Delayed Wound Healing Resulting from Inflammatory Process in Craniectomy Patients Treated with BioGlue: A Case Series with Literature Review.

Background BioGlue is touted as a safe and effective sealant for various surgical procedures. This article describes five cases of delayed wound healing associated with the use of BioGlue after craniectomies. Case Description Five patients of different genders and ages who had undergone craniectomy with BioGlue were presented to our medical center with wound dehiscence and purulent discharge. The first attempt to solve this problem by incision and drainage was unsuccessful. The removal of BioGlue is necessary to eliminate these problems. Discussion The presence of wound dehiscence and aseptic cystic contents may indicate a chronic inflammatory process following the application of BioGlue. This problem usually occurs within a few months after wound closure. For rapid intervention, it is recommended to perform an incision and drainage and remove the BioGlue. The main risk factor is directly applying BioGlue to the skin, subcutaneous tissue, or titanium material. Conclusion Neurosurgeons should exercise caution and be aware of a possible delayed chronic inflammatory process in surgical wounds associated with the use of BioGlue as a sealant, especially when the product is used without cranial coverage or in cases where it comes into direct contact with subcutaneous tissue or titanium material. To resolve this issue quickly, BioGlue should be completely removed at the first attempt at incision and drainage.

Inflammatory response induction as a result of BioGlue adhesive application in cardiac surgery - a review of the literature.

BioGlue is one of the best-known substances used as a tissue adhesive during surgical procedures, especially in cardiac surgery. Inappropriate use of BioGlue can result in inflammation in both the heart and adjacent tissues after its intraoperative application. Inflammation caused by BioGlue in cardiac surgery is a topic that has been discussed by numerous authors in scientific studies, meta-analyses and evaluations of this tissue adhesive. However, there is a lack of collected knowledge on this subject in a single concise article. The purpose of this paper is to review the current medical knowledge on the use of BioGlue in cardiac surgery versus the induction of an inflammatory response. Our paper discusses the details of this problem according to the most recent scientific reports.

A Mesostructure Multivariant-Assembly Reinforced Ultratough Biomimicking Superglue.

The imitation of mussels and oysters to create high-performance adhesives is a cutting-edge field. The introduction of inorganic fillers is shown to significantly alter the adhesive's properties, yet the potential of mesoporous materials as fillers in adhesives is overlooked. In this study, the first report on the utilization of mesoporous materials in a biomimetic adhesive system is presented. Incorporating mesoporous silica nanoparticles (MSN) profoundly enhances the adhesion of pyrogallol (PG)-polyethylene imine (PEI) adhesive. As the MSN concentration increases, the adhesion strength to glass substrates undergoes an impressive fivefold improvement, reaching an outstanding 2.5 mPa. The adhesive forms an exceptionally strong bond, to the extent that the glass substrate fractures before joint failure. The comprehensive tests involving various polyphenols, polymers, and fillers reveal an intriguing phenomenon-the molecular structure of polyphenols significantly influences adhesive strength. Steric hindrance emerges as a crucial factor, regulating the balance between π-cation and charge interactions, which significantly impacts the multicomponent assembly of polyphenol-PEI-MSN and, consequently, adhesive strength. This groundbreaking research opens new avenues for the development of novel biomimetic materials.

In vivo optical coherence tomography visualisation of coronary artery embolism caused by BioGlue in a middle-aged woman with Marfan syndrome who underwent the Bentall procedure: a case report.

