High-strength glue products were approved for topical closure applications in the United States in the late 1990s, but have been used considerably more outside the USA. In other countries, such as the major markets of the EU, high-strength glues and adhesives were approved several years ago and have built up a track record of use in internal surgery. Today, high-strength glues are being used in a wider range of procedures both in the US and outside the US. Physicians and researchers are exploring how these glues may be utilized in current or new procedures to produce more cost-effective, better outcomes with reduced morbidity and mortality.
The unmet need for non-toxic, high-strength, resorbable glues is clearly demonstrated by adoption of existing glue products outside of the United States. The table below displays selected applications (see report #S190 for the comprehensive list) for commercially approved products and illustrates the growing potential for these high-strength glues once they gain universal approval and adoption within the surgical community worldwide. These products have high-strength sealant and adhesive properties is leading to their increasing adoption by clinical practitioners, starting with surgical closure and specific internal procedures for which there is no good alternative. Recent data shows increasing usage for tissue adhesives in vascular, neurological, spinal, orthopedic, and other procedures.
Selected* Surgical Indications for High-Strength Glues
Surgical Field Applications CNS surgery: Adhesive agent in CNS tissue surgery. CNS tissue cannot be sutured. Fibrin glue is almost equivalent to microsurgical suture. Fibrin glue works as a sealant but not a nerve barrier. Repair of dural defects. (Others) Eye surgery: Conjunctival closure in strabismus. Wound closure in glaucoma. Lower blepharoplasties (for lower eyelids). (Others) ENT surgery: Myringoplasty in large persistent tympanic membrane perforation. Repair of laryngotracheal separation with cricoidectomy. Narrowing of nasal fossa in atrophic rhinitis. (Others) Oral and dental surgery: Local hemostatic measures in patients with bleeding disorders and patients on anticoagulants. Sealing of oro-antral fistula. (Others) Head and neck: Parotidectomy closure. Axillary dissection in carcinoma of the breast. Reduces adhesion, bleeding and serous drainage with earlier drain. (Others) Cardiovascular thoracic surgery: Reduced postoperative bleeding and intrapericardial adhesion. In cardiothoracic surgery using fibrin glue significantly reduced postoperative bleeding. (Others) Chest surgery: Sealing of prolonged air leak after thoracotomy in lung cancer. Bronchopleural fistula. Percutaneous lung biopsy. (Others) Vascular surgery: Microvascular anastomosis: Suture may induce vascular narrowing, foreign body reaction, intravascular thrombosis but are less common in those with fibrin glue application. Arterial bypass surgery. (Others) Gastrointestinal surgery: Gastrointestinal sutureless anastomosis-stent. Esophagus perforation. Esophago-jejunal anastomosis. Recurrent tracheo-esophageal fistula. Upper gastrointestinal tract fistula: Endoscopic obliteration. (Others) Liver surgery: Liver resection in benign and malignant diseases. Liver transplantation. (Others) Uro/Gynecological system: Colpofixation in stress urinary incontinent. Intractable transplant-ureteral fistula. Transvaginal colpo-urethropexy. (Others) Gynecological surgery: Recto-vaginal and ano-rectal fistula. Anastomosis of the fallopian tube in animals. (Others) Bone & orthopedic surgery: Joint replacement. Brachial plexus injury repair. (Others) Plastic surgery: Face lift procedure. Fibrin glue reduces major hematomas and ecchymoses. Musculo facial plastic surgery, dorsal hand burns, infected skin graft. (Others)
*See Report #S190 for the comprehensive list.
Source: MedMarket Diligence, LLC, Report #S190, “Worldwide Surgical Sealants, Glues, Wound Closure and Anti-Adhesion Markets, 2010-2017.”