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J.C. Yeh, N. Tucker; The Use of Tisseel in Oculoplastics . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4252.
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Background: Tisseel (tissue fibrin sealant) contains human fibrinogen, bovine aprotinin, calcium chloride, human thrombin, fibronectin, and factor XIII. It is both a tissue adhesive as well as a hemostatic agent. It has been used previously in general plastic surgery, otolaryngology, cardiovascular surgery, and neurosurgery. In plastic surgery, its has been used in endoscopic brow and blepharoplasty surgery. Its reported uses in ophthalmology include sutureless lamellar keratoplasty, pterygium surgery, and management of bleb leaks. Its wide range of possible applications in oculoplastics, to our knowledge, has not previously been described. Purpose: To determine the efficacy of human fibrin sealant (Tisseel) in oculoplastics surgery. Methods: All patients in whom Tisseel was used over a 30–month period (from June 2004 to November 2004) were retrospectively reviewed. This included 27 surgeries: 11 in blepharoplasty, 3 in pterygium excision with conjunctival graft, 2 in basal cell carcinoma removal with free skin graft, 2 in lymphangioma removal (one requiring socket reconstruction using amniotic membrane graft), 2 in mullerectomy, and one in each of the following: Steven Johnson syndrome with socket reconstruction using amniotic membrane graft, orbital cyst removal, browpexy, dermolipoma removal, hemostasis in post–operative hemorrhage following blepharoplasty, superior rectus muscle biopsy, and levator muscle resection. Results: There were no complications related to the use of Tisseel. It had the advantage over sutures in providing both hemostasis as well as wound closure. This was found particularly helpful in the closure of conjunctival incisions to avoid sutures that can cause ocular irritation. It provided an added safety in orbital cases with a significant risk of hemorrhage. In eyelid surgery, the improved hemostasis may minimize post–op ecchymosis. For securing free skin, conjunctival, and amniotic membrane grafts, Tisseel was an excellent adjunct. In all cases, Tisseel was found to be effective and safe. There were no cases of wound dehiscence. Conclusions: The combination of hemostasis and adhesion can be useful in a variety of oculoplastics surgeries. In these cases, Tisseel may be a superior alternative to conventional sutures.
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