title: Autologous fibrin glue: the last step in operative hemostasis.
abstract: BACKGROUND
  Fibrin glue may be the perfect hemostatic agent for operative use as it seals in minutes, has no tissue toxicity, reabsorbs, and promotes local tissue growth and repair. Use in the United States has been limited because of lack of Food and Drug Administration approval of the commercial homologous products, lack of a concentrated source of fibrinogen, and because of the potential for viral transmission, particularly hepatitis, with pooled homologous plasma and cryoprecipitate-based methods. Autologous fibrin glue (AFG) obviates these problems.
  
  
  METHODS
  During the past year, we obtained AFG through the same routine predonation procedure as with red blood cells before major elective surgery. Intraoperatively, we made AFG from the platelet-rich plasma derived from the Plasma-Saver. Our experience has been with 36 patients undergoing aortic, thoracoabdominal, and thoracic surgery, as well as patch graft angioplasty cases.
  
  
  RESULTS
  Fibrin glue formation mimics the final stage in the coagulation cascade. The AFG from predonation acts more like an epoxy glue, while the AFG made during surgery is less viscous and acts more like a sealant because of the lesser concentration of fibrinogen in platelet-rich plasma. In emergencies, however, the intraoperative method is obviously the only choice available, and it is a useful adjunct to hemostasis at the end of the procedure. The technique will be described.
  
  
  CONCLUSIONS
  This relatively new approach to hemostasis should gain popularity because it is easy and fairly inexpensive to produce, and because the patient's own blood is used.
authors.affiliation: Department of Surgery, University of California, San Francisco School of Medicine.
authors.forename: R L
authors.initials: RL
authors.lastname: Tawes
authors.forename: G R
authors.initials: GR
authors.lastname: Sydorak
authors.forename: T B
authors.initials: TB
authors.lastname: DuVall
mesh_terms: D000783:Aneurysm / Q000601:surgery; D017130:Angioplasty; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001782:Blood Donors; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007430:Intraoperative Care; D010956:Plasmapheresis; D011300:Preoperative Care; D013903:Thoracic Surgery; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive