Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_813_Библиотеки_им_академика_М_И_Перельмана.pdf
25. Tissue Glues
Sammy Sinno, Jeremie Oliver Piña
See Essentials of Aesthetic Surger y, pp. 323–328
FIBRIN SEALANT
1. In addition to being a tissue sealant, fibrin is also used in aesthetic surgery as a ____ and ____.
A. Anticoagulant and adhesive.
B. Hemostat and adhesive.
C. Lubricant and hemostat.
D. Emollient and adhesive.
E. Hemostat and synthetic capsule.
FIBRIN SEALANT
2. Which of the following is a proven advantage (through multiple double-blind, randomized, controlled trials)
of the use of fibrin sealant in rhytidectomy?
A. Significantly reduced drainage output on fibrin sealant side compared to control.
B. Significantly reduced hematoma rates.
C. Significantly less postoperative edema.
D. Significantly less postoperative ecchymosis.
E. Significantly reduced seroma rates.
FIBRIN SEALANT
3. Which of the following is true regarding fibrin sealants in abdominoplasty?
A. Fibrin sealant is more effective at achieving closure than quilting sutures alone.
B. Seroma formation is significantly lower when fibrin sealant is applied compared to either drains or quilting
sutures.
C. Seroma formation is significantly greater with fibrin sealant compared to both drain and quilting sutures.
D. Fibrin sealant is only helpful when achieving closure of a fleur-de-lis abdominoplasty technique.
E. There is no evidence to support its efficacy.
FIBRIN SEALANT
4. What is a potential disadvantage of using a fibrin sealant–only technique in upper blepharoplasty?
A. Higher likelihood of milia formation.
B. Slightly higher risk of conjunctivitis.
C. Irritation/allergic reaction.
D. Potential for wound separation.
E. More swelling postoperatively.
CYANOACRYLATES
5. What is a relative disadvantage of using cyanoacrylate glue for wound closure compared to fibrin sealant?
A. Cyanoacrylate is less effective for larger wounds.
B. Cyanoacrylate takes more time to polymerize compared to fibrin sealant.
C. Cyanoacrylates have been associated with foreign body reactions.
D. Cyanoacrylates have not been associated with carcinogenicity.
E. Cyanoacrylates have not been associated with tissue necrosis.
170 Part VI&Adjuncts to Aesthetic Surgery
CYANOACRYLATES
6. When cyanoacrylates are applied to clean, well-approximated, tension-free wound closures, how do they com-
pare to standard monofilament suture closure?
A. Significantly lower cosmetic score.
B. Higher cost.
C. Lower physician and assistant satisfaction with use.
D. More cost-effective.
E. Significantly slower closure time.
CYANOACRYLATES
7. Which of the following is a major potential complication of utilizing bovine tissue sealant products?
A. Infection.
B. Wound dehiscence.
C. Bloodborne pathogen risk (i.e., viral, prion).
D. Greater risk of edema.
E. Increased operative time.
Chapter 25&Tissue Glues 171
Answers
FIBRIN SEALANT
1. In addition to being a tissue sealant, fibrin is also used in aesthetic surgery as a ____ and ____.
B. Hemostat and adhesive.
Fibrin tissue sealant, also known by the trade name Artiss (Baxter), is approved by the FDA as a
hemostat, adhesive, and sealant. Its mechanism of action as a hemostat involves polymerization through
reacting with fibrinogen and thrombin, which eventually forms a clot that degrades within 10 to 14
1,2
days.
REFERENCES
1. Spotnitz WD. Fibrin sealant: past, present, and future: a brief review. World J Surg 2010;34:632
2. Buchta C, Hedrich HC, Macher M, et al. Biochemical characterization of autologous fibrin sealants produced by
CryoSeal and Vivostat in comparison to the homologous fibrin sealant product Tissucol/Tisseel. Biomaterials
2005;26:6233
FIBRIN SEALANT
2. Which of the following is a proven advantage (through multiple double-blind, randomized, controlled trials)
of the use of fibrin sealant in rhytidectomy?
