title: Combined use of fibrin tissue adhesive and acellular dermis in dural repair.
abstract: BACKGROUND
  The management of cerebrospinal fluid (CSF) leaks can be challenging. Acellular dermal grafts derived from human cadavers can be used as a replacement material when autogenous materials are unavailable. Fibrin tissue adhesive (FTA) is a wound support product that has been used for hemostatic and tissue fixation purposes. The combined use of acellular dermis in conjunction with FTA for dural repair remains a subject of study. The aim of this study was to evaluate wound healing and tissue compatibility characteristics of acellular dermal substitute material when used both with and without FTA, for repair of a dural tear in a chinchilla model.
  
  
  METHODS
  Forty-nine chinchillas were included in this randomized case-control study. The squamous portion of the temporal bone was removed to expose the tegmen. A 2 x 2 mm dural defect was removed to create an iatrogenic CSF leak. Then, animals were randomly assigned to one of three treatment groups: group 1, acellular dermis alone; group 2, acellular dermis with FTA; group 3, fibrinogen, acellular dermis, and FTA. Surgical sites were examined grossly at 1- and 2-week intervals. Temporal bones were examined histologically.
  
  
  RESULTS
  Grossly, groups 2 and 3 had significantly less visible CSF leak and brain herniation noted at both 1- and 2-week intervals when compared with group 1. Histological results confirmed the gross results showing the best seal in group 2 and 3.
  
  
  CONCLUSIONS
  Acellular dermis combined with FTA provided superior support compared with acellular dermis alone in repair of induced dural defects.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York 10016, USA. shaha05@med.nyu.edu
authors.forename: Anil R
authors.initials: AR
authors.lastname: Shah
authors.forename: Aaron N
authors.initials: AN
authors.lastname: Pearlman
authors.forename: Kevin M
authors.initials: KM
authors.lastname: O'Grady
authors.forename: Tappan K
authors.initials: TK
authors.lastname: Bhattacharyya
authors.forename: Dean M
authors.initials: DM
authors.lastname: Toriumi
mesh_terms: D000818:Animals; D002555:Cerebrospinal Fluid / Q000378:metabolism*; D002682:Chinchilla; D003094:Collagen / Q000627:therapeutic use*; D020405:Dermis / Q000473:pathology*; D004388:Dura Mater / Q000378:metabolism / Q000601:surgery*; D005337:Fibrin / Q000737:chemistry; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology; D005340:Fibrinogen / Q000378:metabolism; D007431:Intraoperative Complications; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards*; D012449:Safety; D017768:Skin, Artificial; D013997:Time Factors; D014945:Wound Healing
chemical_list: C440568:Alloderm; D015718:Fibrin Tissue Adhesive; D005337:Fibrin; D005340:Fibrinogen; D003094:Collagen