Beruflich Dokumente
Kultur Dokumente
and Maxillofacial
Surgery
Michael J. Buckley, DMD, MBA, MSa,b,*,
Eric J. Beckman, PhDc,d
KEYWORDS
Tissue adhesives Adhesives for bone fixation
Cyanoacrylates Fibrin sealants
Collagen-based sealants
Synthetic polymer-based materials
Protein-based sealants
FIBRIN ADHESIVES
In the early 1940s, the combination of fibrin and
thrombin was first used as an adhesive. These
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CYANOACRYLATES
Cyanoacrylates (superglues) have been used for
years as wound-closure materials. Octyl-cyanoacrylates and butyl-cyanoacrylates have been
recently used as skin-closure adhesives with
good success. All of the cyanoacrylates operate
as adhesives in similar manners. They are applied
as mononers, which then rapidly polymerize to
a high molecular-weight material.1113 The presence of the cyano group on the acrylate monomer
enables initiation of polymerization (curing) simply
by water or amine groups present on proteins,
a characteristic not present in typical acrylates.
Conventional superglue (methyl cyanoacrylate)
cures to a hard, brittle material, whereas the octyl
and butyl analogs used as tissue adhesives form
a more resilient material once cured. While exhibiting a strong adhesive bond once cured, cyanoacrylates do not biodegrade to any real extent and
can induce a significant inflammatory response
given their hydrophobic nature. Their use has
generally been limited to superficial wounds.
Cyanoacrylate tissue adhesives form a strong
bond across tissue-wound edges, enabling
normal healing to occur below the seal. They are
marketed to replace small sutures in incision and
laceration repairs. These adhesives have been
shown to save time and provide a flexible waterresistant protective coating that will seal head
and neck wounds from water exposure and
contamination. They can be used safely in small
wounds, but also in larger wounds where subcutaneous sutures are needed and a watertight sealant
is appropriate. There is a small exothermic reaction during curing, but the patient does not usually
feel the temperature rise. These cyanoacrylates
have been shown to have some antimicrobial
properties.14
POLYURETHANE ADHESIVES
Polyurethane adhesives exhibit a wide range of
physical and mechanical properties that make
them attractive candidates for biomedical use.
Created by the reaction of polyester- or polyether-polyols with polyfunctional isocyanates,
polyurethane polymers are frequently used in
O=C=N-CH2-CH2-CH2-CH2-CH-COO-C2H5
N=C=O
H
HO-CH2-C-CH2-OH
OH
(1) Glycerol
N=C=O
H
O=C-N-CH2-CH2-CH2-CH2-CH-COO-C2H5
O=
H
O-CH2-C-CH2-O-C-N-CH2-CH2-CH2-CH2-CH-COO-C2H5
H
N=C=O
O
O=C-N-CH2-CH2-CH2-CH2-CH-COO-C2H5
H
N=C=O
Fig. 1. Reaction of glycerol and lysine di-isocyanate (LDI). LDI is composed of a lysine core (black) with two isocyanate groups (blue). One glycerol (red) reacts with three LDI molecules to produce an isocyanate-capped glycerol
prepolymer. The reaction of the hydroxyl groups on glycerol with the isocyanate groups on LDI produces
a urethane linkage (green). The resultant prepolymer has three unreacted isocyanate groups remaining.
Fig. 2. Comparison of test lysine di-isocyanate adhesive and control in canine abdominoplasty model.
(From Gilbert TW, Badylak SF, Gusenoff J, et al. Lysinederived urethane surgical adhesive prevents seroma
formation in a canine abdominoplasty model. Plast
Reconstr Surg 2008;122:95102; with permission.)
197
198
Control
Glue
Strain
Strain
(N/cm^2) SD
(N/cm^2) SD
Time
1 hours
0.268
0.213
10.437
12 hours
0.612
0.185
3.883
24 hours
0.992
0.13
8.358
1 week
3.2
1.869
14.472
2 weeks
19.861
11.553
22.789
4 weeks
62.866
22
56.571
5.451
0.937
6.315
4.414
14.912
19.8
70
60
SUMMARY
50
40
Control
Glue
30
20
10
0
1 hours 12 hours 24 hours 1 week
Time
2 weeks 4 weeks
BONE ADHESIVE
A particular problem in oral and maxillofacial
surgery is bone fixation of small pieces of bone
where use of bone screws and bone plates is
impossible or impractical. These applications might
include not only small fragments of bone in the craniomaxillofacial region, but also fixation of intracapsular fractures where the use of screws and bone
plates is precluded. A bone adhesive strong enough
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