A. Significantly reduced drainage output on fibrin sealant side compared to control.
The only example from those listed which has been repeatedly shown in high-powered studies
association between fibrin sealant use and a significantly reduced drainage output volume compared to
control side of rhytidectomy (which did not use any tissue glue). All of the other choices are anecdotally
supported by some, but have not been substantiated to the extent as choice A.
1,2,3
1,2,3
is the
REFERENCES
1. Hester TR Jr, Shire JR, Nguyen DB, et al. Randomized, controlled, phase 3 st udy to evaluate the safety and efficacy
of fibrin sealant VH S/D 4 s-apr (Artiss) to improve tissue adherence in subjects undergoing rhytidectomy.
Aesthet Surg J 2013;33:487
2. Oliver DW, Hamilton SA, Figle AA, et al. A prospective, randomized, double-blind trial of the use of fibrin sealant
for face lifts. Plast Reconstr Surg 2001;108:2101
3. Marchac D, Greensmith AL. Early postoperative efficacy of fibrin glue in face lifts: a prospective randomized trial.
Plast Reconstr Surg 2005;115:911
FIBRIN SEALANT
3. Which of the following is true regarding fibrin sealants in abdominoplasty?
C. Seroma formation is significantly greater with fibrin sealant compared to both drain and quilting
sutures.
Although data seems to be contradictory depending on the study, one prospective analysis demonstrated
fibrin sealant to possibly be inferior to surgical drains or quilting sutures.
cantly lower rate of seroma formation in association with drain (13.9 mL) and quilting suture (16.1 mL)
groups compared with the fibrin sealant (53.6 mL) group (p < 0.05).
1
This study observed a signifi-
1
REFERENCE
1. Bercial ME, Sabino Neto M, Calil JA, et al. Suction drains, quilting sutures, and fibrin sealant in the prevention of
seroma formation in abdominoplasty: which is the best strategy? Aesthetic Plast Surg 2012;36:370
FIBRIN SEALANT
4. What is a potential disadvantage of using a fibrin sealant–only technique in upper blepharoplasty?
D. Potential for wound separation.
172 Part VI&Adjuncts to Aesthetic Surgery
Although there is a small risk of wound separation in the “glue only” technique for upper blepharoplasty,
when compared with standard suture techniques, the incidence of minor problems such as milia formation
was lower.1This was shown to be an acceptable alternative or adjunct to sutures for closure in upper
blepharoplasty.
REFERENCE
1. Mandel MA. Minimal suture blepharoplasty: closure of incisions with autologous fibrin glue. Aesthetic Plast Surg
1992;16:269
CYANOACRYLATES
5. What is a relative disadvantage of using cyanoacrylate glue for wound closure compared to fibrin sealant?
C. Cyanoacrylates have been associated with foreign body reactions.
Although fibrin sealant can safely be used internally within the wound bed, cyanoacrylates are not for
internal use, as they have been associated with foreign body reactions, carcinogenicity, and tissue
necrosis.
1
REFERENCE
1. Toriumi DM, Raslan WF, Friedman M, Tardy ME. Histotoxicity of cyanoacrylate tissue adhesives. A comparative
study. Arch Otolaryngol Head Neck Surg 1990;116:546
CYANOACRYLATES
6. When cyanoacrylates are applied to clean, well-approximated, tension-free wound closures, how do they com-
pare to standard monofilament suture closure?
D. More cost-effective.
Given the clean, well-approximated, tension-free application of cyanoacrylates, they have been validated by
multiple prospective randomized trials in plastic surgery procedures to have equivalent rates of wound
infection, dehiscence, and cosmesis compared to standard sutu re closure methods, with an additional
advantage of greater cost-effectiveness through decreased operative times and elimination of suture
removal or secondary dressing requirements.
