Hans-Werner Waclawiczek - Böcker

Fibrin plays a central role in wound healing. It has a hemostatic effect by forming a temporary wound closure and assists in neovascularization and fibroblast prolifera- tion. It therefore makes the repair of injured or severed parts of the human body by simple glueing possible, a notion that men have dreamed of since ancient times. The first modern attempts in this direction, using clotting substances derived from human blood to achieve hemostasis, were reported by Bergel (in 1909), Grey (in 1915), and Harvey (in 1916), who used fibrin powder or fibrin patches to control bleeding from parenchymatous organs. Two decades later Young and Medawar (1940) and Cronkite (1944) used blood plasma or fibrin solutions, adding thrombin to seal nerve anastomoses and to fix skin grafts in humans. Due to the poor adhesive strength of the fibrinogen the results were unsatisfactory. In 1972 a new era in fibrin sealing was initiated by Matras.By using highly concentrated fibrinogen in combination with factor XIII (fibrin-stabilizing factor) and by delaying fibrinolysis with a fibrinolysis inhibitor (aprotinin), a method was developed which after satisfactory results in animals, soon began to be applied in humans.

This text focuses on open packing of the abdomen (laparostomy) for the treatment of necrotizing pancreatitis and severe peritonitis. Despite the greater expenditure in terms of medical personnel, laparostomy has several advantages over traditional methods: it circumvents the often difficult decision about performing repeat laparostomy; the rates of mortality and of complications are reduced; the course of the disease can be observed closely; and reintervention, a daily necessity in many cases, is quick and simple. Close interdisciplinary co-operation with intensive care staff is essential for good results. This book of proceedings on surgery, intensive care medicine, gastrointestinal system, hepatology is intended for surgeons, gastroenterologists, oncologists, intensive care therapists.