Absorbable Hemostats Research Articles

Efficiency Analysis of Hemostatic Agents in Drainless Neck Surgery: Cellulose-Based Versus Liquid Fibrin Sealants.

Using liquid fibrin sealants has once again questioned the benefit of drain placement in head and neck operations. Cellulose-based hemostats offering different hemostasis mechanisms have scarcely been investigated in drainless neck surgeries.This study aimed to evaluate whether liquid fibrin sealant offers any advantage over cellulose-based hemostats in various head and neck surgeries. A prospective trial of patients who underwent various neck surgeries between 2020 and 2022. Baseline characteristics and postoperative outcomes were compared between the drain-placed and the drainless groups, with the latter sub-categorized into three groups: fibrin sealant, cellulose-based hemostats, and a combination of both. A total of 119 patients were included (63 thyroidectomies, 40 parathyroidectomies, and 16 sialoadenectomies). Fifty eight had a drain placed and 61 had no drain. In the drainless group, 23 patients received cellulose-based absorbable hemostats (SURGICEL®/ FIBRILLAR™); 18 patients had fibrin sealants (EVICEL®/TachoSil®/TISSEEL); in 16, a combination of both was used; and in four patients, no hemostatic agent was used. Three (5%) of the 61 drainless patients developed a seroma compared to one (2%) seroma in the drain-placed patients. No advantage was demonstrated using a combination of FIBRILLAR™ with a fibrin sealant nor for any used separately. Drain placement delayed patient discharge by at least one day compared to the group without a drain (p < 0.001). Drain placement offered a minor advantage in the postoperative course reducing rates of seroma formation, while delaying patient discharge by at least one day. There was no advantage in using a specific hemostatic agent over the other.

Compari̇son of PTFE sutures with polypropylene sutures in suprapopliteal femoropopliteal bypass with PTFE grafts

Aim: Infrainguinal bypass surgery stands as the predominant open surgical procedure for lower limb revascularization and is reserved for cases of intermittent claudication (IC) that have proven unresponsive to maximal medical management. Polypropylene monofilament sutures have been widely used for peripheral vascular surgery operations. Aim of this study is comparing this new type of suture with propylene sutures. Material and Methods: Between January 2022 and December 2022, two cohorts who underwent suprapopliteal femoropopliteal bypass surgery, each comprising 15 patients were included in the study. In Group I (polytetrafluoroethylene (PTFE) Group), PTFE served as the suture material, whereas in Group 2 (Non PTFE Group), polypropylene sutures were employed. All preoperative demographics, perioperative and postoperative data were collected carefully. Results: All patients underwent surgical interventions due to either rest pain or ischemic ulcers. Among the 30 patients, 11 fell into Fontaine class 4, while 19 were categorized as Fontaine class 3. Out of the 30 patients, 18 received cilostazol treatment. The mean age of the patient cohort was 66.97±7.4 years, with a mean body mass index of 29.03±6.2. When we compared the two groups, no statistically significant difference was found between groups according to demographic data. In the evaluation of intraoperative data, the mean operation time was 88.7±9.37 minutes, and the mean hemostasis time was 5.8±2.8 minutes. Group I (PTFE group) exhibited significantly lower hemostasis time and drainage levels on the first and second postoperative days (p&lt;0.0001, p=0.03, and p=0.017, respectively). The use of absorbable hemostats were significantly less in PTFE suture group. Conclusion: The selection of sutures significantly influences the achievement of soft tissue approximation, reduced inflammation, suture hole leakage and capsule formation.

Bleeding and ketorolac use in pediatric circumcision.

Circumcision is a common surgical procedure performed in pediatric male patients. Ketorolac is an effective adjunct in multimodal regimens for postoperative pain control. However, many urologists and anesthesiologists refrain from administering ketorolac due to concern for postoperative bleeding. Compare the risk of clinically significant bleeding after circumcision with and without intraoperative ketorolac administration. A single-center, retrospective cohort study was conducted of pediatric patients 1-18 years of age who underwent isolated circumcision by one urologist from 2016 to 2020. Clinically significant bleeding was defined as bleeding requiring intervention within the first 24 h of circumcision. Interventions included use of absorbable hemostats, placement of sutures, or return to the operating room. Of 743 patients, 314 (42.3%) did not receive ketorolac and 429 (57.7%) received intraoperative ketorolac 0.5mg/kg. Postoperative bleeding requiring intervention occurred in one patient (0.32%) in the non-ketorolac group versus four patients (0.93%) in the ketorolac group (difference 0.6%, 95% CI [-0.8%, 2.0%], p=0.403). There was no statistically significant difference in postoperative bleeding requiring intervention between the non-ketorolac and ketorolac groups. Future studies regarding the association between ketorolac and postoperative bleeding are needed.