Background: Coronary artery embolism caused by BioGlue is a rare complication; therefore, its diagnosis and treatment remain undefined. Case summary: A 47-year-old woman underwent ascending aortic replacement and coronary artery bypass grafting (CABG) for type A acute aortic dissection involving the right coronary artery ostium in 2017. Subsequently, she was diagnosed with Marfan syndrome. Five years later in 2022, she underwent aortic arch replacement, the Bentall procedure, and repeat CABG because of aortic root enlargement and aortic regurgitation progression. Twelve days after surgery, coronary computed tomography angiography (CCTA) revealed left anterior descending (LAD) artery stenosis, whereas pre-operative CCTA was normal. On post-operative day 13, coronary angiography revealed 99% LAD artery stenosis. Intravascular ultrasound (IVUS) showed a non-echoic mass with clear margins, and optical coherence tomography (OCT) demonstrated a crystalloid mass. Both images suggested that the embolus was inorganic matter, suspected as being the surgical adhesive BioGlue. We could not remove the embolus by repeated thrombectomy; therefore, drug-eluting stent implantation was performed. Seven months after surgery, she had no symptoms, and CCTA confirmed stent patency. Discussion: To our knowledge, this is the first case report to describe BioGlue embolism observed by OCT. We performed an in vitro study using a blood vessel model, and the obtained OCT image was very similar to the in vivo image. Although BioGlue embolism is a rare complication, it should be considered in cases of perioperative myocardial infarction of uncertain aetiology, and coronary imaging is useful for diagnosis.

Application of Biological Glue-Clay Composite Substrate in Slope Ecological Restoration.

Given the issues of soil cracking, poor water retention during drought, and erosion damage caused by rainfall, we conducted an in-depth study on the water retention properties, cracking resistance, and scouring resistance of biogel-amended clay using evaporation cracking and scouring tests. The hydrophysical properties and cohesive aggregation mechanism of biogel-amended clay were explored, and the results showed that the incorporation of biogel improved the water retention, cracking resistance, and scour resistance of the clay samples. With an increase in the biogel content, the biogel mucous membrane inside the samples improved the cohesion between soil particles, reduced the generation and development of cracks, and improved the cracking resistance. There was no significant cracking of the samples after the biogel content reached 0.3%, which changed the migration of water in the sample, prevented water evaporation, and improved the water retention of the clay samples. Biofilm can change the migration of water in the sample, prevent some evaporation, and reduce the evaporation rate. To a certain extent, it can enhance the water retention capacity of the sample. Enhanced biofilm content significantly reduced scouring in the process of rainfall and runoff erosion of the sample, and biofilm content of 0.2% significantly reduced the surface of the specimen damaged by erosion. The hydrophysical properties of the composite-adhesive-amended clay samples were significantly improved compared with those of the single-bioadhesive-amended clay samples.

How to test adhesive strength: a biomechanical testing for aortic glue used in type a dissection repair.

OBJECTIVES: The aim of this study was to develop a method to quantify the peel force in an in vitro model simulating repair of ascending aortic dissections with tissue glue (Bioglue). METHODS: This study adapted an adhesive T-Peel test for the determination of the peel strength of adhesives by measuring the peeling force of a T-shaped bonded tissue. Measurements were performed on iatrogenic dissected ascending porcine aorta, which has been repaired with Bioglue using different pressure levels. Four conditions were tested: zero sample pressure according to the manufacturer's recommendation (n = 10), low (504 Pa; n = 11), moderate pressure (1711 Pa; n = 24) and pressure applied by a round shaped vascular 'Borst clamp' (1764 Pa; n = 23). Non-parametric one-way analysis of variance was applied for statistical significance. RESULTS: The median peel force (lower quartile, upper quartile) of aortic samples increased depending on the applied pressure: [no pressure 0.030 N/mm (0.016, 0.057), low pressure 0.040 N/mm (0.032, 0.070) and moderate pressure 0.214 N/mm (0.050, 0.304)]. Samples pressurized with the Borst clamp reached 0.078 N/mm (0.046, 0.152), which was comparable to the peel force of the unpeeled controls [0.107 N/mm (0.087, 0.124)]. Compared to samples without pressure, Bioglue with the application of the Borst clamp (P = 0.021) and with moderate pressure (P = 0.0007) performed significantly better. CONCLUSIONS: The novel T-Peel test offers an attractive method to test tissue glues in defined in vitro environments. Bioglue peel force increased with pressure on the aortic sample in contrast to low or no pressure as per the manufacturer's recommendation. Modifying current recommended use may aid in increasing effectiveness of this approach.

MANAGEMENT OF MINIINVASIVE TREATMENT OF PRIMARY VARICOSE SUPERFICIAL VEINS.

