| Spotnitz came to Temple from
the University of Virginia Health Sciences Center, where
he was director of the Tissue Adhesive Center (TAC), a
position he continues to hold. Created in 1997, the
Center is the first of its type at an American
university, with a mission of developing the best
possible tissue adhesives for the clinical care of
patients. To accomplish this mission, the Center tests
and develops new adhesives that can be used in all types
of operations. TAC’s research base is anticipated
to grow through collaborative research projects with
Temple, according to Spotnitz. He expects that TAC’s
Philadelphia extension will increase knowledge of tissue
adhesives among the surgical staff at Temple, and allow
for a wider range of potential research projects with an
increased patient base.
Although there is a growing family of surgical glues,
by far the most common is fibrin sealant.
Fibrin sealant is glue composed primarily of
fibrinogen and thrombin—the building blocks of a
blood clot. Fibrin sealant works by mimicking the final
stage of the body’s natural clotting mechanism. The
resulting fibrin clot or film adheres to tissues to stop
bleeding and improve the wound healing.
“Fibrin sealant is used for three general
purposes: to stop the flow of blood, to seal tissues and
to provide a delivery system for other biologic agents
such as drugs,” Spotnitz said.
Fibrin sealant can be used in a variety of ways. For
larger surface areas with slow bleeding, a spray
technique is used. For suture lines, a light spray
technique or syringes are used. At the site of heavier,
localized bleeding, a sponge or fleece laced with the
sealant can be used.
Fibrin sealant has gained widespread commercial use in
Europe, Canada and Japan, and in May 1998, was approved
by the FDA for use in the United States.
According to Spotnitz, fibrin sealant has already
proved its value in a number of different surgical
specialties including cardiovascular, thoracic, plastic,
neurologic, orthopedic, gynecologic and gastrointestinal
surgery to name a few.
The concept of surgical glues is not new. The U.S.
Army used a quick-sealing glue to treat battlefield
wounds in the Vietnam War, and surgical glues have been
used in Europe and Canada for more than a decade.
But although surgeons have cut and sewn tissues as far
back as 3500 B.C., the surgical use of glue or adhesives
has only recently begun to catch on in the United States.
“But the age of commercially produced, effective
surgical adhesives is now arriving in the U.S.,”
Spotnitz said.
A variety of factors are driving interest and movement
toward the use of glues. These include improved
production methods, enthusiasm for minimally invasive
procedures and aggressive efforts at cost containment.
Tissue adhesives must meet at least five criteria in
order to be successfully used in the operating
room—safety, effectiveness, usability, cost and
regulatory approval. Tissue adhesives from blood
components or synthetic chemicals designed to meet these
criteria successfully are the subject of intense
commercial interest.
“As recent publications have documented, these
products have a vast number of potential applications,
from helping to stop bleeding and to seal tissues during
surgery, to delivering drugs and other biologics through
the blood stream, and promoting wound healing and
repair,” Spotnitz said.
“Consequently, interest in tissue adhesives in
the U.S. continues to grow rapidly, especially as these
products begin to receive FDA approval and become
commercially available.”
At the University of Virginia, fibrin sealant made in
the hospital’s blood bank has been used since 1985
in more than 4,000 patients for a variety of surgical
applications constituting about 5 percent of all
operations each year. In more than 90 percent of these
uses, the surgeons have judged the sealant effective and
have not had to reoperate. Also, no increase in surgical
infection rates has been noted in these patients.
Over the past year or two, surgical adhesives have
begun to catch on at Temple. A number of surgeons have
already experimented with adhesives in the operating
room. Dr. John Meilahn has used fibrin sealant to repair
esophageal perforations.
“I used the sealant as an adjunct to the normal
repair and it did well,” Meilahn said. “When
repairing these perforations, you put a natural tissue
flap over the hole and create a sandwich. I then stitched
up the repair and glued over it with the adhesive. The
goal of this surgery is to fix the hole and prevent
further breakdown. If that hole leaks, the patient dies.
In both of the cases I used the glue, the repair
held.”
According to Spotnitz, the number of converts is
growing.
“We had 150 people attend a meeting about tissue
adhesives last year at Virginia,” he said.
“This year we expect to have similar attendance at
the meeting.”
Spotnitz expects that clinical trials will soon begin
at Temple.
“There are many different types of new synthetic
glues in the pipeline,” Spotnitz said. “I
expect Temple to be a key site in testing and evaluating
these new products.”
When talking about surgical glues, Spotnitz likes to
use a carpenter analogy.
“Like a carpenter, surgeons have a couple of
essential tools,” he explained. “A
carpenter’s saw is the surgeon’s scalpel. A
carpenter’s nails are a surgeon’s sutures. But
while a carpenter has always had glue as a tool,
it’s not until recently that surgeons had a glue for
our use.
“It’s a big, but exciting, change for
surgeons.”— Andrew
Smith, HSC Public Relations
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