중이수술에 인체에서 추출한 Fibrin 접착제의 이용 : Ammonium Sulfate fibrin 접착제와 ??의 비교

이형철,양미경,박문흠 영남대학교 의과대학 1991 Yeungnam University Journal of Medicine Vol.8 No.1

성공적인 종이수술을 위하여 안전하고 효과적인 접착제가 필요하며, 합성 접착제의 독성작용 때문에 인체에서 추출한 접착제를 사용하게 되었다. Fibrin 접착제가 저장 혈액에서 체취되면 감염성 질환의 전염 위험성이 있지만 자가 Fibrin접착제를 사용하면 전염위험성이 없다. 저자들은 ammonium sulfate fibrin 접착제와 상품화된 fibrin 접착제의 접착력을 비교한 결과 ammonium sulfate fibrin 접착제의 접착력이 상품화된 fibrin 접착제의 반 정도의 접착력을 가지지만 그 정도의 접착력이면 고막재생술, 안면신경 봉합술, 이소골 재건술, 외이도 후벽재건술, 뼈가루를 이용한 전두동 및 유양동폐쇄술등 이비인후과 수술에 사용하기엔 충분한 접착력이다. Successful middle ear surgery requires the availability of al safe, effective bonding material. Side effect caused by synthetic materials have led to the use of biologic adhesive, However, they carry the risk of transmission of infectious diseases if they are prepared from pooled human blood. The adhesive strength of ammonium sulfate fibrin adhesive produce an adhesive strength that is half that of the homologous commercial product. It is, however, good enough for use in several otolaryngological operations, tympanoplasty, facial nerve repair, reconstruction of ossicles. reconstruction of posterior wall of ear canal and obliteration of frontal sinus and mastoid antrum using bone dust.

이종골 이식시 Fibrin adhesive의 사용이 골 재생에 미치는 영향에 관한 조직병리학적 연구

고영우,임성빈,정진형,이종헌,Ko, Young-Woo,Lim, Sung-Bin,Chung, Chin-Hyung,Lee, Chong-Heon 대한치주과학회 2003 Journal of Periodontal & Implant Science Vol.33 No.1

Several effective treatment methods and materials have been developed for the treatment of furcation involvement. Currently, the combination of guided tissue regeneration (GTR) and bone grafts is the most commonly prescribed method of treating furcation involved defects. But because these cases often present with poor accessibility, placement of the membrane may be difficult and consequently, clinically impractical. In this study, the alveolar bone healing patterns of adult beagle dogs presenting with alveolar bone destruction treated by one of two methods - treatment using solely bone allografts (BBP(R)), or treatment using bone allografts (BBP(R)) stabilized by a fibrin adhesive - were comp ared. The effects of the fibrin adhesive on the initial stabilization of the newly formed bone, subsequent regeneration of bone, and the feasibility of the clinical application of the fibrin adhesive were analyzed. The results of the study were as follows: 1. Clinical signs of inflammation at the 4-8 week interval were not observed: but signs of mild inflammation were histologically observed at the 4-week interval. 2. Allografts stabilized by fibrin adhesive showed good bone formation, whereas defects treated with only the allograft material showed incomplete alveolar bone regeneration. 3. Allografts stabilized by fibrin adhesive showed a decrease in the amount old bone with a concurrent increase in the formation of new lamellar bone four weeks post-op, whereas defects treated with only the allograft material showed no new lamellar bone formation at the same interval. 4. In detects treated with only the allograft material, the defective area was filled with connective tissue 8-weeks post-op, whereas fibrin adhesive stabilized allografts showed viable connections between the original bone and the newly formed bone, in addition to neovascularization 8-weeks post-op. The results of this study show that concurrent use of fibrin adhesive materials can stabilize the allograft material and aid in new bone formation Although the stability of fibrin adhesives fall short of the results achievable by GTR membranes, in cases presenting with poor accessibility that contraindicate the use of membranes, fibrin adhesive materials provide a viable and effective alternative to graft stabilization and new bone formation.

