SUR1 Fibrin sealant in trauma surgery. (Surgery).

SUR1 FIBRIN SEALANT IN TRAUMA SURGERY Barry G. Crowe, MD, and Kimball I. Maull, MD. Carraway Methodist Medical Center, Birmingham, Ala.

Fibrin sealant is a natural adhesive that promotes hemostasis, serves as a tissue sealant, and acts as a site-specific vehicle for the delivery of biologically active compounds. In trauma surgery, the hemostatic and tissue sealant properties of fibrin sealant offer clinical advantage in select instances of solid organ injury, surgical complications, and in burn care. Because fibrin sealant mimics the final common pathway in the coagulation cascade by instantaneously converting fibrinogen to fibrin, fibrin sealant is effective in damage control where hypothermia coagulopathy and wet surfaces are encountered. Earlier work by one of us (K. I. M.) and the experience of others suggest the potential lethality of fibrin sealant manufactured from bovine components. These early experiences continue to dissuade many from using fibrin sealant as an adjunct in hemostasis. Current preparations exclude most bovine ingredients and have been proven safe and effective. Drawbacks include preservation requirements, duration of preparation, and cost. However, with documented safety and improved methods for its application, the indications for the use of fibrin sealant are broadening. In this report, specific illustrations of the applicability of fibrin sealant in clinical trauma care involve hemorrhage control and prevention of air leaks in thoracic injuries, in abdominal trauma for hemorrhage control in liver and spleen injuries and as an aid in splenic salvage, and for hemorrhage control and sealant in vascular repair. In conclusion, fibrin sealant has broad applicability in surgery and particular applicability in trauma care. Repair and preservation of solid viscera, control of active hemorrhage, and diversified modes of application, still considered experimental, justify expanded indications for the use of fibrin sealant in trauma surgery.