Tissue Repair by Photochemical Cross-Linking

Authored by: Irene E. Kochevar , Robert W. Redmond

Handbook Ofphotomedicine

Print publication date:  October  2013
Online publication date:  October  2013

Print ISBN: 9781439884690
eBook ISBN: 9781439884706
Adobe ISBN:

10.1201/b15582-73

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Abstract

Sutureless joining of tissue surfaces has been a long-sought goal because use of sutures induces inflammation and subsequent fibrosis and may leave gaps between suture points. Light-initiated techniques to bond tissues together were introduced over 30 years ago. Ideally, these approaches produce a strong, imme-diate, watertight bond without damage to adjacent tissue that maintains its strength over a long period. Such techniques might be especially appropriate for microsurgery since they circum-vent the need for skilled placement of hair-fine sutures in small delicate structures. Two approaches, differing in mechanism, have been developed for light-initiated tissue bonding. The first method developed operates by a thermal mechanism involving rapid absorption of laser energy at the junction of the tissues and a temperature rise above the denaturation temperature of colla-gen. The partially denatured collagen molecules are believed to interact and intertwine so that, upon cooling, a continuous seal forms. The second mechanism involves photochemical reactions that initiate formation of covalent cross-links between collagen molecules on the tissue surfaces. Photochemical cross-linking can occur without a temperature increase or protein denatur-ation, and it produces a continuous molecular level seal between the two surfaces. This review focuses on tissue bonding by photo-chemical cross-linking.

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