조직접착제를 이용한 익상편의 상하결막전위술 3례

김지홍,이지은,이종수.Ji Hong Kim. M.D.. Ji Eun Lee. M.D.. Jong Soo Lee. M.D. 대한안과학회 2006 대한안과학회지 Vol.47 No.12

Purpose: To report the clinical effect of a superior-inferior sliding conjunctival flap for pterygium using fibrin tissue adhesives (Tisseel?; Baxter Healthcare Corporation, Glendale, CA) instead of sutures. Methods: After the primary pterygial tissue was removed from the sclera, a superior-inferior sliding conjunctival flap was created. The fibrin tissue adhesive (Tisseel?) was composed of two solution types: fibrinogen containing aprotinin solution and a CaCl solution containing thrombin. The two solutions with 27 G needle were applied on the bare sclera in sequence, and the conjunctival flap was attached into the bare sclera within 5 seconds. We performed this procedure with a fibrin tissue adhesive instead of sutures in three patients, and follow-up for recurrence of pterygium and postoperative complications. Results: The superior-inferior sliding conjunctival flaps were attached into the bare sclera in all patients using fibrin tissue adhesives. We didn`t find any significant postoperative complications such as ocular pain, epiphora, foreign body sensation, wound defect, or dehiscence. Conclusions: A superior-inferior sliding conjunctival flap constructed with fibrin tissue adhesives should be a useful management tool for the inhibition of the recurrence of pterygial.

Fibrin glue로부터 Ampicillin-Na의 용출 및 Tissue adhesive로서의 접착력

유봉규,권익찬 대한의용생체공학회 1995 의공학회지 Vol.16 No.3

광범위 항생물질인 Ampicillin sodium(AMP-Na)을 두가지 방법 즉, 단순섞임과 bovine serum albumin(BSA)으로 microsphere화한 후 loading 하는 방법으로 fibrin glue(FG)를 제조하였고 이 FG로부터 AMP-Na의 서방성 시험을 시도하였다. 단순섞임의 경우 fibrinogen(FBNG)의 농도를 조적함으로서 FG로부터 AMP-Na의 지속적 방출을 달성할 수 있었으며 특히 이 microsphere를 glutaraldehyde로 가교화시킴으로서 용출속도를 더욱 늦출 수 있었다.(tO.9 : 33hr). FG의 rat perironeum에 대한 접착력은 FBNG과 thrombin의 농도가 각각 5.0%, 25~50 NIHU/ml에서 최대로 나타났다. Factor XIII의 농도는 0~500 U/1g of FBNG의 범위내에서 접착력에 거의 영향을 미치지 않았으며 incubation time은 60분일 때 최대로 나타났다. FG에 AMP-Na 및 BSA micorsphere를 loading하여도 접착력에는 큰 영향을 미치지 않았다. Ampicillin sodium (AMP-Na) was loaded Into fibrin glue (FG) in two different ways and was tried to achieve sustained release from FG. One was loading of AMP-Na in a simple mixing and the other was loading of bovine serum albumin (BSA) microspheres which contained ANP-Na. In case of simple mixing, the release control of AWP-Na from FG was tried by variation of FBNG concentration, but failed. However, the loading of BSA mlcrosphere containing ANP-Na into FG showed sustained re- lease of AMP-Na, especially when microsphere was crosslinked with glutaraldehyde (tO.9 : 33hr). The maximum adhesive strength of FG showed at concentration of FBWG and thrombin, 5.0 % and 25-50 NIHU/ml, respectively. The concentration of Factor Xlll (0-500 U/1g of FBNG) did not affect the adhesive strength of FG. The optimal incubation time was 60 min. The AMP-Na or BSA microsphere which was loaded into FG had no significant effect on the adhesive strength of FG.