OBJECTIVE: The aim: Determination of the optimal method for surgical correction of stages C2-C6s varicose superficial veins. PATIENTS AND METHODS: Materials and methods: The treatment results of 228 patients with stages C2-C6 of primary varicose according to the CEAP classification using thermal and non-thermal treatment methods were analyzed. RESULTS: Results: All patients underwent operations under the control of ultrasound scanning. In patients after EVLA, total trunk obliteration was detected in 148 patients (98.7%) after 1 week, and in 100% after a year. In 2 patients, reflux was diagnosed in the PDSV and in the ZDSV after 1 week. In patients after RFA, inflow reflux on the leg was in 1 patient (5.2%), in others - complete obliteration (18 patients - 94.7%). In patients after MOCA, recanalization was performed in 5 patients (19.2%) with a control ultrasound investigation after 1 month. In patients after cyanoacrylate obliteration, inflow reflux on the leg after 1 month was in 2 patients (14.2%). In patients who underwent UGS of the GSV trunk, 5 patients (33.3%) had persistence of pathological reflux after 1 month with control ultrasound. All corrections were performed using Foam form sclerotherapy. CONCLUSION: Conclusions: EVLA is the most effective method of treating varicose veins and gives the best long-term results. The advantage of non-thermal methods is the lack of influence on paravenous structures and no need for tumescent anesthesia, which is important in case of an allergic history. After applying cyanoacry¬late, there is no need for mandatory compression. The advantage of foam scleroobliteration is its lowest cost among all methods. Foam sclerotherapy was the method of choice for correction of postoperative treatment.

A Super Tough, Rapidly Biodegradable, Ultrafast Hemostatic Bioglue.

Death happening due to massive hemorrhage has been involved in military conflicts, traffic accidents, and surgical injuries of various human disasters. Achieving rapid and effective hemostasis to save lives is crucial in urgent massive bleeding situations. Herein, a covalent cross-linked AG-PEG glue based on extracellular matrix-like amino-gelatin (AG) and PEG derivatives is developed. The AG-PEG glue gelatinizes fast and exhibits firm and indiscriminate close adhesion with various moist tissues upon being dosed. The formed glue establishes an adhesive and robust barrier to seal the arterial, hepatic, and cardiac hemorrhagic wounds, enabling it to withstand up to 380 mmHg blood pressure in comparison with normal systolic blood pressure of 60-180 mmHg. Remarkably, massive bleeding from a pig cardiac penetrating hole with 6 mm diameter is effectively stopped using the glue within 60 s. Postoperative indexes of the treated pig gradually recover and the cardiac wounds regrow significantly at 14 days. Possessing on-demand solubility, self-gelling, and rapid degradability, the AG-PEG glue may provide a fascinating stop-bleeding approach for clinical hemostasis and emergency rescue.

BioGlue cerebral embolism following acute type A aortic dissection repair.

Surgical outcomes of acute Stanford type A aortic dissection (ATAAD) have significantly improved in recent decades due to advances in surgical techniques and adhesives such as BioGlue (Cryolife, Kennesaw, GA, USA). However, this convenient material can sometimes cause complications such as thrombotic embolism and pseudoaneurysm. Herein, we present the case of a 61-year-old man with ATAAD who successfully underwent total arch replacement. Five days after surgery, he collapsed due to right-sided hemiplegia. We immediately performed cerebral thrombectomy to remove thrombotic embolism caused by BioGlue, which was used to obliterate the false lumen of the dissected aorta during ATAAD repair. Learning objective: Thanks to surgical techniques and adhesives such as BioGlue, surgical outcomes of acute Stanford type A aortic dissection have significantly improved recently. However, thromboembolic events due to adhesives such as BioGlue use can happen not only during surgery, but also a few days after it.

BioGlue® is not associated with polypropylene suture breakage after aortic surgery.

