The Physical Properties of Fibrin Glue
A Technical Report
Dr. Britt Borden MD
ABSTRACT
Objective: To determine some of the physical properties of fibrin glue and their relevance to the application of this material in surgery.
Methods : Fibrin glue was prepared by mixing three parts cryoprecipitate with one part thrombin and calcium chloride. The glue was applied to various dural defects and the amount of glue leaking through was measured. The strength of the glue was then tested in different situations by applying pressure.
Results : The incidence and amount of glue leakage increased with hole size, but there was a large variation in leakage. As much as 38% of the glue leaked through the defect.
No 1-4 mm diameter round defect failed below a pressure of 52 cm H2O. No 2 cm linear defect failed below a pressure of 42 cm H2O. Three cm dural patches overlapping 1 cm maintained their integrity to 82 cm H2O which was the highest pressure tested.
Conclusions : The incidence and amount of glue leakage is dependent on hole size with a large variation in amount.
Fibrin glue is strongest when used with overlapping dural patches, is well-suited for sealing holes up to four mm in diameter, and is helpful for sealing linear defects. Glue failure is dependent on pressure and independent of hole size up to 4 mm. Relevant studies support the usefulness of fibrin glue as a sealant at relatively high pressure.
OBJECTIVE
To determine some of the physical properties of fibrin glue and their relevance to the application of this material in surgery.
METHODS
Fibrin glue was prepared with 3 cc of cryoprecipitate and 1 cc of thrombin 2000 u/cc with calcium chloride (Thrombostat kit, Park Davis, White Plains, NY) as described by Stechison (3).
The 4 cc glue was used to seal one, two, three, and four mm diameter round holes (ten examples of each) in human cadaveric dura as well as 2 cm linear incisions (ten examples). The strength of the glue was also tested on two pieces of dura 3 cm long which overlapped one centimeter (ten examples of each).
The amount of glue which leaked through the holes as well as the glue which was hanging from the defect was measured by mass (e.g. weight) on an electronic balance to determine what went through before solidifying. Of note, there was no leakage in the other two types of preparations.
The preparations were inverted and a 3 cm clear plastic tube was attached to a fixture holding the dura. The strength was then tested by filling the tube with a column of 0.9 normal saline of various heights to apply pressure to the opposite side, mimicking pressure from inside the dura against glue outside.
RESULTS
The incidence of glue leakage increased with hole size. No leakage was observed with one mm holes. In ten specimens each, leakage occurred six times with two mm holes, seven times with three mm holes and ten times with four mm holes. The amount of glue leakage also increased with hole size, although there was a large variation in the amount of glue leakage. As much as 38% of the glue leaked through the defect.
No sealed dural hole failed below 52 cm H2O. No sealed two cm dural incision failed below 42 cm H2O. Fifty percent of these defects maintained their integrity up to 82 cm H2O, which was the highest pressure tested. All overlapping dural patched held to 82 cm H2O.
CONCLUSION
Glue failure is dependent on pressure, but is not completely related to hole size up to four mm. Overlapping patches sealed with fibrin glue consistently held up to the highest pressures. Round holes sealed with fibrin glue held up to more pressure than linear defects. The greater strength observed is most likely due to the glue plugging the defect rather than lying on top of it.
Our data shows that dural defects sealed with fibrin glue alone will maintain their integrity even at what would be considered high intracranial pressure. In addition, it has been shown that fibrin glue will maintain its shape and integrity for six days in vitro (3). If this is true in vivo, this should be adequate to permit healing of the dural defects (1,2,3,4). This will be the subject of a future study.
Fibrin glue is strongest when used in conjunction with overlapping dural patches, is also well-suited for sealing holes up to four mm, and seems adequate for linear defects. Our data provide relevant physical properties of fibrin glue.
REFERENCES
- Fujii T. Misumi S, Onoda K, Takeda F: Simple management of cerebrospinal fluid rhinorrhea after pituitary surgery. Surg Neurol 26:345-348, 1986.
- Shaffey CI, Spotnitz WD, Shaffey ME, Jane JA: Neurosurgical applications of fibrin glue: augmentation of dural closure in 134 patients. Neurosurgery 26:207-210, 1990.
- Stechison MT: Rapid polymerizing fibrin glue from autologous or single-donor blood: preparation and injections. J Neurosurg 76:626-628, 1992.
- Symon L, Pell MF: Cerebrospinal fluid rhinorrhea following acoustic neurinoma surgery. Technical note. J Neurosurg 74:152-153, 1991.