Clinical applications of medical/surgical sealants and related products

Medical/surgical sealants and adhesives are being adopted in a large and growing number of procedures.  Sutures, clips and staples, by comparison, hold a large share of procedure volume and are stubborn to give ground against sealants and adhesives.  There is no doubt, however, that the relatively higher growth rates for the novel closure products are steadily eroding the century-long hold dominance of sutures in wound closure.

Below are illustrated selected procedural indications for sealants and adhesives by clinical area (the full list including “Others” is given in Report #S190).

 

Surgical FieldApplications
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)

Source: MedMarket Diligence, LLC; Report #S190.

The overall potential for these products is strongest in cardiology, where bleeding represents the most likely complication.  It is also worth noting that while the U.S. and Europe, as is typical of most medtech markets, represent a large share of the global market, there remains considerable upside for the adoption of sealant/glues and related products in Asia and developing nations (see below).

Source: MedMarket Diligence, LLC; Report #S190.