Violation of the integrity of the airway (pulmonary parenchymal air leak or tracheobronchial injury) remains a challenging problem in chest medicine and thoracic surgery. Tissue sealants such as fibrin glue have been suggested to improve outcomes but they are still associated with significant failure rates. Laser tissue welding (LTW) is an alternative method that produces wound repairs that are significantly stronger than those of fibrin glue and may be used to repair air leaks.
We used an Institutional Animal Care and Use Committees-approved New Zealand white rabbit model of lung parenchymal and tracheal injury. Lung wounds (n = 8 per condition) were created and either left open or repaired using fibrin glue or LTW. Tracheal wounds (n = 5 per condition) were created using incisions in the membranous and cartilaginous portions or by removing a tracheal ring, and were repaired using LTW. Within each tissue type, the burst strength of the wounds was measured using a digital manometer and were compared with one another using a two-tailed, paired Student t test.
Among the lung injuries, the burst strength of the LTW repair (19.95 ± 4.98 mm Hg) was significantly stronger than that of the fibrin glue repair or open wound (10.53 ± 5.01 mm Hg, P = .001, and 7.61 ± 2.64 mm Hg, P < .001, respectively). Among the tracheal injuries, the burst strength of the membranous incision (101.00 ± 20.25 mm Hg) was significantly higher than that of the cartilaginous incision (75.08 ± 10.50 mm Hg, P = .03) but not that of the cartilaginous defect (77.34 ± 12.35 mm Hg).
LTW is capable of sealing wounds in the tracheobronchial tree and can produce bonds that are twice as strong as fibrin glue in lung parenchyma. LTW may be a better alternative than fibrin glue in the repair of injuries to the airway. CHEST 2010; 138(2):345–349