Fibrin Sealant as an Adjunct in the Operative Care of Recurrent Pneumothorax

Abstract

Human fibrinogen cryoprecipitate has found a large field of application as a biological tissue adhesive in thoracic and cardiovascular surgery. Fibrin glue was used routinely to seal porous prostheses in aortic arch replacements and proved successful even in cases of excessive bleeding under extracorporeal circulation.

During 2 years fibrin adhesion was applied in all surgical procedures involving persistent or recurrent pneumothoraces and it was used prophylactically to cover large parenchymal defects following standard lung resections. The benefit of its application on pleura and lung tissue derives from added reinforcement of sutures and sealing of nonsuturable defects.

Twenty-one patients with recurrent spontaneous pneumothoraces revealed a clearly reduced average drainage period as compared with 15 nonglued cases with lesions of comparable size. Similarly, in 20 cases where tissue adhesive was applied to extensive pleural defects following segmental lung resection or lobectomy, suction drainage time was significantly less than in 11 cases of comparable, nonglued defects. Compared with 140 lung resections performed prior to the use of fibrin glue, these 20 cases were found to require the same average drainage time, although the extent of their lesions otherwise would have warranted longer periods of continued suction drainage.