На начальном этапе развития микрососудистой хирургии и в настоящее время известны многочисленные разработки, направленные на сокращение времени выполнения анастомозов артерий и вен малого диаметра и улучшение их проходимости. Одно из направлений этих разработок – применение адгезивов и тканевых герметиков. В статье анализируются результаты этих разработок по данным экспериментальных исследований и клинических испытаний. В качестве материала использованы публикации баз данных Medline и Pubmed, доступные on-line. Доступные хирургам тканевые адгезивы и герметики подразделяются на две группы: цианакрилаты и фибриновый гель. Несмотря на многообещающие результаты экспериментальных исследований, публикаций о результатах клинического применения цианакрилатов в микрососудистой хирургии не найдено. Имеются единичные клинические исследования применения фибринового клея. Представления о возможности использовании цианакрилатов или фибринового клея в качестве альтернативы микрохирургии являются ошибочными. Если в дальнейших разработках будут достигнуты оптимальные качества тканевых адгезивов и герметиков (эластичность и прочность адгезии во влажной среде и в условиях меняющегося кровотока, отсутствие гистоксических и аллергических реакций), применение их в качестве вспомогательного инструмента микрососудистого анастомоза представляется перспективным.
Since initial steps of microsurgery and recently multiple inventions for shortening of microvascular arteries and vein anastomosis time and improvement of their patency are made. One of the currently available technologies – tissue adhesives and glues. In the article the results of experimental researches and clinical trials of such inventions are analysed. Material for analysis – on-line publications of Medline and Pubmed databases. Available for surgeons tissue adhesives and glues may be classified in two groups: cyanoacrylates and fibrin glues. In spite of promising results of experimental research the publications about cyanoacrylate clinical use for microvascular surgeries are not found. Sporadic clinical trials of fibrin glue in microvascular surgery are known. Notions about tissue adhesives and glues as alternatives of microsurgery are mistakable. If in further inventions the optimal qualities of tissue adhesives and glues (elasticity and strength of adhesion in wet conditions and volatile blood flow, absence of histotoxic and allergic reactions) will be achieved their implementation as auxiliary tool in microsurgery should be a perspective shift.
1. О’Брайен Б. Микрососудистая восстановительная хирургия / пер. с англ. – М.: Медицина, 1981. – 422 с, ил.
2. Acland R. Technical prerequisites and tramingin microsurgery: technique of small vessel anastomosis. In: Meyer V., Black M., editors. Microsurgical procedures. – Philadelphia: Saunders, 1991. – P. 123-136.
3. Ang E.S., Tan K.C., Tan L.H., Ng R.T., Song I.C. // J. Reconstr. Microsurg. – 2001. – V. 17, № 3. – P. 193-201.
4. Annabi N., Yue K., Tamayol A., Khademhosseini A. Elastic sealants for surgical applications // Eur. J. Pharm. Biopharm. – 2015. – V. 95. – P. 27-39.
5. Ardakani M.R., Hormozi A.K., Ardakani J.R., Davarpanahjazi A.H., Moghadam A.S. // J. Res. Med. Sci. – 2012. – V. 17, № 5. – P. 461-465.
6. Bey E., Brachet M., Lambert F., Cariou J.L. Microsurgery: History of instrumental vascular anastomoses, our experience with eversion-stapling using VCS forceps // Ann. Chir. Plast. Esthet. – 2005. – V. 50, № 1. – P. 12-18.
7. Bot G.M., Bot K.G., Ogunranti J.O., Onah J.A., Sule A.Z., Hassan I., Dung E.D. // J. Surg. Tech. Case Rep. – 2010. – V. 2, № 1. – P. 44-48.
8. Brunner F.X. Histological findings in sutured and fibrin-glued microvascular anastomosis // Arch Otorhinolaryngol. – 1984. – V. 240, № 3. – P. 311-318.
9. Bschorer R., Frerich B., Wolburg H., Gehrke G., Schwenzer N. // J. of Cranio-Maxillofacial Surgery. – 1993. – V. 21, I. 5. – P. 192-198.
10. Buchta C., Hedrich H.C., Macher M., H?cker P., Redl H. // Biomaterials. – 2005. – V. 26, № 31. – P. 6233-6241.
11. Chang E.I., Galvez M.G., Glotzbach J.P., Hamou C.D., El-ftesi S., Rappleye C.T., Sommer K.M., Rajadas J., Abilez O.J., Fuller G.G., Longaker M.T., Gurtner G.C. // Nat. Med. – 2011. – V. 28, № 17(9). – P. 1147-1152.
12. Cho A.B., J?nior R.M. Effect of Fibrin Adhesive Application in Microvascular Anastomosis: A Comparative Experimental Study // Plastic & Reconstructive Surgery. January. – 2007. – V. 119, I. 1. – P. 95-103.
13. Cho A.B., J?nior R.M. Application of fibrin glue in microvascular anastomoses: comparative analysis with the conventional suture technique using a free flap model // Microsurgery. – 2008. – V. 28, № 5. – P. 367-374.
14. Conrad M.H., Adams W.P. Pharmacologic Optimization of Microsurgery in the New Millennium // Plast. & Reconstr. Surg. – 2001. – V. 108, № 7. – P. 2088-2096.
15. Frost-Arner L., Spotnitz W.D., Rodeheaver G.T., Drake D.B. Comparison of the thrombogenicity of internationally available fibrin sealants in an established microsurgical model // Plast. Reconstr Surg. – 2001. – V. 108, № 6. – P. 1655-1660.
16. Gestring G.F., Lerner R., Requena R. The Sutureless Microanastomosis // Vascular Surgery. – 1983. – V. 17, I. 6. – P. 364-367.
