title: The role of n-butyl-2-cyanoacrylate in the repair of traumatic diaphragmatic injuries.
abstract: Diaphragmatic injuries either by blunt or penetrating trauma require prompt surgical intervention and are often exigent to repair. N-butyl-2-cyanoacrylate (n-butyl-2-CA) is a tissue adhesive which has gained wide application in many areas of surgery including emergency. To repair the extensive injuries of the diaphragm it may be necessary the use of synthetic mesh by fixing it with sutures or staples. The use of tissue adhesives may circumvent the potential problems associated with mesh fixation. This study aimed to evaluate the efficacy and safety of tissue adhesives usage for mesh fixation in diaphragmatic injury repair. Twenty-four rats were divided into 3 groups each of them containing 8 rats. A 1- cm diaphragmatic defect was created in all rats. The defect was repaired by polypropylene suture in Group I, by mesh fixed with sutures in group II and by mesh fixed with n-butyl-2-CA in group III. The rats were sacrificed after 1 month. The episode of hernia and the adhesions were assessed by adhesion density score. Also, the abscess and inflammation in the repaired tissue were evaluated microscopically. The Kruskal-Wallis test was performed for the histopathological analysis. No diaphragmatic hernia was detected in any group. While Group III had higher adhesion density scores than group I (P: 0.027), there were no differences between group III and II (P: 0.317) and group II and I (P = 0.095) regarding adhesion density scores. The inflammation grade was higher in group III than group I and II (P < 0.001) and was higher in group II than group I (P < 0.05). There was no differences between each groups, concerning microabcsess formation (P > 0.05). Repair of traumatic diaphragmatic injury in penetrating wound, with polypropylene mesh fixed by n-butyl-2-CA in rats appears to be as efficacious and safe as conventional methods in early period. However, further experimental and clinical study are needed to compare the long-term results of adhesive mesh repair with those of the traditional sutured techniques.
authors.affiliation: Department of Surgery, Umraniye Training and Research Hospital Istanbul, Turkey.
authors.forename: Gurhan
authors.initials: G
authors.lastname: Bas
authors.affiliation: Department of Surgery, School of Medicine, University of Sakarya Sakarya, Turkey.
authors.forename: Orhan Veli
authors.initials: OV
authors.lastname: Ozkan
authors.affiliation: Department of Surgery, Umraniye Training and Research Hospital Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Alimoglu
authors.affiliation: Department of Surgery, School of Medicine, University of Akdeniz Antalya, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Eryilmaz
authors.affiliation: Department of Surgery, Vakif Gureba Training and Research Hospital Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sahin
authors.affiliation: Department of Surgery, Vakif Gureba Training and Research Hospital Istanbul, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Okan
authors.affiliation: Department of Pathology, School of Medicine, University of Istanbul Istanbul, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Cevikbas
keywords: Diaphragmatic injury; cyanoacrylate; repair; synthetic graft