Abstract
Background. In various surgical cases, effective tissue adhesives are required for both hemostasis
(eg, intraoperative bleeding) and air sealing (eg, thoracic surgery). We have designed
a chitosan molecule (Az-CH-LA) that can be photocrosslinked by ultraviolet (UV) light
irradiation, thereby forming a hydrogel. The purpose of this work was to evaluate
the effectiveness and safety of the photocrosslinkable chitosan hydrogel as an adhesive
with surgical applications. Methods. The sealing ability of the chitosan hydrogel, determined as a bursting pressure,
was assessed with removed thoracic aorta, trachea, and lung of farm pigs and in a
rabbit model. The carotid artery and lung of rabbits were punctured with a needle,
and the chitosan hydrogel was applied to, respectively, stop the bleeding and the
air leakage. In vivo chitosan degradability and biologic responses were histologically
assessed in animal models. Results. The bursting pressure of chitosan hydrogel (30 mg/mL) and fibrin glue, respectively,
was 225 ± 25 mm Hg (mean ± SD) and 80 ± 20 mm Hg in the thoracic aorta; 77 ± 29 mm
Hg and 48 ± 21 mm Hg in the trachea; and in the lung, 51 ± 11 mm Hg (chitosan hydrogel),
62 ± 4 mm Hg (fibrin glue, rubbing method), and 12 ± 2 mm Hg (fibrin glue, layer method).
The sealing ability of the chitosan hydrogel was stronger than that of fibrin glue.
All rabbits with a carotid artery (n = 8) or lung (n = 8) that was punctured with
a needle and then sealed with chitosan hydrogel survived the 1-month observation period
without any bleeding or air leakage from the puncture sites. Histologic examinations
demonstrated that 30 days after application, a fraction of the chitosan hydrogel was
phagocytosed by macrophages, had partially degraded, and had induced the formation
of fibrous tissues around the hydrogel. Conclusions. A newly developed photocrosslinkable chitosan has demonstrated strong sealing ability
and a great potential for use as an adhesive in surgical operations. (Surgery 2001;130:844-50.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evaluation of crosslinked gelatin as a tissue adhesive and hemostatic agent: an experimental study.Surgery. 1966; 59: 1024-1030
- Experimental studies with a new gelatin-resorcine-formaldehyde glue.Surgery. 1969; 66: 377-382
- A new biological glue from gelatin and poly (L-glutamic acid).J Biomed Mater Res. 1996; 31: 157-166
- Modification of synthesis and investigation of properties for 2-cyanoacrylates.Biomaterials. 1990; 11: 73-79
- Cyanoacrylate tissue adhesive for closing skin wounds: a double blind randomized comparison with sutures.Biomaterials. 1993; 14: 737-743
- Fibrin adhesive and its application in thoracic surgery.Thorac Cardiovasc Surg. 1981; 29: 290-292
- Fibrin adhesive: an important hemostatic adjunct in cardiovascular operations.J Thorac Cardiovasc Surg. 1982; 84: 548-553
- Fibrin glue: an effective hemostatic agent for nonsuturable intraoperative bleeding.Ann Thorac Surg. 1984; 38: 409-410
- Fibrin seal adhesive versus nonabsorbable microsuture in peripheral nerve repair.J Hand Surg [AM]. 1988; 13A: 273-278
- Rapidly curable biological glue composed of gelatin and poly (L-glutamic acid).Biomaterials. 1996; 17: 1387-1391
- Use of fibrin glue in thoracic surgery.Ann Thorac Surg. 1985; 39: 521-524
- Experience with fibrin seal (Tisseel) in operations for congenital heart defects.Ann Thorac Surg. 1984; 38: 411-413
- Application of chitin and chitosan for biomaterials.Biotechnol Genet Eng Rev. 1995; 13: 383-420
- Chitosan as a biomaterial.Biomater Artif Cells Artif Org. 1990; 18: 1-24
- Application of chitin and chitosan in large animal practice.in: Advances in chitin and chitosan. Elsevier Applied Science, London1992: 61-69
- The discovery of potent pure chemical wound-healing accelerator.Am J Surg. 1970; 119: 560-564
- Evaluation of chitin and chitosan on open wound healing in dogs.J Vet Med Sci. 1995; 57: 851-854
- Accelerating effects of chitosan for healing at early phase of experimental open wound in dogs.Biomaterials. 1999; 20: 1407-1414
- Water-soluble chitin as a wound healing accelerator.Biomaterials. 1999; 20: 2139-2145
- Chitosan-mediated stimulation of macrophage function.Biomaterials. 1994; 15: 1215-1220
- Stimulation of cytokine production in mice using deacetylated chitin.Vaccine. 1986; 4: 151-156
- Effect of chitin and its derivatives on the proliferation and cytokine production of fibroblasts in vitro.Biomaterials. 1997; 18: 947-951
- Photocrosslinkable chitosan as a biological adhesive.J Biomed Mater Res. 2000; 49: 289-295
- Improved techniques of applying fibrin glue in lung surgery.Eur Surg Res. 1999; 31: 180-186
- Interleukin-8 as a macrophage-derived mediator of angiogenesis.Science. 1992; 258: 1798-1801
- Biochemical significance of exogenous chitins and chitosans in animals and patients.Carbohydr Polym. 1993; 20: 7-16
- Use of chitosan as a biomaterial: studies on its safety and hemostatic potential.J Biomed Mater Res. 1997; 34: 21-28
Article info
Publication history
Accepted:
May 5,
2001
Footnotes
*Reprint requests: Masayuki Ishihara, PhD, Division of Biomedical Engineering, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
