Tisseel

One week after BICAL, the temporalis muscle was detached from the cranium to the zygoma on the left side. A 5 × 5 mm craniectomy underneath the temporalis muscle was performed, and the exposed dura was excised. 0.2 mL of TISSEEL® (0.1 mL of fibrinogen and 0.1 mL of thrombin) (Baxter Healthcare Corporation) was applied onto the exposed brain surface with dura mater opening; then, the temporalis muscle was placed back in contact with the TISSEEL and the brain surface. Light pressure was maintained on the muscle for 2 min, and excess TISSEEL was squeezed out and removed. The wound was closed after hemostasis was achieved.

A 57-year-old lady, diabetic, nonsmoker underwent a left-sided neck dissection for metastatic melanoma on November 17, 2011. On postoperative day 2, she underwent reexploration due to dramatic chyle leak. She continued having high output drainage, average 2550 mL per day, even with very low fat diet and control of hyponatremia. She started total parental nutrition (TPN) on the November 25 but continued with high output up to 5230 mL a day. She had an omohyoid and hemi-SCM muscle flap to cover the leak and sealed with TISSEEL (Baxter Healthcare, Newbury, UK) on December 1. The TPN was stopped and normal diet resumed on December 7, but the fluid output (biochemically serous fluid) continued to a maximum of 300 mL daily. After deciding to remove the drain with an output between 160 and 220 mL per 24 hours and applying PICO over the wound site on December 11, she was discharged the same day after being in hospital for 24 days. PICO dressing needed replacing as soaked every 24 hours until December 16 and then the dressing lasted 4 days after which it was applied weekly for 2 weeks. During the weekly PICO application, the dressing acquired minimal exudate. PICO stopped with no further drainage from the left neck on January 4, 2012. Total 8 visits to clinic, so £82 × 8 = £656; PICO dressing changes 5 times at the rate of £120, so 5 × £120 = £600; grand total = £1256.

Matriderm (Medskin Solutions, Suwelack A.G., Billerbeck, Germany) is a 3D bovine collagen–elastin matrix consisting of bovine collagen types I, III, and V. In this study, matrices of 148 x 105 x 1 mm were used. The collagen–elastin matrix was sliced into circular 22 mm punches and transferred into six-well cell culture inserts (BD Falcon, Bedford, MA, USA), then stored under sterile conditions in six-well plates until use. Matriderm scaffolds were inoculated with 3 x 10⁵ NHDF per cm² in Tisseel (Baxter, Derfield, IL, USA) and submersed with fibroblast growth medium used for dermal scaffold skin equivalents. After three days, 3 x 10⁶ NHEK were seeded on top of each dermal equivalent. Skin equivalents were submersed in equal volumes of DMEM and keratinocyte growth medium with 5% fetal calf serum (FCS), 50 μg ascorbic acid, and 5 μg/ml aprotinin (Applichem, Chicago, IL, USA). On the following day, skin equivalents were lifted to the air–liquid interface. The calcium concentration of the culture medium was increased to 1.0 mM and medium was changed every other day [18 (link)].

Applying a muscle‐sparing approach, a surgeon accessed the proximal sciatic nerve of the right legs of 12‐month‐old White New Zealand female rabbits placed under general anesthesia (Miller et al., 2018). After transecting the nerve, the ends of the proximal and the distal stumps were pulled into a conduit (Axoguard Nerve Connector; Axogen Corp.) and secured on each end with sutures, then sealed with the fibrin glue (TISSEEL; Baxter International Inc.). Following surgery, the rabbits were allowed free cage activity. Subsequently, the rabbits were sacrificed at 2 weeks (n = 3), 4 weeks (n = 3), 6 weeks (n = 4), and 10 weeks (n = 4) after injury, and then, the corresponding segments of the injured and uninjured nerves were harvested for histological and spectroscopic analyses.