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Background: Since the first experiments with fibrin glue application in microvascular anastomoses in 1977, several studies have reported its benefits on suture reduction and anastomosis decreased time. In spite of that, clinical experience has been limited. The objective of this presentation is to share our cumulated experience with the fibrin glue application in microvascular anastomoses for almost 10 years.

Methods: In the first experimental study (2003), we performed end-to-end anastomoses in the femoral and carotid arteries of rats, comparing the conventional suture technique with the fibrin glue assisted technique in terms of anastomoses speed and patency rates, number of sutures per anastomosis and histological findings. In the second study (2008), the experimental model consisted of a free groin flap transfer to the anterior cervical region in rabbits. The flap’s circulation was restored by means of an end-to-side anastomosis between the femoral and carotid arteries, and an end-to-end anastomosis between the femoral and external jugular veins.In the clinical study, 24 consecutive cases of free flaps were performed, from March 2005 to June 2006.

Results: in both experimental studies, the application of fibrin glue reduced the number of sutures (30 to 50% of suture reduction) and the time required to complete the anastomoses (2 to 6 minutes less). The anastomotic bleeding was also significantly reduced. The patency rates and the flaps’ survival rate were not adversely affected by the fibrin glue application and were kept around 90%. The histopathological findings revealed a non-significant increase in the inflammatory process around the anastomoses in rabbits, but not in rats. In the clinical study, the fibrin glue cut by half the number of sutures and the time required to complete the anastomoses. The survival rate of the flaps were similar in both groups: 84.6% (11/13) in the fibrin glue group and 85.7% (6/7) in the conventional group.

Discussion: Since our first experience with fibrin glue in microvascular anastomoses, we accomplished more than 34 cases of free flaps with a cumulated success rate of  91%.Although we tried to demonstrate the usefulness of fibrin glue in our studies through objective measurable parameters the major benefit of fibrin glue application is subjective. It makes the microvascular surgery easier to perform because we can complete the anastomoses with less sutures and with a wider interval between the suture knots.

Conclusions: Fibrin glue application in microvascular anastomoses proved to be feasible, safe and reliable in experimental and clinical studies.