Closure of Long Surgical Incisions with Hemostatic Tissue Adhesive in a Porcine Skin Model
Ariel Neiman1, Inbar Eshkol-Yogev, Aviad Keren
1Ariel Neiman, MD, is Attending Plastic Surgeon and Head of Breast Reconstruction and Microsurgery, Meir Health Center, Kfar Saba, Israel. Inbar Eshkol-Yogev, DMD, PhD, is Clinical Lecturer, Eastman Dental Institute, UCL, London, UK. Aviad Keren, PhD, is Lab Manager, Israel Institute of Technology, Haifa. Maytal Foox, PhD, is Director of Food Technology and Product Development, Aleph Farms, Rehovot, Israel. Oded Pinkas, PhD, is Director of Process Development, NanoGhost, Netanya, Israel. Nyra Goldstein, BSc, is Researcher, Biond Biologics, Misgave Industrial Park, Israel. Also at Israel Institute of Technology, Amos Gilhar, MD, is Director, Skin Research Laboratory, Ruth & Bruce Rappaport Faculty of Medicine. Meital Zilberman, PhD, is Professor of Biomedical Engineering, Tel-Aviv University. Yehuda Ullmann, MD, is Director of the Surgical Division, Rambam Health Care Campus, Haifa.
Objective:
Skin adhesives offer many advantages over traditional wound-closure devices. Recently, the current research group reported on tissue adhesives composed of natural polymers (gelatin and alginate), which are biocompatible with mechanical properties suitable for tissue adhesion. The objective of the present study was to conduct clinical and histologic assessment of this hemostatic bioadhesive in the healing of long skin incisions (≥4 cm) in comparison with traditional and commercially available methods.
Methods:
Researchers created 24 long incisions on the ventral side of two domestic pigs to compare four different treatment modalities: two topical bioadhesives based on gelatin and alginate combined with the hemostatic agent kaolin, nylon sutures, and commercial tissue adhesive N-butyl-2-cyanoacrylate. The bioadhesive compounds were spread on the incision surface and then mixed either manually or with a double-headed syringe. After 14 days, clinical and histologic measurements were performed to evaluate the healing phase of the wounds.
Results:
The bioadhesive formulation that contained a relatively low crosslinker concentration demonstrated superior results to the formulation that contained a standard crosslinker concentration. However, no significant statistical differences were observed compared with the control incisions (sutures and commercial adhesive N-butyl-2-cyanoacrylate). This was verified by immunohistochemical analysis for epithelial integrity and scar formation as well as by clinical assessment.
Conclusions:
This newly developed bioadhesive demonstrated suitable properties for the closure of long incisions in a porcine skin model.
