[Topical haemostatic agents in neurosurgery].

Haemostasis is of fundamental significance in neurosurgery, and insufficient control of bleeding is associated with morbidity and mortality. Topical haemostatic agents play an important role, as the characteristics of neuronal tissue limit the use of classical surgical haemostasis techniques. Appropriate choice of agent depends on the location and type of bleeding, but also on knowledge of the products' mechanisms of action, indications, price and accessibility. Biological products are superior to the mechanical in efficacy but require more preparation and are significantly more cost-intensive.

Uso de fibrinógeno humano en la generación de soportes para la obtención de equivalentes tisulares / Use of human fibrinogen in the generation of scaffold for obtaining Tissue equivalents

Desde sus orígenes, la Ingeniería de Tejidos ha buscado diversos materiales que puedan ser utilizados para la generación de soportes que sirvan para el anclaje, proliferación y diferenciación celular que conduzcan a la obtención de tejidos humanos. Muchos materiales de tipo cerámico, polimérico y metálico se han evaluado, pero hasta la fecha muchos de ellos han sido rechazados por diversas razones, entre otras su escasa biocompatibilidad y biodegradabilidad, la respuesta inmune generada, la baja resistencia mecánica o el riesgo de transmisión de virus o priones. El fibrinógeno es una proteína presente en el plasma sanguíneo que puede ser utilizada para la generación de soportes tridimensionales que favorezcan el crecimiento de células; se obtiene a partir del propio paciente, bancos de sangre o como proteína purificada (Tisseel® o Tissucol®, Laboratorios Baxter). El fibrinógeno evita el desencadenamiento de una respuesta inmunológica y el uso de productos xenogénicos. Debido a la estructura proteica, la adhesión y proliferación celular se ven favorecidas dando excelentes resultados en la generación de equivalentes de piel, cartílago, córnea y reemplazos cardiacos en aplicaciones in vitro e in vivo. Como desventajas presenta su rápida degradación y su baja resistencia mecánica; sin embargo, en los últimos años se han venido evaluando mezclas con algunos biopolímeros como ácido poliláctico (PLLA), ácido poli-glicólico (PGA) y alginato de sodio. Esta revisión presenta algunas de las principales aplicaciones del fibrinógeno en Ingeniería de Tejidos.

Since its origin, Tissue Engineering has sought various materials that can be used for generation of scaffolds that serve to anchor, proliferation and cell differentiation leading to the production of human tissues. Many materials such as ceramic, polymeric and metal type have been evaluated to date but many have been rejected for various reasons, including its limited biocompatibility and biodegradability, immune response generated, low mechanical strength or the risk of transmission of virus or prions. Fibrinogen is a protein present in blood plasma that can be used to generate three-dimensional scaffolds that favors growth of cells, it is obtained from the patient itself, bank of blood or purified protein (Tisseel® or Tissucol®, Laboratorios Baxter). Fibrinogen acts slowing or reversing the immune response and avoiding the use of xenogeneic materials. Because the protein structure, adhesion and cell proliferation is favored with excellent results in the generation of skin equivalents, cartilage, cornea and even heart replacements in vitro and in vivo. The disadvantages presented are the rapid degradation and low mechanical strength, but in recent years it has been evaluating some biopolymer mixtures as polylactic acid (PLLA), poly-glycolic acid (PGA) and sodium alginate. This review presents some of the main applications of fibrinogen in Tissue Engineering.

Pain after laparascopic bilateral hernioplasty : Early results of a prospective randomized double-blind study comparing fibrin versus staples.

BACKGROUND: The use of fibrin for mesh fixation in laparascopic hernioplasty has theoretical advantages in that it could result in reducing postoperative pain. The objective of this study is to demonstrate this improvement in postoperative pain with the highest level of evidence possible. METHODS: Unicenter single surgeon prospective randomized double-blind study of transabdominal preperitoneal (TAPP) bilateral hernioplasties comparing autologous fibrin sealant (FG) used for mesh fixation on one side and staples (SG) on the other. Data were collected regarding anthropometric measures, costs, complications and pain evaluation at postoperative days 7, 30 and 180 using a visual analogue scale. The patients were also asked to answer the following simple question: "On which side do you have more pain?" RESULTS: Twenty-two eligible patients were included in the study. Both groups were comparable. The operating time was significantly longer (30 min more) in the FG. The incidence of seroma was similar in both groups, and that of hematoma was higher in the SG (0 vs. 9.1%). At 1 week, the visual analogue scale scores were significantly lower in the FG (median: 1.7 vs. 4.5; MWU:103.5, p < 0.05). At 1 month, this difference became clinical and statistically insignificant. 72.7% of the patients referred more pain on the side with staples at 1 week, 38% at 1 month, and 0% at 6 months (after patients with hernia recurrence were excluded). The recurrence rate was higher in the FG (9.9 vs. 13.6%). A hernia in the FG cost 200 Euros more than that in the SG, or even more if a complete economic study is considered. CONCLUSIONS: The use of fibrin produces less postoperative pain in the first week, but prolongs operating time and increases costs. Moreover, there appears to be a higher recurrence rate and a lower incidence of hematoma, while the incidence of seroma remains unchanged.

Fibrin glue and clinical impact on haemophilia care.

Fibrin glues, a kind of biological sealant, have been used for enhancement of local haemostasis, tissue sealing and wound healing for haemophilia and similar disorders. Commercial viral-inactivated fibrin glue products are available in Europe and have recently been approved in the USA. Using fibrin glue, hospitalization, medical cost, viral transmission risk and factor supplementation will be reduced. In the near future, the role of fibrin glues will be increased in the haemophilia field.