mixed, the thrombin cleaves fibrinogen into fibrin and activates factor XIII to form factor XIIIa. Factor XIIIa leads to cross-linking of the fibrin, which results in a stable, tear-resistant but at the same time elastic fibrin network. This process corresponds to the last stage of natural blood clotting . Therefore, the fibrin network can also be dissolved (lysed) by the body's own enzymes . “Pulling threads” after the wound has healed is therefore superfluous. For this reason, fibrin glue is particularly suitable for use inside the body. Factor XIIIa is built into the fibrin clot during coagulation and delays fibrinolysis in its natural function. In order to ensure adequate wound healing even under difficult conditions, component 1 contains aprotinin. Aprotinin delays fibrinolysis by binding to the enzyme plasmin . Because it is a reversible bond, the plasmin does not become unusable, but only hampers its function. This slows down the lysing effect.

Production of the individual ingredients

ingredient Manufacturing, annotations
Fibrinogen (factor I): Obtained from human blood plasma by plasma fractionation .
Thrombin (factor IIa) Extraction of prothrombin ( factor II ) from human blood plasma by plasma fractionation and subsequent activation to thrombin (factor IIa)
Factor XIII Obtained from human blood plasma by plasma fractionation.
Aprotinin Extraction by fermentation of crushed beef lungs and subsequent purification z. B. by gel filtration . Aprotinin is a protein and can be broken down by the human body. However, since this is a foreign protein for humans, anaphylactic reactions can occur under certain circumstances .
Calcium ions Usually as a solution of calcium chloride dihydrate . Calcium ions are essential for blood clotting.

Application possibilities and application examples

The components can be administered (applied) successively (one after the other: first component 1, then component 2) or simultaneously (both components at the same time) by spraying on with a special double syringe. Fibrin glue can also be used as part of endoscopic methods . The following list gives a brief overview of the numerous possible uses of fibrin glue.

  • The internal organs of the liver , spleen , lungs , pancreas and kidneys : connection of the wound edges after injury or surgery without causing further damage, as would be the case with conventional surgical sutures. Bleeding stops quickly, which is a great advantage for these organs, which often bleed heavily.
  • Skin : Improved and faster growth of grafts to treat burns while providing better protection against infections . Fibrin glue ensures a gas- and water-tight wound closure and thus prevents the penetration of pathogens .
  • Ophthalmology: During operations on the lens of the eye (e.g. cataracts ), the new lens can be glued into the eye instead of being sewn in.
  • In cosmetic surgery, fibrin glue is used to avoid additional scarring from sutures and to improve wound healing.
  • Treatment of bleeding gastrointestinal injuries through an endoscope by applying the fibrin glue directly.
  • In addition, there are many examples of applications in ear, nose and throat medicine , because here the areas to be treated are often difficult to access and / or very small and sensitive.

hints and notes

Since the starting materials fibrinogen, thrombin, factor XIII and aprotinin are biological substances, infection with pathogens can never be completely ruled out. In the case of the ingredients produced by plasma fractionation , this particularly affects the risk of infection with HIV and hepatitis B , as well as other pathogens that can be transmitted through blood products . Fibrin glue is widely used in Germany today. The considerable costs of the components are in contrast to the benefits from its application. An expansion of the application possibilities to less difficult cases is currently often not possible for cost reasons. Nevertheless, the use of fibrin glue is being tried again and again in new areas to improve the success of conventional methods.

An interesting alternative / addition to fibrin adhesives is cyanoacrylate , which has also been used in medicine since 1964 . It can stop massive bleeding, close wounds seamlessly and, due to its purely chemical production, does not pose a risk of infection.

literature

  • Monika Barthels, Mario von Depka: The coagulation compendium . Quick orientation, interpretation of findings, clinical consequences. Thieme, Stuttgart a. a. 2002, ISBN 3-13-131751-5 .
  • G. Dickneite, HJ Metzner, M. Kroez, B. Hein, U. Nicolay: The importance of factor XIII as a component of fibrin sealants. In: Journal of Surgical Research . 107, 2, Oct. 2002, pp. 186-195.

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