Which bioabsorbable sheet is optimal for combined application with fibrin sealant against alveolar air leakage?

BACKGROUND: There are few basic comparative data on the sealing effect of various bioabsorbable sheets in combination with fibrin sealant (FS), which is a more effective tool for the control of alveolar air leakage than the single use of FS alone. The objective of this study was to investigate which bioabsorbable sheet had the best sealing effect against alveolar air leakage when used in combination with FS, in terms of material quality, weaving pattern, and/or thickness. METHODS: Standardized 20 mm × 30 mm pleural defects were covered with three pieces of the following sheets using the Rub + Soak B technique in an ex vivo porcine lung model. Seal-breaking burst pressure (SBBP) was compared between groups. Experiment 1: 0.15 mm-thick (Group 1), 0.3 mm-thick (Group 2) and 0.5 mm-thick (Group 3) non-woven polyglycolic acid (PGA) felt were compared. Experiment 2: 0.15 mm-thick non-woven PGA felt (Group 1), 0.15 mm-thick meshed oxidised regenerated cellulose (ORC) (Group 4); 0.11 mm-thick woven PGA (Group 5) and 0.18 mm-thick knitted PGA (Group 6) were compared. Experiment 3: TachoSil(®) alone (Group 7), TachoSil(®) combined with FS (Group 8) and 0.15 mm-thick non-woven PGA felt (1 piece) (Group 9) were compared. RESULTS: In Experiment 1, SBBP was significantly higher in Group 1 than in Group 3. The SBBP in Group 2 was significantly higher than that in Group 3. In Experiment 2, SBBP in Group 4 was significantly lower than that in Groups 1, 5, and 6. In Experiment 3, SBBP in Group 7 was significantly lower than that in Groups 8 and 9. CONCLUSIONS: Regarding the sheet thickness of PGA felt, the 0.15 mm was the most effective. Regarding the material quality, the ORC was the least suitable. TachoSil(®) combined with FS was comparable to the most effective 0.15 mm-thick non-woven PGA felt.