11
20)
While aiming at the treatment site and holding the device nozzle approximately 2 to 4 centimeters away,
apply firm even pressure to the center of the syringe pusher assembly to dispense the mixed solution (Fig.
B-4).
21)
Continue applying the Adherus sealant system until a thin coating (
approximately 1
–
2 mm
) is formed.
Note
: Gauging Thickness:
Sutured dural closure:
Ensure that all suture knots are completely covered with hydrogel
sealant. Typically, size 4-0, size 3-0 and size 2-0 sutures are used for dural closure. The
smallest of these is size 4-0 which has a diameter of 0.15 mm to 0.2 mm. A knot of size 4-0
suture will have at least four widths of suture or approximately 0.6 to 0.8 mm of thickness.
Complete knot coverage ensures that the minimum thickness of application is achieved.
Onlay duraplasty closure:
Ensure that enough hydrogel sealant is applied to cover the
duraplasty onlay and at least 3-4 mm of surrounding native dura with 1-2 mm of hydrogel
using the height of the onlay material as a depth reference. Note that when moistened with
saline, two common onlay duraplasty materials, DuraGen
®
Dural Graft Matrix and
Durepair
®
Dura Regeneration Matrix are approximately 3 mm and 1 mm thick respectively.
Stopping a Spray Application
22)
The application may be interrupted at any time during a treatment by halting the pressure applied to the
pusher assembly. However, to prevent clogging, do not turn off the pump until the final sealant application
has been completed.
Note
: If excess hydrogel forms on the spray nozzle during an application, it may be removed by gently
wiping with a piece of gauze.
Finishing a Delivery
23)
If necessary, excess sealant beyond the edges of the dural margin may be removed with a Penfield probe,
scissors or mechanical disruption.