1,2,3,4
REFERENCES
1. Gennari R, Rotmensz N, Ballardini B, et al. A prospective, randomized, controlled clinical trial of tissue adhesive
(2-octylcyanoacrylate) versus standard wound closure in breast surgery. Surgery 2004;136:593
2. Scott GR, Carson CL, Borah GL. Dermabond skin closures for bilateral reduction mammaplasties: a review of 255
consecutive cases. Plast Reconstr Surg 2007;120:1460
3. Greene D, Koch RJ, Goode, RL. Efficacy of octyl-2-cyanoacrylate tissue glue in blepharoplasty. A prospective controlled study of wound-healing characteristics. Arch Facial Plast Surg 1999;1:292
4. Nipshagen MD, Hage JJ, Beckman WH. Use of 2-octyl-cyanoacrylate skin adhesive (Dermabond) for wound closure following reduction mammaplasty: a prospective, randomized intervention study. Plast Reconstr Surg
2008;122:10
CYANOACRYLATES
7. Which of the following is a major potential complication of utilizing bovine tissue sealant products?
C. Bloodborne pathogen risk (i.e., viral, prion).
Commercial preparations of tissue sealants carry the risk of spreading bloodborne pathogens (i.e., viral,
prions) upon application.
1
All standard precautions for patient and staff safety must be followed.
REFERENCE
1. O’Grady KM, Agrawal A, Bhattacharyya TK, et al. An evaluation of fibrin tissue adhesive concentration and application thickness on skin graft survival. Laryngoscope 2000;110:1931
26. Fixation Devices
Sammy Sinno, Jeremie Oliver Piña
See Essentials of Aesthetic Surger y, pp. 329–334
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
1. After placement of a polylactic acid/polyglycolic acid (Endotine) tack in browlift surgery, how long will it take
for the tack to be completely absorbed?
A. 3 months.
B. 6 months.
C. 12 months.
D. 18 months.
E. 24 months.
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
2. Which of the following is a relative disadvantage of the polylactic acid/polyglycolic acid tack technique in
browlift surgery?
A. Steep learning curve for surgeons to adapt.
B. Device remains palpable and tender prior to absorption.
C. Cannot be used in conjunction with endoscope.
D. Adds substantially to operative time.
E. Very high infection rate.
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
3. The Ultratine tack has been shown to be more rapidly absorbed compared to the Endotine tack. Which of the
following potential implications of this modification could impact surgical outcomes?
A. Decreased infection risk.
B. Potential loss of fixation.
C. Less inflammation.
D. Decreased need for revision surgery.
E. Decreased cost of procedure.
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
4. When considering the use of Endotine ribbon as an adjunct for ptosis correction at the cervicomental junction
of a patient with thin soft tissue in the face and neck, which of the following is an important potential longterm result of placement of this device?
A. Wound dehiscence.
B. Tenderness/pain at placement site after 12 months postoperatively.
C. Potential for palpability of ribbon.
D. Reversal of cervicomental ptosis.
E. Overcorrection of ptosis.
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
5. Which of the following differentiates the Mini-Mitek soft tissue anchor (Ethicon) from Endotine fixation
devices?
A. It is less applicable to facial aesthetic surgery.
B. Potential for the device to be palpable through thin soft tissue areas.
C. Much more expensive.
D. Does not absorb.
E. Low learning curve for surgeons to adapt to practice.
174 Part VI&Adjuncts to Aesthetic Surgery
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
6. Which of the following pertains to the use of the V-Loc barbed suture (Covidien)1compared to traditional
suture in wound closure?
A. Decreased operative time.
B. 10 to 15% longer scars through the “accordion effect.”
C. Increased risk of suture extrusion.
D. Increased cost of the procedure.
E. V-Loc 180 (Polyglyconate) has a shorter time to absorption.
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
7. How does the Quill suture (Angiotech Pharmaceuticals)
A. Quill suture is used in the closure of body contouring procedures.
B. Quill suture is composed of both bioabsorbable and permanent material.
C. Quill suture is a barbed suture.
D. Quill suture is bidirectional.
E. These two suture types do not differ functionally.
1,2
differ from the V-Loc suture?