Objective: We have encountered broken or damaged polypropylene sutures (Prolene®) at the anastomotic sites during aortic reoperations. Because a surgical sealant, bovine serum albumin-glutaraldehyde (BioGlue®), was used in previous aortic surgery in some of these cases, we undertook this in vitro study to evaluate whether the use of BioGlue® was associated with breakage of polypropylene sutures at the aortic anastomosis. Materials and methods: The broken polypropylene sutures, anastomotic sites and aortic tissue at the location of suture breakage were visually inspected and evaluated intraoperatively. Six human cadaveric aortic samples were incised circumferentially and anastomosed proximally to a valved conduit with running 4-0 polypropylene sutures (Prolene®). In the test group (n = 3), BioGlue® was applied directly to the Prolene® sutures at the anastomotic sites, while in the control group (n = 3) the anastomoses were not sealed with any surgical adhesive. The six samples were immersed in Dulbecco's phosphate buffered saline solution and mounted on a M-6 Six Position Heart Valve Durability Testing System and tested up to 120 million cycles for a 2-year period. During and upon completion of the testing, the integrity of Prolene® sutures, the anastomosis and aortic tissues was regularly assessed by visual inspection. Results: Intraoperative findings included a stretched and thin aortic wall (some with thrombus), a small cleft between the aortic tissue and the Dacron vascular graft. An excessive amount of BioGlue® was often found around the anastomosis, with cracking material, but no signs of mechanical damage were observed in these cases. Upon visual inspection during and after in vitro testing, there was no apparent damage to the polypropylene sutures on the interior or exterior of the aortic anastomoses in any of the samples. No difference was observed in the physical integrity of the polypropylene sutures at anastomotic lines, the anastomoses and aortic tissues between the test and control samples. Conclusions: The results of this study suggest that the use of BioGlue® was not associated with breakage of the polypropylene sutures at the anastomotic sites after aortic dissection repair.

Biomedical engineering of polysaccharide-based tissue adhesives: Recent advances and future direction.

Tissue adhesives have been widely used for preventing wound leaks, sever bleeding, as well as for enhancing drug delivery and biosensing. However, only a few among suggested platforms cover the circumstances required for high-adhesion strength and biocompatibility, without toxicity. Antibacterial properties, controllable degradation, encapsulation capacity, detectability by image-guided procedures and affordable price are also centered to on-demand tissue adhesives. Herein we overview the history of tissue adhesives, different types of polysaccharide-based tissue adhesives, their mechanism of gluing, and different applications of polysaccharide-based tissue adhesives. We also highlight the latest progresses in engineering of tissue adhesives followed by existing challenges in fabrication processes. We argue that future studies have to place focus on a holistic understanding of biomaterials and tissue surface properties, proper fabrication procedures, and development of magnetic and conductive responsive adhesives in order to bridge the huge gap between the present studies for clinical implementation.

Cerebral embolic shower secondary to BioGlue use in triple valve surgery.

Hemostasis is a crucial step in cardiac surgery which determines postoperative outcomes. Tissue sealants and glues are necessary to achieve hemostasis in situations where conventional methods are unsuccessful. BioGlue, a commonly used topical hemostatic agent, has been reported to cause systemic embolic complications. We report a case of cerebral embolic shower following the use of BioGlue for posterior aortic suture line bleeding in a 49-year-old lady who underwent triple valve surgery. This report brings to light a rare but devastating complication of BioGlue usage in the present era of complex aortic surgeries. We also postulate a mechanism for BioGlue embolization.

Bioglue endovascular treatment of fusiform aneurysm rupture of the distal anterior temporal artery of the middle cerebral artery: a case report.

The treatment of a ruptured fusiform distal anterior temporal artery aneurysm is a challenge for the stroke physician, however surgical closure and coil endovascular intervention are options. A total blockage can result in memory problems as well as object-related questions. We'd like to provide the clinical example of a 56-year-old woman with many underlying medical illnesses who was admitted to the hospital with a grade 7/10 headache and a Glasgow score of 15, but no focal neurological deficits, and was diagnosed with a ruptured distal temporal artery aneurysm. The aneurysm is positioned in the distal region, making endovascular intervention difficult to perform. As a result, we used an endovascular approach to repair with bioglue. When a patient develops fusiform aneurysms of the distal temporal artery, our findings provide an additional therapy option.

