Potential of Fibrin Glue and Mesenchymal Stem Cells (MSCs) to Regenerate Nerve Injuries: A Systematic Review

Cell-based therapy is a promising treatment to favor tissue healing through less invasive strategies. Mesenchymal stem cells (MSCs) highlighted as potential candidates due to their angiogenic, anti-apoptotic and immunomodulatory properties, in addition to their ability to differentiate into several specialized cell lines. Cells can be carried through a biological delivery system, such as fibrin glue, which acts as a temporary matrix that favors cell-matrix interactions and allows local and paracrine functions of MSCs. Thus, the aim of this systematic review was to evaluate the potential of fibrin glue combined with MSCs in nerve regeneration. The bibliographic search was performed in the PubMed/MEDLINE, Web of Science and Embase databases, using the descriptors (“fibrin sealant” OR “fibrin glue”) AND “stem cells” AND “nerve regeneration”, considering articles published until 2021. To compose this review, 13 in vivo studies were selected, according to the eligibility criteria. MSCs favored axonal regeneration, remyelination of nerve fibers, as well as promoted an increase in the number of myelinated fibers, myelin sheath thickness, number of axons and expression of growth factors, with significant improvement in motor function recovery. This systematic review showed clear evidence that fibrin glue combined with MSCs has the potential to regenerate nervous system lesions.

Evolution of a concept with enzymatic debridement and autologous in situ cell and platelet-rich fibrin therapy (BroKerF)

Background Deep partial-thickness burns are traditionally treated by tangential excision and split thickness skin graft (STSG) coverage. STSGs create donor site morbidity and increase the wound surface in burn patients. Herein, we present a novel concept consisting of enzymatic debridement of deep partial-thickness burns followed by co-delivery of autologous keratinocyte suspension and plated-rich fibrin (PRF) or fibrin glue. Material and methods In a retrospective case study, patients with deep partial-thickness burns treated with enzymatic debridement and autologous cell therapy combined with PRF or fibrin glue (BroKerF) between 2017 and 2018 were analysed. BroKerF was applied to up to 15% total body surface area (TBSA); larger injuries were combined with surgical excision and skin grafting. Exclusion criteria were age <18 or >70 years, I°, IIa°-only, III° burns and loss of follow-up. Results A total of 20 patients with burn injuries of 16.8% ± 10.3% TBSA and mean Abbreviated Burn Severity Score 5.45 ± 1.8 were identified. Of the patients, 65% (n = 13) were treated with PRF, while 35% (n = 7) were treated with fibrin glue. The mean area treated with BroKerF was 7.5% ± 0.05% TBSA, mean time to full epithelialization was 21.06 ± 9.2 days and mean hospitalization time was 24.7 ± 14.4 days. Of the patients, 35% (n = 7) needed additional STSG, 43% (n = 3) of whom had biopsy-proven wound infections. Conclusion BroKerF is an innovative treatment strategy, which, in our opinion, will show its efficacy when higher standardization is achieved. The combination of selective debridement and autologous skin cells in a fibrin matrix combines regenerative measures for burn treatment. Lay Summary Patients suffering from large burn wounds often require the use of large skin grafts to bring burned areas to heal. Before the application of skin grafts, the burned skin must be removed either by surgery or using enzymatic agents. In this article, we describe a method where small areas of skin are taken and skin cells are extracted and sprayed on wound areas that were treated with an enzymatic agent. The cells are held in place by a substance extracted from patients’ blood (PRF) that is sprayed on the wound together with the skin cells. We believe this technique can be helpful to reduce the need of skin grafts in burned patients and improve the healing process.

A case report of refractory congenital chylous ascites in infant – surgical treatment with Fibrin glue

Congenital chylous ascites is a rare disease that results from abnormal development of the intra-abdominal lymphatic system. No gold standard treatment has been described so far, however, a combination of medium–chain triglyceride based diet or total parenteral nutrition along with octreotide and abdominal paracentesis is considered as a conservative management. This treatment is often a challenge to physicians since chylous ascites is often refractory and result in malnutrition and immune deficiency because of the loss of proteins and lymphocytes. We report a four-month old boy with congenital chylous ascites who was refractory to medical treatment with prolonged bowel rest, total parenteral nutrition, octreotide and repeated paracentesis. The baby well responded to surgical treatment with application of fibrin glue on the surface area of the leak site and was discharged after 2 month of hospitalization. When following up the patient had no recurrence of the ascites and he was growing up normally.

Role of Autologous Fibrin Glue (AFG) to Reduce Drainage Volume After Modified Radical Mastectomy for Breast Cancer

Background: Seroma is arguably the most significant complication that can happen after mastectomy. Although seroma is not a life-threatening complication, this condition can lead to severe morbidities. This situation can cause prolonged hospital stays and delayed adjuvant therapy. In this regard, autologous fibrin glue is a hemostatic agent that can accelerate fibrin formation, stop vascular oozing, and decrease dead space. Therefore, this research was performed to evaluate autologous fibrin glue function in lowering seroma volume after mastectomy and shortening the length of hospital stay.Methods: This randomized control trial research was designed to compare the effect of autologous fibrin glue to a control group that did not receive autologous fibrin glue. Seroma volume was calculated every 24 hours. The drains were then removed after the production of seroma less than 30 mL/24 hours.Results: We recruited 20 patients for each of the two groups who met the inclusion criteria. Age, histopathology type, breast cancer stage, number of lymph nodes, and tumor size did not significantly differ. However, patients in the fibrin glue group had significantly lower cumulative drain production. The median seroma volume in the treatment group was 9.30 mL, while the median in the control group was 20.90 mL (p < 0.05).Conclusions: Autologous fibrin glue significantly decreased seroma formation and length of hospital stay.