OUTCOMES
8. Despite its significant association with retention cysts, when comparing Ultratine vs. Endotine tacks in brow -
lift surgery, the Ultratine tack has shown higher patient satisfaction scores compared to Endotine tack in
browlift surgery. Which of the following is a potential reason for this finding?
A. Decreased cost with the Ultratine tack.
B. Ultratine tack is 50% bioabsorbed by 4 months.
C. Ultratine tack is 75% bioabsorbed by 18 months.
D. Ultratine tack is 90% bioabsorbed by 24 months.
E. Increased palpability.
Chapter 26&Fixation Devices 175
Answers
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
1. After placement of a polylactic acid/polyglycolic acid (Endotine) tack in browlift surgery, how long will it take
for the tack to be completely absorbed?
C. 12 months.
Endotine tacks (COAPT Systems)
secured through the outer cortex of the cranium for fixation in browlift surgery. These materials are
bioabsorbable; thus, they do not need to be removed. The degradation process is achieved through hydrolysis and enzymatic breakdown of (first) polyglycolic component and (second) polylactic acid component
over a period of 12 months.
REFERENCES
1. Saltz R, Ohana B. Thirteen years of experience with the endoscopic midface lift. Aesthet Surg J 2012;32:927
2. Holzapfel AM, Mangat DS. Endoscopic forehead-lift using a bioabsorbable fixation device. Arch Facial Plast Surg
2004;6:389
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
2. Which of the following is a relative disadvantage of the polylactic acid/polyglycolic acid tack technique in
browlift surgery?
B. Device remains palpable and tender prior to absorption.
Several advantages to utilizing Endotine tack technology in browlift surgery include the ability to achieve
timely, direct fixation to the cranium and soft tissue through digital pressure, low learning curve for
surgeons to apply the technique to their practice, capability to be used in conjunction with an endoscope,
and bioabsorption of the device within 12 months of placement. However, the relative disadvantages include
the added costs to the procedure for the device itself (not for extra time in the OR), postoperative tenderness
over the device and palpability until the dev ice begins to absorb, and the difficulty in application for temporal laxity and/or more severe cases of brow ptosis.
1,2
are made of 82:18 ratio of polylactic acid/polyglycolic acid and are
1
REFERENCE
1. Cervelli V. An original application of the Endotine Ribbon device for brow lift. Plast Reconstr Surg 2009;124:1652
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
3. The Ultratine tack has been shown to be more rapidly absorbed compared to the Endotine tack. Which of the
following potential implications of this modification could impact surgical outcomes?
B. Potential loss of fixation.
Although the Ultratine tack (COAPT Systems)
months postoperatively, the reported disadvantages compared to Endotine tack include the potential for
loss of fixation point (likely given the faster absorptive action, allowing less time for soft tissue adhesion
to device on outer cortex of cranium), as well as reports of inflammatory retention cysts requiring surgical correction and increasing costs of the procedure.
1,2,3
undergoes 50% absorption by 4 months, and 70% by 10
REFERENCES
1. Servat JJ, Black EH. A comparison of surgical outcomes with the use of 2 different biodegradable multipoint fixation devices for endoscopic forehead rejuvenation. Ophthal Plast Reconstr Surg 2012;28:401
2. Savar A, Shore J. Ultratine retention: report of a case. Ophthal Plast Reconstr Surg 2009;25:501
3. Apfelberg DB, Newman J, Graivier M, et al. Multispecialty contralateral study of clinical experience with the
Ultratine forehead fixation device: evolution of the original Endotine device. Arch Facial Plast Surg 2008;10:280
176 Part VI&Adjuncts to Aesthetic Surgery
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
4. When considering the use of Endotine ribbon as an adjunct for ptosis correction at the cervicomental junction
of a patient with thin soft tissue in the face and neck, which of the following is an important potential longterm result of placement of this device?
C. Potential for palpability of ribbon.
Although a useful adjunct for correction of cervicomental ptosis, in a patient with thin soft tissue the placement of an Endotine ribbon can potentially result in chronic palpability of the ribbon beneath the skin.