Surgical glue-induced left main trunk stenosis removed by directional coronary atherectomy.

A 55-year-old man underwent aortic repair for acute aortic dissection. The pseudolumen of the Valsalva sinus was reapproximated with BioGlue by placing a sponge inside of it to prevent the BioGlue from entering. Postoperative contrast-enhanced computed tomography showed stenosis of the left main trunk. Directional coronary atherectomy was performed; complete release of the stenosis was achieved. Various fragments retrieved from the left main trunk were pathologically consistent with BioGlue. When we reapproximated the dissected aortic wall, inserting a sponge into the aorta did not prevent the surgical glue from entering. Directional coronary atherectomy was a good therapeutic option to treat glue-induced coronary artery stenosis.

Bio-based and bio-inspired adhesives from animals and plants for biomedical applications.

With the "many-headed" slime mold Physarum polycelphalum having been voted the unicellular organism of the year 2021 by the German Society of Protozoology, we are reminded that a large part of nature's huge variety of life forms is easily overlooked - both by the general public and researchers alike. Indeed, whereas several animals such as mussels or spiders have already inspired many scientists to create novel materials with glue-like properties, there is much more to discover in the flora and fauna. Here, we provide an overview of naturally occurring slimy substances with adhesive properties and categorize them in terms of the main chemical motifs that convey their stickiness, i.e., carbohydrate-, protein-, and glycoprotein-based biological glues. Furthermore, we highlight selected recent developments in the area of material design and functionalization that aim at making use of such biological compounds for novel applications in medicine - either by conjugating adhesive motifs found in nature to biological or synthetic macromolecules or by synthetically creating (multi-)functional materials, which combine adhesive properties with additional, problem-specific (and sometimes tunable) features.

Sinonasal outcomes associated with the use of BioGlue® in endoscopic transsphenoidal pituitary surgery.

Concerns have been raised in the neurosurgical literature regarding the use of BioGlue®, a tissue sealant initially developed for cardiothoracic surgery, due to reports of an increased incidence of infection, wound breakdown, and CSF fistulae. The aim of this study was to determine if the use of BioGlue® in skull base repair impacts on the sinonasal outcomes and the incidence of post-operative infection following endoscopic pituitary surgery. SNOT-22 questionnaires were completed pre-operatively, and at 6, 12, and 24 weeks post-operatively by 50 patients. Pre- and post-operative MRI scans were reviewed and assessed for evidence of post-operative sinusitis. Patient records were consulted to ascertain the incidence of post-operative infection. Repeated measures ANOVA and Wilcoxon signed rank test were used for data analysis. Statistical analysis revealed a significant difference in the mean SNOT-22 scores across the four time intervals (F(1.605, 78.642) = 9.180, p = 0.001). This difference was powered by a deterioration at 6 weeks that recovered completely by 12 weeks. The mean SNOT-22 score in the study cohort at 24 weeks was 16.84/110 (range 0-57, ± 2.04) which was lower than the mean pre-operative score and is consistent with mild rhinosinusitis. There were no cases of post-operative meningitis and 1/50 (2%) case of post-operative sinusitis in this cohort. The use of BioGlue® in endoscopic endonasal pituitary surgery does not appear to lead to significant sinonasal morbidity. Previous concerns about the use of BioGlue® in transcranial procedures may not apply to extradural application of this tissue sealant in endoscopic transnasal surgery.

MRI appearance of adjunct surgical material used in spine surgery.