Peri-operative hemostatic management of tooth extraction in patients with hemophilia A, with and without inhibitors, receiving emicizumab prophylaxis.

Emicizumab treatment may allow patients with hemophilia A without (PwHA) and with inhibitors (PwHA-I) to undergo some minor surgeries, such as tooth extraction, without peri-operative factor infusions. However, criteria for determining the necessity of factor infusions before minor surgeries are unknown. We report the peri-operative hemostatic management and outcomes of emicizumab-treated PwHA and PwHA-I cases who underwent tooth extractions using our institutional protocol. We retrospectively evaluated PwHA and PwHA-I who underwent tooth extraction with emicizumab prophylaxis at our institution. Local bleeding risk was assessed based on the method, number, and site of tooth extraction. Hemostasis was monitored peri-operatively by rotational thromboelastometry (ROTEM). Hemostatic agents and a mouth splint were used. Twenty-nine extractions (17 interventions) were performed in eight PwHA and two PwHA-I. Based on ROTEM, pre-operative factor infusions were used in ten PwHA and four PwHA-I interventions. Among nine low local bleeding risk interventions, three (33.3%) each received no infusions, one dose of factor infusion pre-operatively, and pre- and post-operative factor infusions. All eight high local bleeding risk interventions involved planned factor infusions. Absorbable hemostats were used in all extractions. A mouth splint was used in 21/25 (84.0%) PwHA and in 4/4 (100%) PwHA-I extractions. No post-extraction bleeding or thrombotic events occurred. Use of a systemic hemostatic treatment plan according to the local bleeding risk, peri-operative coagulation status assessment using ROTEM, filling the extraction socket with hemostats, and use of a mouth splint can achieve effective and safe hemostatic management in emicizumab-treated PwHA and PwHA-I.

Silk Fibroin-Based Biomaterials for Hemostatic Applications.

Hemostasis plays an essential role in all surgical procedures. Uncontrolled hemorrhage is the primary cause of death during surgeries, and effective blood loss control can significantly reduce mortality. For modern surgeons to select the right agent at the right time, they must understand the mechanisms of action, the effectiveness, and the possible adverse effects of each agent. Over the past decade, various hemostatic agents have grown intensely. These agents vary from absorbable topical hemostats, including collagen, gelatins, microfibrillar, and regenerated oxidized cellulose, to biologically active topical hemostats such as thrombin, biological adhesives, and other combined agents. Commercially available products have since expanded to include topical hemostats, surgical sealants, and adhesives. Silk is a natural protein consisting of fibroin and sericin. Silk fibroin (SF), derived from silkworm Bombyx mori, is a fibrous protein that has been used mostly in fashion textiles and surgical sutures. Additionally, SF has been widely applied as a potential biomaterial in several biomedical and biotechnological fields. Furthermore, SF has been employed as a hemostatic agent in several studies. In this review, we summarize the several morphologic forms of SF and the latest technological advances on the use of SF-based hemostatic agents.

