Original research
Experimental study and clinical application of polyglycolic acid sheet with fibrin glue for oral soft tissue surgery

https://doi.org/10.1016/j.ajoms.2017.02.006Get rights and content

Abstract

Objective

The purpose of the present study was to examine the effects of a Polyglycolic acid (PGA) sheet with fibrin glue in the prevention of scar shrinkage.

Methods

A PGA sheet with fibrin glue was grafted into the tongue after partial glossectomy in 25 rabbits. The wounds were examined histologically and compared to those of animals without grafts at 1, 2, 4, and 8 weeks after surgery, with particular focus on the change in the shape of the tongue and scar shrinkage. Furthermore, a retrospective study was conducted for cases in which the material was grafted into the raw surface of the tongue after partial glossectomy in 20 patients with early tongue cancer or leukoplakia. Postoperative pain and bleeding, and functional disadvantages were compared between the patients with PGA grafts and 6 patients that received partial glossectomy followed by a collagen-based artificial dermis graft.

Results

In the animal experiment, less scar shrinkage was observed in rabbits receiving the graft of the PGA sheet with fibrin glue than in those with an open wound. Clinical application of the PGA sheet with fibrin glue indicated that the materials could prevent postoperative pain and functional disadvantages compared to collagen-based artificial dermis, although no statistical analysis was conducted on these results because of a historical controlled study with a small number of patients.

Conclusions

The results of this study suggest that a PGA sheet with fibrin glue is useful for treating an open wound after soft tissue surgery of the oral cavity.

Introduction

In patients with a small defect after oral soft tissue surgery such as a partial glossectomy, the surgical wound is primarily sutured, whereas an extended defect generally requires reconstructive surgery using a vascularized free flap. In patients with a defect of an intermediate size, a skin graft is commonly used for covering the wound [1], [2], [3]. However, a skin graft has been associated with some problems such as causing damage to the donor site and partial or total necrosis of the grafted skin. A collagen-based artificial dermis (Terudermis®, Terumo Co., Ltd., Tokyo, Japan), in which collagen is combined with a silicone membrane allowing for suturing to the adjacent mucosa, has been widely used for an oral mucosal defect of intermediate size since the 1990s. Terudermis® is an excellent artificial material with good wound-healing and pain-relieving properties [4], but a tie-over dressing method is necessary because of the lack of adhesive ability to the surrounding tissue.

Recently, bio-absorbable polyglycolic acid (PGA) sheets with fibrin glue have been widely used for wounds during lung [5], liver [6], and gastrointestinal surgery [7] for the purpose of reinforcing the tissue and preventing leakage. Some investigators reported that these materials could also be used for coverage of a raw surface in oral surgery to decrease postoperative pain and bleeding. Takeuchi et al. [8] indicated that application of a PGA sheet with fibrin glue to the soft tissue wound after partial glossectomy may decrease functional disadvantages as well as prevent postoperative pain or bleeding; however, the efficacy of these PGA sheets in minimizing scar shrinkage has not been well investigated. Accordingly, the purpose of the current study was to investigate the effect of a PGA sheet with fibrin glue on the prevention of scar shrinkage after partial glossectomy in an animal model, and to retrospectively evaluate the clinical usefulness of this material in patients who had tongue cancer or a premalignant lesion and underwent partial glossectomy.

Section snippets

Animal experiment

A total of 43 New Zealand White Rabbits (SPF, male, 13 week-old, Biotek. Co.,Ltd, Saga, Japan) of approximately 2.0 kg in weight were used for the animal experiments. They were divided into two groups: PGA group (25 animals) and control group (18 animals). In the PGA group, a defect of approximately 12 × 10 × 3 mm was made on the dorsum of the tongue, and a 0.15-mm-thick PGA sheet (Neoveil®, Gunze Co., Ltd., Tokyo, Japan) with fibrin glue (Bolheal®, Chemo-Sero-Therapeutic Research Institute,

Wound healing in the animal experiment

The histologic examinations of the control group at one week after defect formation showed a lack of the epithelial layer and clear infiltration of inflammatory cells into the wound. The findings were similar between the PGA group and the control group. Remaining PGA fibers were evident, and the degree of inflammatory cells infiltration did not differ between the groups.

After 2 weeks, the specimens of control group and PGA group (Fig. 3A, B) exhibited partial repair of the epithelium, although

Discussion

A primary suture is generally performed in a small wound after resection of a premalignant or malignant lesion of the tongue. However, in cases with larger wounds, a primary suture causes deformation of the tongue. A free skin graft, which is sometimes applied to a moderately sized mucosal defect of the tongue, results in surgical damage of the donor site. A collagen-based artificial dermis has recently been used on the mucosal surface after soft tissue surgery of the oral cavity instead of a

Conclusions

The results of this study suggest that a PGA sheet with fibrin glue is useful for treating an open wound after soft tissue surgery of the oral cavity. Future studies will focus on a larger clinical trial to evaluate the general usefulness of these materials in oral surgery.

Ethical approval

Owing to the retrospective nature of this clinical application study, it was granted an exemption of approval in writing by the Institutional Review Board of Nagasaki University Graduate School of Biomedical Sciences and complied with the standards of the Declaration of Helsinki.

Conflict of interest

None.

Acknowledgement

This work was supported by the experimental materials from Chemo-sero-therapeutic Research Institute (Kaketsuken), Kumamoto City, Japan.

References (10)

  • K. Fujikawa et al.

    Clinical application of polyglycolic acid sheet after resection of tongue squamous cell carcinoma

    J Oral Maxillofac Surg Med Pathol

    (2013)
  • M.H. Riqby et al.

    Soft tissue reconstruction of the oral cavity: a review of current options

    Curr Opin Otolaryngol Head Neck Surg

    (2013)
  • K. Ohtsuki et al.

    Clincal application of Chitin, artificial skin material in oral mucous defects

    J Oral Maxillofac Surg

    (1990)
  • T. Fujiwara et al.

    Use of lyophilized porcine skin to the oral wound: clinical application and experimental evaluation as a temporary dressing material

    J UOEH

    (1984)
  • K. Bessyo et al.

    The use of a new bilayer artificial dermis for vestibular extension

    Br J Oral Maxillofac Surg

    (1998)
There are more references available in the full text version of this article.

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    Other lesions were resected with a safety margin of a few millimeters. After resection, PGA sheets with a thickness of 0.15 mm were applied with fibrin glue.6-8 After hemostasis of the raw surfaces, about 1 mL of solution A of the fibrin glue was rubbed on the raw surfaces with the surgeon's finger.

AsianAOMS: Asian Association of Oral and Maxillofacial Surgeons; ASOMP: Asian Society of Oral and Maxillofacial Pathology; JSOP: Japanese Society of Oral Pathology; JSOMS: Japanese Society of Oral and Maxillofacial Surgeons; JSOM: Japanese Society of Oral Medicine; JAMI: Japanese Academy of Maxillofacial Implants.

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