1,2,3
REFERENCES
1. Knott PD, Newman J, Keller GS, et al. A novel bioabsorbable device for facial suspension and rejuvenation. Arch
Facial Plast Surg 2009;11:129
2. Cervelli V. An original application of the Endotine ribbon device for brow lift. Plast Reconstr Surg 2009;124:1652
3. Bartsich S, Swartz KA, Spinelli HM. Lateral canthoplasty using the Mitek Anchor system. Aesthetic Plast Surg
2012;36:3
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
5. Which of the following differentiates the Mini-Mitek soft tissue anchor (Ethicon) from Endotine fixation
devices?
D. Does not absorb.
The Mini-Mitek anchor device, in contrast to Endotine fixation devices described previously, is a permanent implantable device. Otherwise, it is very applicable to facial aesthetic surgery, is relatively easy to
use, and has a similar cost to other implantable fixation devices.
1,2
REFERENCES
1. Cervelli V. An original application of the Endotine ribbon device for brow lift. Plast Reconstr Surg 2009;124:1652
2. Bartsich S, Swartz KA, Spinelli HM. Lateral canthoplasty using the Mitek Anchor system. Aesthetic Plast Surg
2012;36:3
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
6. Which of the following pertains to the use of the V-Loc barbed suture (Covidien)1compared to traditional
suture in wound closure?
A. Decreased operative time.
The V-Loc barbed suture has shown superior results in wound closure compared to traditional buried
suture closure in that it shortens the operative time (and may reduce operative costs as a result),
potentially shortens scar length from the “accordion effect” of barbed suture placement, evenly
distributes tension along the wound closure, and has shown decreased numbers of suture extrusion
during wound healing given the fewer number of buried knots in subcutaneous and dermal planes.
Loc 90 has an approximate time to absorption of 90 days whereas V-Loc 180 has an approximate time to
absorption of 180 days.
1
1
V-
REFERENCE
1. Nguyen AT, Ritz M. Body contouring surgery with the V-loc suture. Plast Reconstr Surg 2011;128:332
FIXATION OF BROWLIFTS, MIDFACE LIFTS, AND NECKLIFTS
7. How does the Quill suture (Angiotech Pharmaceuticals)
D. Quill suture is bidirectional.
While the V-Loc barbed suture is unidirectional and uses a loop at the end for fixation, the Quill barbed
suture is bidirec tional with a tapered needle at both ends of the suture. This differs functionally from
other barbed suture in that suture is run starting in the mid-portion of the wound and running in both
directions away from the mid-point, and finally either run back toward the midline or cut at the wound
endpoint.
1,2
1,2
differ from the V-Loc suture?
Chapter 26&Fixation Devices 177
REFERENCES
1. HurwitzDJ, Reuben B. Quill barbed sutures in body contouringsurgery: a 6-year comparison with running absorbable braided sutures. Aesthet Surg J 2013;33(3 Suppl):S44
2. Moya AP. Barbed sutures in body surgery. Aesthet Surg J 2013;33(3 Suppl):S57
OUTCOMES
8. Despite its significant association with retention cysts, when comparing Ultratine vs. Endotine tacks in brow -
lift surgery, the Ultratine tack has shown higher patient satisfaction scores compared to Endotine tack in
browlift surgery. Which of the following is a potential reason for this finding?
B. Ultratine tack is 50% bioabsorbed by 4 months.
Ultratine undergoes hydrolysis at a faster rate than Endotine. About 50% of the device is absorbed in 4
months, and 70% is absorbed in 10 months. This in turn makes it less palpable due to a faster absorption.
Ultratine tack does show greater patient satisfaction outcomes in browlift surgery compared to Endotine,
despite the signif icant association of required surgical correction of postoperative retention cysts.
1
REFERENCE
1. Servat JJ, Black EH. A comparison of surgical outcomes with the use of 2 different biodegradable multipoint fixation devices for endoscopic forehead rejuvenation. Ophthal Plast Reconstr Surg 2012;28:401