Treatment of grade 4 renal stab wounds with absorbable fibrin adhesive bandage in a porcine model.
OBJECTIVE
In a porcine model we evaluated the efficacy of the absorbable fibrin adhesive bandage and other novel fibrin products for treating major renal stab wounds.


METHODS
In commercial swine we produced an almost lethal, grade 4 renal stab wound via a 3.5 cm. sagittal, centrally located, through-and-through laceration. Each pig then received treatment in random fashion, including conventional oversewing of capsular defects with absorbable gelatin sponge and horizontal mattress sutures in 6, external absorbable fibrin adhesive bandage that was pressure held for 60 seconds in 6, external and internal absorbable fibrin adhesive bandage that was applied externally, inserted into the renal defect and pressure held for 60 seconds in 6, liquid fibrin sealant that was placed in the laceration and held for 60 seconds in 8, fibrin foam that was applied in the same manner as liquid fibrin in 5 and closing of the peritoneum over the lacerated kidney without further treatment in 6. Blood loss and time to hemostasis were recorded. Animals were sacrificed at 6 weeks to evaluate the injured renal unit.


RESULTS
Compared with conventional therapy the absorbable fibrin adhesive bandage applied externally alone or externally and internally resulted in significantly less bleeding and significantly less time to hemostasis (p <0.001). Liquid fibrin and fibrin foam did not reliably achieve hemostasis. Postoperatively computerized tomography and histological sectioning suggested that the absorbable fibrin adhesive bandage results in a stable, durable clot and healing is at least as successful as with conventional treatment.


CONCLUSIONS
The absorbable fibrin adhesive bandage appears to be a safe, rapid means of renal salvage after injury.
Morey
A F
AF
Urology Service and Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Anema
J G
JG
Harris
R
R
Gresham
V
V
Daniels
R
R
Knight
R W
RW
Beall
D
D
Macphee
M
M
Cornum
R L
RL
D000818:Animals; D001458:Bandages; D005260:Female; D005339:Fibrin Foam; D015718:Fibrin Tissue Adhesive; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D023421:Models, Animal; D013552:Swine; D014014:Tissue Adhesives; D014950:Wounds, Penetrating / Q000628:therapy*
D005339:Fibrin Foam; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives