title: Transporous hernia mesh fixation with fibrin sealant in an in vitro model of spray application.
abstract: BACKGROUND
  The spray application of fibrin sealant (FS) is widely used for atraumatic mesh fixation in open and laparoscopic hernia surgery. Studies focusing on the optimization of sealant distribution are rare. This study elucidates the impact of spray distance and pressure, the thrombin concentration of the FS, as well as the mesh design on the spray process and the resulting sealant distribution. Furthermore, the effect of interrupting the spray process on sealant distribution was investigated.
  
  
  METHODS
  Three different meshes were sprayed in a vertical test arrangement with 0.4 mL FS. Fibrin sealants containing 4 and 500 IU/mL thrombin (Tisseel and Artiss; Vienna, Austria) provided by Baxter Biosciences were used. The application distances varied from 5 to 8 cm. The relative fibrin sealant distribution on the individual mesh surfaces was evaluated and compared, as well as loss of FS and patterns of clot formation.
  
  
  RESULTS
  Spray distances between 5 and 8 cm led to a homogenous sealant distribution. Lower thrombin concentrations led to significant losses of FS due to slower polymerization. Differences of the fibrin sealant distribution and mesh pore sizes were found. No differences between continuous and discontinuous application were observed.
  
  
  CONCLUSIONS
  The spray application of FS provides a uniform sealant film in a defined range of distances. However, design and pore size of different meshes substantially impact sealant distribution. These findings should be considered when selecting prosthesis for hernia repair. In general, the amount of sealant should not exceed 0.08 mL per cm(2) to avoid obstruction of mesh pores.
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Austrian Cluster for Tissue Regeneration, Donaueschingenstraße 13, A-1200 Vienna, Austria.
authors.forename: Julian
authors.initials: J
authors.lastname: Brand
authors.forename: Simone
authors.initials: S
authors.lastname: Gruber-Blum
authors.forename: Kerstin
authors.initials: K
authors.lastname: Gruber
authors.forename: René H
authors.initials: RH
authors.lastname: Fortelny
authors.forename: Heinz
authors.initials: H
authors.lastname: Redl
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Petter-Puchner
mesh_terms: D004867:Equipment Design; D015718:Fibrin Tissue Adhesive / Q000592:standards*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D066298:In Vitro Techniques; D008422:Materials Testing; D009779:Occlusive Dressings / Q000592:standards*; D013526:Surgical Mesh; D013917:Thrombin / Q000032:analysis
chemical_list: D015718:Fibrin Tissue Adhesive; D013917:Thrombin
keywords: Fibrin sealant; Hernia; Mesh fixation; Spray application