17. Green A.R., Milling M.A.P. Butylcyanoacrylate Adhesives in Microvascular Surgery: An Experimental Pilot Study // J. of Reconstructive Microsurgery. – 1986. – V. 2, № 2. – P. 103-105.
18. Isogai N., Cooley B.G., Kamiishi H. Clinical outcome of digital replantation using the fibrin glue-assisted microvascular anastomosis technique // J. Hand Surg. Br. – 1996. – V. 21, № 5. – P. 573-575.
19. Janmey P.A., Winer J.P., Weise J.W. Fibrin gels and their clinical and bioengineering applications. // J. R. Soc. Interface. – 2009. – V. 6, I. 30. – P. 1-10.
20. Kletter G. Fibrin Adhesives in Intracranial Microvascular Surgery. In: Fibrin Sealant in Operative Medicine. – 1986. – Vol. 2: Ophthalmology – Neurosurgery. Eds: Schlag G., Redl H. – P. 129-138.
21. Langer S., Schildhauer T.A., Dudda M., Sauber J., Spindler N. // GMS Interdiscip. Plast. Reconstr. Surg. – 2015. – V. 4. – Doc. 14.
22. Lemaire D., Mongeau J., Dorion D. Microvascular anastomosis using histoacryl glue and an intravascular soluble stent // J. Otolaryngol. – 2000. – V. 29. – P. 199-205.
23. Lumsden A.B., Heyman E.R. Closure Medical Surgical Sealant Study Group. Prospective randomized study evaluating an absorbable cyanoacrylate for use in vascular reconstructions // J. Vasc. Surg. – 2006. – V. 44. – P. 1002-1009.
24. Masia J., Olivares L., Koshima I., Teo T.C., Suominen S., Van Landuyt K., Demirtas Y., Becker C., Pons G., Garusi C., Mitsunaga N. // J. Reconstr. Microsurg. – 2014. – V. 30, № 1. – P. 53-58.
25. Marek C.A., Amiss L.R., Morgan R.F., Spotnitz W.D., Drake D.B. // Ann. Plast. Surg. – 1998. – V. 41, № 4. – P. 415-419.
26. Mintz P.D., Mayers L., Avery N., Flanagan H.L., Burks S.G., Spotnitz W.D. // Ann. Clin. Lab. Sci. – 2001. – V. 31, № 1. – P. 108-118.
27. M?cke T., Wolff K.D. Performing microvascular anastomosis with fibrin glue-faster, easier, and more reliable? // Microsurgery. – 2009. – V. 29, № 1. – P. 80-81.
28. Ong Y.S., Yap K., Ang E.S., Tan K.C., Ng R.T., Song I.C. // Microsurgery. – 2004. – V. 24, № 4. – P. 304-308.
29. Padubidri A.N., Browne E. A new method of applying fibrin glue at the microvascular anastomotic site: the «paintbrush» technique // Microsurgery. – 1996. – V. 17, № 8. – P. 428-430.
30. Pearl R.M., Wustrack K.O., Harbury C., Rubenstein E., Kaplan E.N. Microvascular anastomosis using a blood product sealant-adhesive // Surg. Gynecol. Obstet. – 1977. – V. 144, № 2. – P. 227-231.
31. Pratt G.F., Rozen W.M., Westwood A., Hancock A., Chubb D., Ashton M.W., Whitaker I.S. Technology-assisted and sutureless microvascular anastomoses: Evidence for current techniques // Microsurgery. – 2012. – V. 32. – P. 68-76.
32. Sacak B., Tosun U., Egemen O., Sucu D.O., Ozcelik I.B., Ugurlu K. Two-suture fish-mouth end-to-side microvascular anastomosis with fibrin glue // The J. of Craniofacial Surgery. – 2012. – V. 23, № 4. – P. 1120-1124.
33. Sacak B., Tosun U., Egemen O., Sakiz D., Ugurlu K. Microvascular anastomosis using fibrin glue and venous cuff in rat carotid artery // J. Plast. Surg. Hand Surg. – 2015. – V. 49, № 2. – P. 72-76.
34. Souther S.G., Levitsky S., Roberts W.C. Bucrylate Tissue Adhesive for Microvascular Аnastomosis: Technique, Results, and Histologic Evaluation // Arch Surg. – 1971. – V. 103, № 4. – P. 496-499.
35. Schenk W.G., Spotnitz W.D., Burks S.G., Lin P., Bush R.L., Lumsden A.B. Absorbable cyanoacrylate as a vascular hemostatic sealant: a preliminary trial // Am. Surg. – 2005. – V. 71. – P. 658-661.
36. Spotnitz W.D. Invited Commentary. Hemostats, Sealants, and Adhesives: A Practical Guide for the Surgeon // The American Surgeon. – 2012. – V. 78, № 12. – P. 1305-1321.
37. Tamai S., Sasauchi N., Hori Y., Tatsumi Y., Okuda H. Microvascular surgery in orthopaedics and traumatology // J. Bone Joint Surg. Br. – 1972. – V. 54, № 4. – P. 637-647.
38. Wadstr?m J., Wik O. Fibrin glue (Tisseel) added with sodium hyaluronate in microvascular anastomosing // Scand. J. Plast. Reconstr. Surg. Hand Surg. – 1993. – V. 27, № 4. – P. 257-261.
39. Zhu Y., Wei W., Li Y. 2-Octylcyanoacrylate-assisted microvascular anastomosis in rat orthotopic small bowel transplantation. // J. Reconstr. Microsurg. – 2011. – V. 27, № 3. – P.151-156.