Robotic central hepatectomy: technical tips and tricks

Purpose: Minimal invasive (MI) central hepatectomy is considered a technical complex procedure. The robotic approach could provide benefits over traditional laparoscopy, thanks to 3D visualization, endowrist technology and tremor filtration. Based on three different cases, this video aims to demonstrate technical tips and tricks for robotic central hepatectomy. Methods: The cases consisted of an anatomic segment 4 resection for two hepatocellular carcinoma (HCC), a MI resection of segment 5 and part of segment 8 for a solitary colorectal liver metastasis, and a MI resection of segment 4, 5 and 8 for a mixed cholangiocarcinoma and HCC. Results: A series of tips and tricks are proposed. (1) Installation: supine anti-Trendelenburg position with four robotic ports and an AirSeal port. (2) Exposure: optimal instrument and gauze placement, and application of a percutaneous traction suture to facilitate resection of segment 8 lesions. (3) Intraoperative ultrasound: demarcation of the tumor margins with monopolar scissors. (4) Pringle maneuver: an extracorporeal method with an umbilical tape encircling the hepatoduodenal ligament inserted in a chest tube, versus an intracorporeal method based on the Huang loop technique with application of a vascular bulldog clamp instead of a locking clip to apply tension, allowing to Pringle intermittently. (5) Parenchymal transection: in both healthy and cirrhotic liver tissue the combination of bipolar sealing device, Kelly-crush technique with fenestrated bipolar forceps, and monopolar scissors, proved to be highly efficient. (6) Hemostasis: achieved by preoperative hypovolemic phlebotomy with blood salvage, locking polymer clips, barbed resorbable sutures, hemostatic matrix, fibrillar absorbable haemostat and fibrin sealant patch. Operative time was 198 ± 12.6 minutes. The Pringle maneuver was applied 52.3 ± 8.7 minutes. Blood loss was 60 ± 26.5 cc. No intraoperative complications were encountered. R0-resection was obtained in all patients. The postoperative course was uneventful. Discharge happened on postoperative day 3 ± 1. Conclusion: A systematic approach of robotic central hepatectomy provides a technically feasible and adequate alternative for laparoscopy.

Robotic redo hepatectomy: resection SG 4B seven years after open right hemihepatectomy

Purpose: Evidence shows that repeat liver resection is often the best treatment option for recurrent colorectal liver metastases. Although repeat resections can be complex due to adhesion and altered liver anatomy, laparoscopic liver resection has been shown to be feasible in selected patients, and has been associated with shorter operative time, less blood loss, and shorter hospital stay. Compared to laparoscopy, robotic liver surgery has the advantage of 3D visualization and a larger range of motion thanks to endowrist technology. This video aims to demonstrate the experience of a hepatopancreaticobiliary surgeon with robotic redo hepatectomy. Methods: This report describes a robotic segment 4B resection, seven years after open right hemihepatectomy, in a patient with a solitary colorectal liver metastasis. Surgical risk was assessed by the Southampton laparoscopic liver resection difficulty score, and was classified as extremely high-risk. The patient was placed in supine position with 12 degrees anti-Trendelenburg. Four robotic 8 mm ports were placed, and one assistant 12 mm port. Extensive adhesiolysis was performed with monopolar scissors and a bipolar sealing device. Intraoperative ultrasound was used to demarcate the transection line. The Pringle maneuver was applied by the Huang loop technique. Liver parenchyma transection was done by a bipolar sealing device. Locking polymer clips, hemostatic matrix and fibrillar absorbable haemostat were used to counter blood loss. Results: The Pringle maneuver was performed for 18 minutes. Operative time was 170 minutes, and blood loss was 30 cc. Pathology confirmed a R0 resection of the colorectal liver metastasis. There were no intraoperative complications encountered. The postoperative course was uneventful, and the patient was discharged on postoperative day 2. Conclusion: Robotic redo hepatectomy is feasible after previous open extensive liver surgery for repeat metastatic liver disease in selected patients.

Absorbable nanocomposites composed of mesoporous bioglass nanoparticles and polyelectrolyte complexes for surgical hemorrhage control.

Absorbable polyelectrolyte complexes-based hemostats are promising for controlling hemorrhage in iatrogenic injuries during surgery, whereas their hemostatic efficacy and other performances require further improvement for clinical application. Herein, spherical mesoporous bioglass nanoparticles (mBGN) were fabricated, and mBGN-polyelectrolyte complexes (composed of carboxymethyl starch and chitosan oligosaccharide) nanocomposites (BGN/PEC) with different mBGN contents were prepared via in situ coprecipitation followed by lyophilization. The effect of various mBGN content (10 and 20wt%) on morphology, zeta potential, water absorption, degradation behavior and ion release were systematically evaluated. The in vitro degradability was dramatically promoted and a more neutral environment was achieved with the incorporation of mBGN, which is preferable for surgical applications. The in vitro coagulation test with whole blood demonstrated that the incorporation of mBGN facilitated blood clotting process. The plasma coagulation evaluation indicated that BGN/PEC had increased capability to accelerate coagulation cascade via the intrinsic pathway than that of the PEC, while have inapparent influence on the extrinsic and common pathway. The in vivo hemostatic evaluation in a rabbit hepatic hemorrhage model revealed that BGN/PEC with 10wt% mBGN (10BGN/PEC) treatment group had the lowest blood loss, although its hemostatic time is close to that of 20BGN/PEC treatment group. The cytocompatibility evaluation with MC3T3-L1 fibroblasts indicated that 10BGN/PEC induced a ~25% increase of cell viability compared to the PEC at days 4 and 7, indicating improved biocompatibility. These findings support the promising application of absorbable BGN/PEC with optimized mBGN content as internal hemostats and present a platform for further development of PEC-based hemostats.

Naturally Prefabricated Marine Biomaterials: Isolation and Applications of Flat Chitinous 3D Scaffolds from Ianthella labyrinthus (Demospongiae: Verongiida).

Marine sponges remain representative of a unique source of renewable biological materials. The demosponges of the family Ianthellidae possess chitin-based skeletons with high biomimetic potential. These three-dimensional (3D) constructs can potentially be used in tissue engineering and regenerative medicine. In this study, we focus our attention, for the first time, on the marine sponge Ianthella labyrinthus Bergquist & Kelly-Borges, 1995 (Demospongiae: Verongida: Ianthellidae) as a novel potential source of naturally prestructured bandage-like 3D scaffolds which can be isolated simultaneously with biologically active bromotyrosines. Specifically, translucent and elastic flat chitinous scaffolds have been obtained after bromotyrosine extraction and chemical treatments of the sponge skeleton with alternate alkaline and acidic solutions. For the first time, cardiomyocytes differentiated from human induced pluripotent stem cells (iPSC-CMs) have been used to test the suitability of I. labyrinthus chitinous skeleton as ready-to-use scaffold for their cell culture. Results reveal a comparable attachment and growth on isolated chitin-skeleton, compared to scaffolds coated with extracellular matrix mimetic Geltrex®. Thus, the natural, unmodified I. labyrinthus cleaned sponge skeleton can be used to culture iPSC-CMs and 3D tissue engineering. In addition, I. labyrinthus chitin-based scaffolds demonstrate strong and efficient capability to absorb blood deep into the microtubes due to their excellent capillary effect. These findings are suggestive of the future development of new sponge chitin-based absorbable hemostats as alternatives to already well recognized cellulose-based fabrics.

Absence of asymptomatic unruptured renal artery pseudoaneurysm on contrast-enhanced computed tomography after robot-assisted partial nephrectomy without parenchymal renorrhaphy

ObjectiveTo assess the incidence of asymptomatic unruptured renal artery pseudoaneurysm (RAP) on contrast-enhanced computed tomography (CE-CT) after robot-assisted partial nephrectomy (RAPN) without parenchymal renorrhaphy. MethodsFrom May 2016 to December 2017, 78 patients underwent RAPN for renal tumors. Inner suture was performed in the opened collecting system or renal sinus, whereas parenchymal renorrhaphy was not. For hemostasis, the soft coagulation system was used, and absorbable hemostats were placed on the resection bed. CE-CT was carried out within 7 days after surgery. Data on these patients were prospectively collected. A single radiologist determined the diagnosis of RAP. ResultsMedian (range) data were as follows: Patient age, 65 (19–82) years; radiographic tumor size, 30 (12–95) mm; operating time, 166 (102–294) min; warm ischemic time, 16 (7–67) min; and blood loss, 15 (0–4450) mL. One patient (1.6%) required a perioperative blood transfusion. No patient required conversion to open surgery or nephrectomy. CE-CT was carried out at median 6 (3–7) days after surgery. CE-CT showed no RAP development in all 61 patients. Urinary leakage was not observed. One patient had acute cholecystitis, a postoperative complication classified as Clavien-Dindo grade higher than 3, which was treated with cholecystectomy. Positive surgical margin was identified in four patients (6.6%). ConclusionRAPN using soft coagulation and absorbable hemostats without renorrhaphy appears to be feasible and safe. Our technique could eliminate the risk of RAP.

IJU this issue

This issue of International Journal of Urology contains two Review Articles, eight Original Articles and six Urological Notes. Tanaka et al. (Osaka, Japan) reviewed the current topics and trends of hyperbaric oxygen (HBO) therapies in urological diseases. HBO therapy can be an effective option for treating some urological conditions, including radiation-induced hemorrhagic cystitis, Fournier gangrene and interstitial cystitis. In the past, there have been concerns about whether HBO could accelerate cancer cell growth through increased oxygen delivery. However, previous studies concluded that HBO did not promote cancer aggressiveness and that HBO was a safe treatment for cancer patients. This is good news for many urological physicians. Ito (Tokorozawa, Japan) reviewed recent advances in the systemic treatment of metastatic non-clear cell renal cell carcinomas (nccRCCs). At present, there is no standard treatment for metastatic nccRCCs. There are various types of nccRCCs with different genetic backgrounds and molecular features. Currently, tyrosine kinase inhibitors are a treatment option for metastatic papillary RCC as both first-line and second-line agents, whereas both tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors can be applicable for metastatic chromophobe RCC. However, further evidence is required to clarify appropriate therapeutic strategies for nccRCC using new agents and combination regimens. In the Original Articles, Tohi et al. (Kobe, Japan) assessed the perioperative outcomes of robot-assisted partial nephrectomy without renorrhaphy for cT1b renal tumors compared with cT1a. They concluded that robot-assisted partial nephrectomy without renorrhaphy using the soft-coagulation system and absorbable hemostats appears to be feasible for cT1b tumors, although longer warm ischemic time and a high rate of complications can be expected compared with cT1a tumors. It is notable that pseudoaneurysm occurred in none of the 66 patients with cT1a tumors and only one of the 34 patients with cT1b tumors. Okumi et al. (Tokyo, Japan) investigated biopsy-proven recurrence rates and risk factors for immunoglobulin A nephropathy recurrence in 299 kidney transplant recipients. The 10-year recurrence rate was 34%. Related-donor transplantation and post-transplant increased proteinuria were identified as potential risk factors for recurrence. The results have clinical implications in that the signs of recurrent immunoglobulin A nephropathy should be evaluated carefully in recipients receiving related-donor transplants. In the Urological Notes, Suzuki et al. (Tokyo, Japan) reported penile size and stretched rate in a Japanese male population using fresh cadavers. This is a unique study. As Fukuhara (Osaka, Japan) described in the Editorial Comment, penile size is an important factor for men to have a better self-image and better satisfaction during sexual activity. This study provides on-demand helpful data to urologists, because there is scarce knowledge in this field. Yamada et al. (Kyoto, Japan) investigated the feasibility of virtual reality for surgical planning and intraoperative management in partial nephrectomy. Virtual reality technology allows the surgeon to understand the patient's anatomy more accurately and plan the surgical procedures with more care. Although the objective usefulness of the case-specific 3-D virtual reality-based surgical simulation is not shown, it can be a useful technique to intuitively understand surgical anatomy and facilitate surgical decision-making in partial nephrectomy. Unfortunately, the limited space does not allow me to introduce all the articles. However, all the papers are very interesting and informative. Please enjoy this issue of International Journal of Urology. None declared.

The Effects of Locally Administered Morphine Over the Dura on Postoperative Morphine Consumption and Pain After Lumbar Disc Surgery: A Prospective, Randomised, Double-Blind and Placebo-Controlled Study.

Effective pain management by avoiding side effects in the perioperative period is essential for patient outcome. Lumbar disc surgery is associated with moderate to severe postoperative pain, and opioids are widely used. The primary aim of the present study was to compare the effects of 1 mg and 2 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura on morphine consumption, and the secondary aims were to compare pain scores and opioid-related side effects during postoperative 24 h. The study included 44 patients (American Society of Anesthesiologists I and II). After the discectomy procedure and before the closure, in Group A (n=15), 1 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura was used. In Group B (n=14), 2 mg morphine was used for the same technique, and in Group C (n=15) (control), normal saline was used. All patients used intravenous morphine patient-controlled analgesia pumps for 24 h following lumbar disc surgery. Morphine consumption, pain scores and opioid-related side effects were recorded at 10 min, 1, 2, 6, 12 and 24 h postoperatively. Morphine consumption, pain scores and opioid-related side effects were similar among the groups. Morphine-impregnated absorbable cellulose haemostat material placement over the dura after single level lumbar discectomy did not reduce postoperative morphine consumption, pain scores and incidence of opioid-related side effects.

Microporous polysaccharide hemosphere efficacy and safety in primary total knee arthroplasty

Absorbable hemostats such as microporous polysaccharide hemospheres (MPH) are used to manage hemostasis and prevent complications in total knee arthroplasty (TKA). We aimed to determine safety and effectiveness of MPH use in TKA. Records were reviewed for blood loss, hematomas, and infections. No differences existed regarding demographics, superficial infections (P = 0.933) or hematomas (P = 0.393). Positive correlation existed between hematoma and superficial infection (P = 0.009). Blood loss was greater in the treatment group (P = 0.014). MPH demonstrated inferior bleeding control and had no effect on complications. Our results suggest application of this agent may be unnecessary.