BACKGROUND CONTEXT: Early postoperative MR images are frequently necessary after spine surgery. The appearance of commonly used adjunct hemostatic agents and dural sealants in MR images has not been systematically evaluated. PURPOSE: The purpose of this experimental study was to systematically analyze and describe the characteristics of the most commonly applied hemostatic agents and dural sealants in spine surgery on early postoperative MR images. STUDY DESIGN: Cadaver Study METHODS: Four commonly applied dural sealants (Duraseal, Bioglue, Tachosil, Tisseel) and five commonly used hemostatic agents (Surgiflo, Bonewax, , Spongostan, Gelfoam, Avitene) were investigated. The experimental setting involved a human cadaver where a standard left-sided laminotomy was performed on nine levels of the thoracolumbar spine, and the materials were separately applied and mixed with fresh blood or water for hemostatic and dural sealants, respectively. The cadaver model was scanned at a 3 Tesla MRI and the imaging findings for all materials were compared to the surrounding tissue and systematically reported. RESULTS: All investigated dural sealants and hemostatic agents were distinguishable from the surrounding tissue on MR images with different appearances on the MR sequences. A detailed atlas for the identification of the materials in postoperative spine MRI was established. CONCLUSION: Commonly used hemostatic agents and dural sealants can be successfully identified on early postoperative spine MRI. CLINICAL SIGNIFICANCE: Knowledge about MRI appearances of commonly used adjunct surgical materials helps in interpretation of postoperative imaging and supports clinical decision making.

Prevention versus cure: Is BioGlue priming the optimal strategy against E-Vita NEO graft oozing?

BACKGROUND: Since the introduction of the E-Vita Open NEO aortic prosthesis in 2020, several incidences of post-anastomotic oozing from the polyester portion of the graft have emerged. The use of BioGlue to prime E-Vita Open NEO to prevent this has been suggested as a way to mitigate this worrying complication. We investigate the extent of graft oozing in E-Vita Open NEO and evaluate the use of BioGlue in preventing oozing, both experimentally and in terms of potential clinical complications. MATERIALS AND METHODS: E-Vita Open NEO (in straight and branched configurations) was implanted in a perfused model. The distal stent graft and side branches were clamped, and the graft was pressurized with blood to 120 mmHg. The volume of blood (ml) oozing from the graft within 60 s was measured. Nonpressurized grafts were coated with BioGlue up to a thickness of 1, 2, and 3 mm, and the volume (mm3 ) of BioGlue required to do so was recorded. RESULTS: Within 60 s, 250.0 ml of blood oozed from the grafts tested. 43.694, 87.389, and 174.778 mm3 of BioGlue were required to coat the device with 1, 2, and 3 mm of BioGlue. CONCLUSION: Graft oozing from E-Vita Open NEO represents an omnipresent and worrying risk. The use of BioGlue herein is likely associated with several adverse consequences, which are an additional risk on top of that posed by graft oozing. These risks call into question the suitability of E-Vita Open NEO, especially when compared to alternative devices not affected by oozing.

Effect of the bio-inspired modification of low-cost membranes with TiO2:ZnO as microbial fuel cell membranes.

Microbial fuel cells (MFCs) are a novel technique for converting biodegradable materials into electricity. In this study, the efficiency of mixed crystal (TiO2:ZnO) as a membrane modifier of a low-cost, antifouling and self-cleaning cation exchange membrane for MFCs was studied. The modification was prepared using polydopamine (PDA) as the bio-inspired glue, followed by gravity deposition of a mixture of catalyst nanoparticles (TiO2:ZnO 0.03%, 1:1 ratio) as anti-biofouling agents. The effects of the membrane modification were evaluated in terms of power density, open circuit potential, coulombic efficiency, anti-biofouling properties and also color and COD removal efficiency. The results showed that the use of the PDA-modified membrane and a mixture of catalysts facilitated the transfer of cations released during the oxidation process in the anodic compartment of the MFC, which increased the power generation in the MFC by 2.5 times and 5.7 times the current compared to pristine and PDA pristine membranes, decreased the MFC operating cycle time from 5 to 3 days, doubled the lifetime of the membranes and demonstrated higher COD removal efficiency and color removal. Finally, SEM and AFM analysis showed that the modification significantly minimized surface fouling. The modified membranes in this study proved to be a potential alternative to the expensive membranes currently used in MFCs, furthermore, this modification could be an interesting alternative modification for other potential membranes for use in MFCs, due to the fact that the catalyst activation was only performed with visible light (artificial and solar), which could decrease operating costs.