하악 2급 이개부 병변에서 이종골 이식시 Fibrin adhesive와 Calcium sulfate barrier의 사용에 타른 임상적 효과에 대한 비교 연구

곽승호,정진형,임성빈,홍기석,Kwak, Seung-Ho,Chung, Chin-Hyung,Lim, Sung-Bin,Hong, Ki-Seok 대한치주과학회 2006 Journal of Periodontal & Implant Science Vol.36 No.2

Periodontal regeneration refers to the restoration of bone, cementum and periodontal ligament to their original levels before damage from periodontal disease process. Various surgical techniques to the promotion of periodontal regeneration have been used. Bone graft and guided tissue regeneration have used for the regeneration of furcation involvements which caused by periodontal disease. Fibrin adhesive is agents that have been shown to be effective in periodontal regeneration and biological carrier. Calcium sulfate which is one of the resorbable barrier materials has used for guided tissue regeneration. The purpose of this study was to compare the clinical effects between bone graft using fibrin adhesive and calcium sulfate barrier in the mandibular class II furcation involvement. For the study, twenty-six class II furcation involved teeth were surgically treated. 13 furcation defects(test group) were treated with bonegraft and fibrin adhesive and the others(control group) were treated with bone graft and calcium sulfate barrier. Pocket depth, clinical attachment level and gingival recession were measured at baseline, postoperative 3 and 6 months. The results of the study are as follows: 1. The change of pocket depth and clinical attachment level in both groups was decreased significantly at 3, 6 months than at baseline(p<0.05). 2. The change of gingival recession in both groups was increased significantly at 3, 6 months than at baseline(p<0.05). 3. The change of pocket depth and clinical attachment level in both groups was decreased at 3, 6 months, and the change of gingival recession in both groups was increased at 3, 6 months but there were no statistically or clinically significant differences with both groups. 4. The significant reduction of the pocket depth and clinical attachment level exhibited marked changes at 3 months in both groups. In conclusion, the results of this study suggest that there are no statistically or clinically significant differences between fibrin adhesive and calcium sulfate barrier in the treatment of class II furcations using xenograft.

Limited eye movement caused by clumping of fibrin glue used in blowout fracture surgery: a care report

신진용,이내호,Min-Seok Kim,노시균,Yoon Kyu Chung 대한두개안면성형외과학회 2022 Archives of Craniofacial Surgery Vol.23 No.5

Fibrin glue is a topical agent widely used for hemostasis, wound healing, and surgical adhesion. Complications of fibrin glue itself are extremely rare because it is absorbed over time, but can occur as a result of inappropriate application. We report a case of a postoperative complication caused by inappropriate application of fibrin glue in blow-out fracture surgery. A 65-year-old male patient presented with periorbital swelling and an open wound on the right infraorbital area. Computed tomography showed a right orbital floor fracture. After reduction of the herniated tissue into the orbit, an implant was inserted and fibrin glue was applied to stabilize the implant. This procedure was performed without difficulty, but the patient complained of persistent diplopia and limited eyeball movement after surgery. An imaging study showed a mass-like lesion, which was not a hematoma, in the orbital cavity. In a second operation, the mass was identified as clotted fibrin glue that had not been applied properly. After removal, the patient’s symptoms were relieved without further complications. Appropriate and careful application of fibrin glue is necessary to avoid unnecessary complications.

CASE REPORT : Fibrin Glue Fixation for Suction Blister Epidermal Grafting in Two Patients with Stable Vitiligo

( Hyo Jin Kim ),( Jeong Nan Kang ),( Sung Hwan Hwang ),( Jong Keun Seo ),( Ho Suk Sung ) 대한피부과학회 2014 Annals of Dermatology Vol.26 No.6

Vitiligo is a chronic disorder characterized by depigmented macules which can slowly enlarge with the concurrent development of new lesions. Although autologous suction blister epidermal grafting is an established technique for the treatment of recalcitrant, stable vitiligo, the donor tissue graft is not easy to fix at the recipient site, especially in areas such as the joints, face, cutaneous folds, hands, feet, and hair- bearing areas. Therefore, various methods of donor tissue fixation have been attempted. We report two cases of vitiligo treated with suction blister epidermal grafting, with fibrin tissue adhesion. The first case is that of 16-year-old female patient presented with hypopigmented patches on the forehead and frontal scalp area. The other case is that of 32-year-old female patient presented with hypopigmented patches on the chin. We treated them with phototherapy for 1∼4 years; however, the lesions were recalcitrant. Therefore, we tried treatment with a suction blister epidermal graft. Because graft fixation is difficult at the recipient sites, fibrin glue was sprayed on the grafts. Thereafter, we applied a porous silicone wound contact layer over the graft area and applied sterile gauze dressing that was left for a week. One week after the procedure, firm fixation of the donor tissue was observed in both cases. Fibrin glue seemed to improve the graft fixation, providng protection against infection and an optimal environment for wound healing. This report suggests that the application of an epidermal graft with fibrin glufixation, can provide the best result in the surgical treatment of stable vitiligo. (Ann Dermatol 26(6) 751∼754, 2014)

