Sealing Effect of Cross-Linked Gelatin Glue in the Rat Lung Air Leak Model Norikazu Kawai, MD, Shuko Suzuki, PhD, Hiroshi Naito, MD, Keiji Kushibe, MD,

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Sealing Effect of Cross-Linked Gelatin Glue in the Rat Lung Air Leak Model Norikazu Kawai, MD, Shuko Suzuki, PhD, Hiroshi Naito, MD, Keiji Kushibe, MD, Takashi Tojo, MD, Yoshito Ikada, PhD, Shigeki Taniguchi, MD The Annals of Thoracic Surgery Volume 102, Issue 1, Pages 282-286 (July 2016) DOI: 10.1016/j.athoracsur.2016.02.038 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Gelatin glue cross-linked with glutaraldehyde. The Annals of Thoracic Surgery 2016 102, 282-286DOI: (10.1016/j.athoracsur.2016.02.038) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Schematic representation of the experimental setup for measuring the bursting pressure of the needle-punctured and glue-sealed lung (puncture created with a 23-gauge needle inserted to a depth of 2 mm). The Annals of Thoracic Surgery 2016 102, 282-286DOI: (10.1016/j.athoracsur.2016.02.038) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Experimental procedure for sealing of the wound in the rat pulmonary fistula model. (a) The pulmonary fistula model was created in the rat lung with the use of a 23-gauge needle inserted to a depth of 2 mm from the surface. (b) After bleeding was stopped by compression with the use of cotton balls, air leak was checked by observing bubble formation. (c) The fistula sealed with gelatin glue (0.1 mL) (group A). (d) The fistula sealed with fibrin glue (0.1 mL) and a polyglycolic acid sheet (10 mm × 10 mm) (group C). The Annals of Thoracic Surgery 2016 102, 282-286DOI: (10.1016/j.athoracsur.2016.02.038) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The gelatin glue adhered well to the lung surface (punctured with a 23-gauge needle) at elevated air pressure. The Annals of Thoracic Surgery 2016 102, 282-286DOI: (10.1016/j.athoracsur.2016.02.038) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Seal-breaking pressure (SBP) in groups A (47.88 ± 6.69 mm Hg), B and C. SBP was significantly higher in group A (p < 0.05) than in group B (24.67 ± 3.24 mm Hg) or C (28.67 ± 3.55 mm Hg). (PGA = polyglycolic acid.) The Annals of Thoracic Surgery 2016 102, 282-286DOI: (10.1016/j.athoracsur.2016.02.038) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Gelatin glue (0.2 mL, prepared by mixing 26% wt/vol gelatin solution and 1% wt/vol glutaraldehyde solution) applied on the rat lung wound (a 5-mm-long incision to a depth of 1 mm) and implanted for 3, 7, or 14 days (hematoxylin and eosin staining; ×100 magnification). The Annals of Thoracic Surgery 2016 102, 282-286DOI: (10.1016/j.athoracsur.2016.02.038) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions