ABSORBABLE (OXIDIZED) GAUZE AS A HEMOSTATIC AGENT IN GYNECOLOGIC SURGERY

Abstract

Summary Experience with absorbable gauze during the past ten months has shown that it was frequently useful in controlling bleeding during abdominal gynecologic operations. It should in no sense replace the careful control of hemor rhage by clamp and ligature. However, when bleeding was difficult to control by such methods, either because of its oozing character or because the source of hemorrhage was not readily accessible, absorbable gauze was found to have a, definite place as a hemostatic agent. Its application to the area of bleeding followed by momentary digital pressure was successful in most instances. When, in a few cases, hemorrhage recurred following the removal of digital pressure, satisfactory results were attained by superimposing ordinary packing. The latter material was removed in twenty-four hours with evidence of a minimal amount of bleeding in the interim, and no recurrence of bleeding following its removal. The early complete removal of plain packing without fear of provoking fresh hemorrhage was a great advantage. No reaction could be traced to the leaving of varying amounts of oxidized gauze within the abdominal or pelvic cavities. A few unusual applications of it during abdominal operations have been mentioned. Undoubtedly others will occur as experience in the application of this material grows. Absorbable gauze also proved to be of value during vaginal procedures. As has been pointed out, it sometimes proved to be ineffective when applied to the oozing incision of completed plastic operations. Its inability to control such bleeding cannot be regarded as a failure, but as a faulty application. The gauze must be placed in direct contact with the bleeding vessels under temporaxy or permanent pressure to cause hemostasis. On the other hand, absorbable gauze was used effectively during the course of a plastic operation to check oozing not readily controlled by ligature. It was effective in controlling hemorrhage from biopsy wounds and from the crater of a carcinomatous cervix. The most valuable application of this material noted in this series of cases was in a group exhibiting violent secondary hemorrhage some days after a, plastic operation, a cervical amputation, or a complete hysterectomy. Absorbable gauze placed against the source of hemorrhage and held in position with plain packing promptly controlled such hemorrhage. Formerly plain packing usually proved ineffective Trader such circumstances, necessitating ligation of bleeding vessels and resuture of the disrupted area under conditions of difficult exposure. The use of absorbable gauze in such cases appeared to offer great advantages.