폐수술 후 지속적 공기누출에 희석한 Fibrin Glue의 효과

이석열,최창우,이승진,이철세,이길노 대한흉부외과학회 2006 Journal of Chest Surgery (J Chest Surg) Vol.39 No.10

배경: 폐수술 후 흉관을 통한 지속적 공기누출은 환자의 입원기간을 증가시킬 뿐 아니라 농흉 등의 많은 합병증을 초래할 수 있다. 이러한 공기누출을 막고자 화학적 흉막 유착술을 흔히 사용하게 된다. 본 연구는 폐수술 후 흉관을 통한 지속적 공기누출이 있는 환자들에게 희석한 Fibrin Glue를 이용한 흉막유착술을 시행하여 치료의 유용성과 합병증을 관찰하였다. 대상 및 방법: 2001년 9월부터 2005년 8월까지 순천향대학교 천안병원 흉부외과에서 폐수술을 시행 받고 흉관을 통한 공기누출이 7일 이상 지속되었던 환자 16명을 대상으로 하였다. 먼저 용해시킨 fibrinogen 1.0 g과 aprotinin 50만 KIU를 50 cc 주사기 한 곳에 모았다(혼합액 A). 그리고 용해시킨 thrombin 5,000 IU와 calcium chloride 600 mg을 50 cc 주사기에 하나로 모았다(혼합액 B). 세 번째로는 cefazolin 1.0 g을 50 cc 생리식염수에 희석시켜서 50 cc 주사기에 모았다(혼합액 C). 환자의 흉관과 배액병 사이에 고무줄을 삽입하여 삽입된 고무관이 환자보다 상방으로 약 60 cm 올라가서 아래로 향하도록 loop형태의 모양이 되도록 하였다. 그리고는 가장 높은 고무관에 혼합액 A, B, C를 환자측 방향으로 순서대로 주입을 하였다. 결과: 16명 모두에서 다음날 공기누출이 사라졌다. 그리고 3일 후에 흉관을 모두 제거하였다. 부작용으로는 흉통이 12명(75%), 혈액검사상 백혈구 증가가 14명(88%), 고열과 한기가 14명(88%)에서 나타났다. 이러한 부작용들은 모두 일시적이었으며 특별한 치료를 하지 않아도 시간경과와 함께 사라졌다. 결론: 저자들은 폐수술 후 흉관을 통한 7일 이상의 지속적 공기누출이 있던 16명의 환자들을 대상으로 희석한 Fibrin Glue를 흉관을 통해 주입하는 화학적 흉막유착술을 시행하여 모든 환자에서 공기누출이 멈추는 좋은 효과를 보았다. 희석한 Fibrin Glue를 이용한 화학적 흉막유착술은 별다른 합병증 없이 비교적 손쉽게 지속적 공기누출을 치료하는 데 효과적인 방법이라고 생각한다. 그러나 더 많은 환자를 대상으로 장기적인 추적관찰이 필요하다고 생각한다.