Comparative Evaluation of Biological Performance, Biosecurity, and Availability of Cellulose-Based Absorbable Hemostats.

Hemorrhage remains a leading cause of death after trauma, and developing a hemostat with excellent performance and good biosecurity is an extremely active area of research and commercial product development. Although oxidized regenerated cellulose (ORC) has been developed to address these problems, it is not always efficient and its biosecurity is not perfect. We aimed to refine ORC via a simple and mild neutralization method. The prepared neutralized oxidized regenerated cellulose (NORC) showed a superior gel property due to its chemical structure. The biological performance of both ORC and NORC was systematically evaluated; the results showed that ORC would induce erythema and edema in the irritation test, whereas NORC did not cause any adverse inflammation, indicating NORC had desirable biocompatibility. We further demonstrated that NORC confirmed to the toxicity requirements of International Organization for Standardization (ISO) standards; however, ORC showed an unacceptable cytotoxicity. The rabbit hepatic defect model stated that NORC exhibited better ability of hemostasis, which was attributed to its significant gel performance in physiological environment.

Absorbable Hemostatic Aggregates

Topical absorbable hemostats are routinely utilized in surgical procedures to assist in controlling intraoperative bleeding. SURGICEL Original Absorbable Hemostat, one of the most frequently used adjunctive hemostats, is composed of oxidized regenerated cellulose (ORC). We report here that a novel powdered form of ORC, composed of aggregates of ORC fine fibers, provides additional valuable hemostatic performance characteristics and retains the biochemical and bactericidal profile of the parent ORC fabric. The ORC aggregates are more effective in promoting coagulation than their constituent ORC fine fibers because of more favorable surface energetics and surface area. Aggregates with similar particle size distributions that have higher sphericity values exhibit better coagulation efficacy. Finally, ORC aggregates more effectively promote clot formation than starch-based hemostatic particles. The results of this investigation indicate that the efficacy of this novel powdered hemostat is based on its chemical composition, morphology, and particle surface energetics.

SURGICAL CLOSURE OF LARGE OROANTRAL FISTULA BY MODIFIED SANDWICH TECHNIQUE AND PEDICLED BUCCAL FAT PAD : (A CLINICAL STUDY)

Aim: The aim of this study was to evaluate the efficacy of modified sandwich technique and pedicled buccal fat pad (PBFP) to achieve both hard and soft tissue closure of large OAF. Patients and methods: The bony defects of five patients complaining from large OAF were grafted by modified sandwich technique comprising Fisiograft bone substitute between absorbable haemostat membrane (surgicel) and guided tissue regeneration membrane. Then the sandwich graft was covered by buccal bad fat graft. The patients were followed up clinically after 1, 2, 4 and 12 weeks postoperatively. Radiographic evaluation by OPG and nuclear bone scan was performed immediately, 3, and 6 month postoperatively. Results: Successful closure of the OAF was achieved in all cases without reported recurrence of the OAF or regurgitation of fluids from the nose. Radiographically, after 3rd month, bony defects of the OAF showed partial radioopecity which completed at 6th month interval. Bone scan measurements showed highly statistically significant increase in the bone activity values at grafted site after 3rd month postoperatively. While activity index (AI) values at 6 month interval decreased to return toward lower level than baseline values. Conclusion: The results clearly concluded that this technique with PBFP is successful in achieving proper anatomical closure of large OAF in terms of both hard and soft tissues.

Terahertz Time-Domain Spectroscopy for Studying Absorbable Hemostats

This study deals with the kinetics of absorbable hemostats used for supporting the hemostasis and wound closure during surgical intervention. There are several types of hemostats of different composition therefore with different mechanism of action. Here, terahertz (THz) time-domain spectroscopy is used for studying the absorption kinetics of the reactions between the hemostatic and the physiological saline solution (PSS). The reactions correspond with the changes of the THz radiation response measured in time. These time dependences are analyzed to find time constants for mathematical description of the hemostatic kinetics and the significant differences among all types of hemostats are found. The physiological saline solution is replaced by human blood in the additional measurement. Based on the results, we can compare the reaction rate of different types of hemostats that could be beneficial in the surgery practice.

