A recent publication (Injury, 2012) from surgeons at the University Hospital of Bordeaux, France describes the incidence, management and complications of incidental durotomy during spinal surgery.
Patrick Guerin and colleagues undertook a retrospective review of 1,326 patients who underwent spinal surgery at their unit over a twelve month period during 2005. In this series, 51 dural tears were identified (≈4%). Thirteen patients developed postoperative complications including cerebrospinal fluid leaks (7), wound infections (2), postoperative haematomas (2) and pseudomeningoceles (2). Of these, 9 patients required further surgery. The paper details the intraoperative management of these incidental durotomies, ranging from no treatment to the use of sutures, fibrin glue, oxidised regenerated cellulose or a combination of all three.
Dural tears are a frequent complication of spinal surgery, with the rates of incidental durotomy in the literature ranging from 1-17%. Their incidence is affected by a number of factors including of course complexity of case. Revision surgery may also be required. Without repair dural tears can lead to a persistent cerebrospinal fluid leak, meningitis, pseudomeningocele and wound infections.
Tissuemed’s TissuePatchDural sealant film can be used as an adjunct to conventional dural closure in both cranial and spinal surgery. It is quick, easy to use requiring no advance preparation and has low bulk, being only 40microns thick. Following application it adheres to the underlying tissue forming a strong watertight seal. During standard in vitro burst pressure testing (ASTM method) to repair 3mm diameter defects, TissuePatchDural achieved average burst pressures in excess of 130mmHg compared to <20mmHg for fibrin sealant.
For further information regarding TissuePatchDural please contact Tissuemed at firstname.lastname@example.org or call on +44 (0)113 2000519.