피브린 접착제를 이용한 공막 내 인공수정체고정술의 안축장 및 전방깊이에 따른 효과 분석

손현우(Hyeon Woo Son),박정민(Jung Min Park) 대한안과학회 2021 대한안과학회지 Vol.62 No.5

목적: 유리체절제술과 피브린 접착제를 이용한 공막 내 인공수정체고정술을 실시한 환자에서 안축장 길이와 전방깊이에 따른 효과차이를 알아보고자 한다. 대상과 방법: 인공수정체 이탈 환자에 대한 치료로 유리체절제술과 피브린 접착제를 이용한 공막 내 인공수정체고정술 후 6개월 이상 경과 관찰이 가능한 61명, 61안에 관하여 후향적으로 분석하였다. 안축장의 길이에 따라 22 mm 미만을 1군, 22 mm 이상, 25 mm 미만을 2군, 25 mm 이상을 3군, 전방깊이가 3.0 mm 미만을 A군, 3.0 mm 이상, 3.6 mm 미만을 B군, 3.6 mm 이상을 C군으로 나누어 각 군의 술 전후 교정 시력, 구면값, 원주값, 구면렌즈대응치를 측정 비교 분석하였다. 결과: 술 전후 최대교정시력의 유의미한 향상을 확인할 수 있었으며, 술 전후 구면값, 구면렌즈대응치는 모든 군에서 유의미한 차이를 관찰할 수 있었다(p<0.05). 다만 안축장의 길이와 전방깊이가 길어질수록 Haptic slippage, IOL dislocation 등의 합병증 발생률이 증가함을 확인할 수 있었다. 결론: 안축장의 길이와 전방깊이는 굴절이상에 영향을 줄 수 있어 수술 방법을 선택할 때 고려 요인 중 하나이다. 피브린 접착제를 이용한 공막 내 인공수정체고정술 후 최대교정시력, 구면값, 구면렌즈대응치의 유의한 향상으로 시력호전을 확인할 수 있고 술 후원주값의 유의한 변화가 없어 인공수정체의 뒤틀림과 난시의 유발이 낮음을 알 수 있다. Purpose: The purpose of this study was to evaluate the effect of axial length and anterior chamber depth in vitrectomy and intraocular lens intrascleral fixation with a fibrin adhesive. Methods: The study retrospectively reviewed 61 eyes of 61 patients, who were followed up for over 6 months after surgery. The patients were divided into three groups according to their axial length: group 1, < 22 mm; group 2, 22 to < 25 mm; and group 3, > 25 mm. The patients were further divided into three sub-groups according to their anterior chamber depth: group A, < 3.0 mm; group B, 3.0 mm to < 3.6 mm; and group C, > 3.6 mm. We measured and analyzed the best-corrected visual acuity, spherical value, cylindrical value, and spherical equivalent of each group before surgery and at 6 months postoperatively. Results: When comparing the groups preoperatively and postoperatively, the best-corrected visual acuity, spherical value, and spherical equivalent showed significant improvement in all groups (p < 0.05). The incidence of complications, such as haptic slippage and intraocular lens dislocation, increased with the axial length and anterior chamber depth. Conclusions: The use of fibrin adhesive for intraocular lens intrascleral fixation improves visual acuity and reduces refractive error. Postoperatively, there was no significant change in cylindrical value. Because axial length and anterior chamber depth affect refractive error, both should be considered in correlation with the surgical method.

신경문합술과 피브린접합술 후 활동전위차 및 신경재생 효과

정태영(Tae-Young Jung),김욱규(Uk-Kyu Kim),정인교(In-Kyo Chung),신상훈(Sang-Hoon Shin) 대한구강악안면외과학회 2005 대한구강악안면외과학회지 Vol.31 No.5

The purpose of this study was to compare clinical availability of fibrin adhesive technique with microneural suture technique. We applicated fibrin adhesive technique and microneural suture technique on cut sciatic nerve in rat and used to Compound muscle action potential of rat thigh muscle compartment and histologic finding for comparision of clinical availability. The results were as following. 1. Using latency and amplitude in Compound muscle action potential test, we compared microneural suture technique with fibrin adhesive technique for nerve regeneration effect. the means was slightly different between two method. but there’s no statistically significant differences. 2. Histologic finding was similar in microneural suture technique and fibrin adhesive technique for regeneration of axon and myelin sheath in destruction site after nerve anastomosis. These results showed that the efficacy of fibrin adhesive technique was similar to that of conventional microneural suture technique. Moreover, fibrin adhesive technique is decreased operating time and imporved of incapability of accessment in conventional suture technique. Therefore this technique is a useful method to nerve anastomosis in nerve enervation and neurotransplantation.