The Use of Fibrin Glue to Protect Microanastomoses in Limb Reconstructive Surgery

Introduction: After completion of the microvascular anastomosis and onset of reperfusion, the vein is filled with blood and the artery shows its typical pattern of physiological pulsation and kinking. Every microsurgeon suffers from this experience: in some cases, they find the kinking alarming, and the moving artery does not stay at the site desired by the surgeon. Moreover, the tight vein filled with venous blood calls for an outer shield e.g., fibrin glue.

Methodology and Material: Within a period of 18 months (10/2010-04/2012 University of Bochum), all microvascular cases in which fibrin glue was used were recorded. These operations were all performed by a single surgeon (SL). Data were retrospectively analyzed and Ethics committee approval (AZ 34/L2010) was obtained. Patients (111 male, 55 female) were treated mainly for trauma (53%), infection (27%) and oncological problems (20%).

Results: Fibrin glue was used in a wide spectrum of microvascular surgery. End-to-end as well as end-to-side microvascular anastomoses profit from stabilization with fibrin glue. No adverse effects were observed during the application (e.g., vasoconstriction of vessels, adverse reaction of surrounded tissues). An average of 1,1ml fibrin glue was used in 253 individual applications. The flap survival rate was higher 95%. There were 4 cases of flap death in peripheral arterial vascular disease patients who had undergone lower limb reconstruction.

Conclusions: The use of fibrin glue for the stabilization of anastomosed vessels as well as the covering of veins or venous transplants has an important influence on outcome of microsurgical work. Especially fragile veins profit from coverage with a thin, moldable and soft material. Fibrin glue offers a standard procedure in all kind of vessel or nerve based microsurgery since it provides optimal feature of controlling microanastomoses. Fibrin glue should not be used to repair insufficient, e.g., leaking anastomoses, but it does protect the site of anastomosis from tissue and fluid pressure and it´s use facilitates relocation in cases of revision surgery.