Comparison of conjunctival pedicle flap to corneal adhesion achieved by Tisseel® fibrin glue, ethyl cyanoacrylate adhesive, ReSure® hydrogel sealant, and conventional suturing with 8-0 VICRYL® suture
| Autor: | VerHulst, Elodie Marie |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2023 |
| Předmět: | |
| Druh dokumentu: | Diplomová práce |
| Popis: | Background: Conjunctival pedicle flaps are one of the most frequently employed surgical interventions used to address a variety of sight threatening corneal diseases in veterinary ophthalmic practice. Securing the conjunctiva to the cornea is typically achieved through suturing, which is technically challenging and can result in prolonged surgical times, increased corneal edema, increased scar tissue, foreign body reaction, suture abscess and dehiscence. In human ophthalmology, a number of sutureless techniques to affix ocular tissues are being explored. Specifically, these approaches include synthetic tissue adhesives, bioadhesives, and hydrogel sealants. The proposed advantages of adhesives over suture, include reduced operative times, watertight seals, decreased foreign-body sensation and inflammation, faster healing times and tissue regeneration with original architecture restoration. Objective. To evaluate the maximum tensile force a conjunctival pedicle flap is able to withstand with respect to different fixation methods, i.e., Tisseel® fibrin glue, ethyl cyanoacrylate adhesive, ReSure® hydrogel sealant, or 8-0 VICRYL suture. Animals Studied. Ex-vivo porcine globes Procedures. Following a 500-micron restricted depth lamellar keratectomy, conjunctival pedicle flaps were dissected and secured to corneal defects with either the bioadhesive Tisseel®, or the synthetic adhesives ReSure®, ethyl cyanoacrylate, or 8-0 VICRYL® suture. Harvested corneoconjunctival flap interfaces were clamped to an accelerometer and potentiometer device, and loaded under video surveillance until the point of failure. Peak load at failure was determined for each test and used to compare between sample types. Results. 40 flaps underwent tensile force testing, with 6 being omitted for dehiscence prior to tensile testing. Of the 34 tests included in analysis, 10 conjunctival flaps were secured with suture, 10 with cyanoacrylate, 8 with ReSure® hydrogel sealant, and 6 with Tisseel® fibrin glue. A significant increase in maximum withstood tensile force was recorded between sutured flap fixation when compared with cyanoacrylate glue (p=0.02474), ReSure® hydrogel sealant (p= 0.00000), and Tisseel® fibrin glue (p= 0.00002). Cyanoacrylate fixation was significantly stronger when compared with ReSure® hydrogel sealant and Tisseel fibrin glue (p=0.01194 and 0.01798 respectively). There was no significant difference in adhesion strength between ReSure® hydrogel sealant and Tisseel® fibrin glue (p=0.95675). Conclusions. Conjunctival pedicle flap fixation using 8-0 VICRYL® suture fixation was able to withstand significantly greater maximum tensile force application in comparison with the ReSure®, Tisseel®, or cyanoacrylate adhesives. Master of Science Conjunctival pedicle flaps are one of the most frequently employed surgical interventions to address sight threatening corneal disorders in companion animals. Due to its redundant nature and close proximity to the corneal surface, conjunctival tissue is readily available for grafting to the cornea. It is surgically dissected to appropriate size and repositioned over the corneal defect where it effectively aids in healing through direct provision of structural support and indirectly via its rich blood supply. Securing the conjunctiva to cornea is typically achieved through suturing, which is technically challenging and can result in prolonged surgical times, increased corneal edema, increased scar tissue, foreign body reaction, abscess and dehiscence. In human ophthalmology, a number of sutureless techniques to affix ocular tissues are being explored. Specifically, these approaches include synthetic tissue adhesives, bioadhesives, and hydrogel sealants. The proposed advantages of tissue adhesives over suture, include reduced operation times, watertight closures, decreased foreign-body reaction and inflammatory response, faster healing times and increased ability to induce regeneration of the original tissue architecture. The purpose of this study was to evaluate the maximum tensile force a corneoconjunctial pedicle flap is able to withstand with respect to four different fixation methods, 40 ex-vivo porcine globes underwent conjunctival pedicle flap procedures. Each pedicle flap was secured to cornea with either 8-0 Vicryl® suture, Tisseel®, ethyl cyanoacrylate, or ReSure®. After harvesting from the globe, the corneoconjunctival unions were clamped to an accelerometer and potentiometer device, and loaded under video surveillance until the point of failure. The peak load was determined for each test and used to compare between sample types. |
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