Variation in hospital resource use and cost among surgical procedures using topical absorbable hemostats.

BackgroundAdjunctive hemostats are used to assist with the control of intraoperative bleeding. The most common types are flowables, gelatins, thrombins, and oxidized regenerated celluloses (ORCs). In the US, Surgicel® products are the only US Food and Drug Administration-approved ORCs.ObjectiveTo compare the outcomes of health care resource utilization (HRU) and costs associated with using ORCs compared to other adjunctive hemostats (OAHs are defined as flowables, gelatins, and topical thrombins) for surgical procedures in the US inpatient setting.Patients and methodsA retrospective, US-based cohort study was conducted using hospital inpatient discharges from the 2011–2012 calendar years in the Premier Healthcare Database. Patients with either an ORC or an OAH who underwent a cardiovascular procedure (valve surgery and/or coronary artery bypass graft surgery), carotid endarterectomy, cholecystectomy, or hysterectomy were included. Propensity score matching was used to create comparable groups of ORC and OAH patients. Clinical, economic, and HRU outcomes were compared.ResultsThe propensity score matching created balanced patient cohorts for cardiovascular procedure (22,718 patients), carotid endarterectomy (10,890 patients), cholecystectomy (6,090 patients), and hysterectomy (9,348 patients). In all procedures, hemostatic agent costs were 28%–56% lower for ORCs, and mean hemostat units per discharge were 16%–41% lower for ORCs compared to OAHs. Length of stay and total procedure costs for patients treated with ORCs were lower for carotid endarterectomy patients (0.3 days and US$700) and for cholecystectomy patients (1 day and US$3,350) (all P<0.001).ConclusionCosts and HRU for patients treated with ORCs were lower than or similar to patients treated with OAHs. Proper selection of the appropriate hemostatic agents has the potential to influence clinical outcomes and treatment costs.

The efficacy of absorbable polysaccharide haemostats in wound healing.

Wound healing represents an ancient problem for humans, and various materials and methods have been tried for wound dressing. A dressing should protect against infection and shorten healing; moreover, it should not cause tissue damage and should be nonallergenic, cost effective and easy to apply. These are characteristics that may be found in herbal extracts. An absorbable polysaccharide haemostat (APH) is a plant-based haemostatic agent. We aimed to evaluate the effect of APH on wound healing. A total of 24 Wistar rats were divided into three groups, each consisting of eight rats. We generated triangular tissue defects on the dorsal regions of the rats. The wound size of each rat was drawn on acetate paper on the 3rd, 7th and 14th days and dressed with APH, saline and wheat meal. Wound healing rates were calculated using planimetric software. Scar tissue excision was performed on the 14th day and histopathological examination was carried out. The mean wound contraction rate was statistically higher in the APH group than in the wheat meal and saline groups on the 14th day (P < 0.05). There was no significant difference in polymorphonuclear leukocytes intensity between the saline and APH groups when stained with haematoxylin and eosin (P > 0.05). However, the intensities of fibroblasts (P < 0.01), vascular proliferation (P = 0.01) and inflammatory score (P = 0.02) were significantly different in the saline and APH groups. APH has favourable effect on wound healing. In addition to its blood-stopping effect, APH may be useful for tissue defects, which arise after trauma or surgical procedures.

Hemostatic, antibacterial and degradable performance of the water-soluble chitosan-coated oxidized regenerated cellulose gauze

In this research, the oxidized regenerated cellulose (ORC) gauze was prepared by oxidation of regenerated cellulose using NO2/CCl4, subsequently treated with the dissolved chitosan (CTS) in aqueous acetic acid (CTS/ORC) and finally neutralized with NaOH/C2H5OH (CTS/ORC-Na). The hemostatic, antibacterial and degradable properties of treated ORC-based gauze were evaluated. The results of the hemostatic test on rabbit liver and ear-artery injuries showed that the attachment of high molecular weight chitosan to the surface of ORC gauze significantly improved the hemostatic effect of ORC without compromising the antibacterial and degradability of ORC. It is found that the water-soluble CTS/ORC-Na gauze was more suitable as the hemostatic material applied in rabbit liver injury in comparison with in ear-artery injury and it further improved the hemostatic efficacy and enhanced the degradable rate. It is promised that the CTS/ORC gauze and the water-soluble CTS/ORC-Na gauze would be applicable in medical fields such as surgical absorbable hemostats for control bleeding.