ABSTRACT
Fibrin sealants (FS), also termed fibrin glues or fibrin adhesives, are the most successful of the tissue sealants in terms of tissue compatibility, biodegradation, and clinical utility [1,2]. FS consists of naturally occurring molecules and proteins, the main ingredients being brinogen and thrombin, but additional components such as calcium, factor XIII, or antibrinolytic agents being occasionally added. As the thrombin and brinogen solutions combine, a clot develops in the same way as it would form during normal blood clotting through a series of chemical reactions
17.1 Introduction .................................................................................................. 513 17.2 History .......................................................................................................... 514 17.3 Chemistry ..................................................................................................... 515
17.3.1 Fibrinogen ....................................................................................... 516 17.3.2 Thrombin ........................................................................................ 516 17.3.3 Factor XIII ...................................................................................... 517 17.3.4 Calcium Chloride ............................................................................ 517 17.3.5 Antibrinolytic Agents .................................................................... 517
17.4 Physical Properties of FS .............................................................................. 517 17.4.1 Structure of Fibrin Clots ................................................................. 517 17.4.2 Mechanical Properties .................................................................... 518 17.4.3 Adhesion Characteristics ................................................................ 519
17.5 Clinical and in vivo Applications ................................................................. 522 17.5.1 Cardiovascular and Vascular Surgery ............................................. 522 17.5.2 Occlusion of Fistula ........................................................................ 523 17.5.3 Urologic Surgery............................................................................. 524 17.5.4 Neurosurgery .................................................................................. 525 17.5.5 Plastic and Reconstructive Surgery ................................................ 525 17.5.6 Oncology Surgery ........................................................................... 525 17.5.7 Orthopedic Surgery ......................................................................... 526 17.5.8 Thoracic Surgery ............................................................................. 526 17.5.9 A Selection of Other Surgical Applications .................................... 527
17.6 Summary ...................................................................................................... 527 References .............................................................................................................. 528
known as the coagulation cascade. At the end of the cascade, the thrombin breaks up the brinogen molecules into smaller segments that arrange themselves into strands termed fibrin. The brin is then crosslinked by a blood factor known as Factor XIII to form a net-like pattern that stabilizes the clot.
