Hemostatic Gelatin Sponge Research Articles

A Randomized Controlled Trial Comparing Collagen Matrix to Hemostatic Gelatin Sponge as Socket Seal in Alveolar Ridge Preservation.

(1) Objectives: This study aimed to compare a collagen matrix to a hemostatic gelatin sponge as a socket seal in alveolar ridge preservation (ARP). (2) Methods: Systemically healthy patients planned for ARP at two sites with more than 50% of the buccal bone wall remaining after tooth extraction were eligible for inclusion. ARP involved socket grafting using collagen-enriched deproteinized bovine bone mineral. Sites were then randomly assigned to the test group (collagen matrix) or the control group (hemostatic gelatin sponge). The primary outcome was soft tissue thickness in the center of the site at 4 months, analyzed on cone-beam computed tomography. Secondary outcomes included the buccal and lingual soft tissue heights, horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and Socket Wound Healing Score (SWHS). (3) Results: In total, 18 patients (12 females, 6 males) with a mean age of 57.3 years (SD 11.1) were included. Four months after ARP, the soft tissue thickness in the center of the site amounted to 2.48 mm (SD 0.70) in the test group and 1.81 mm (SD 0.69) in the control group. The difference of 0.67 mm (95% CI: 0.20-1.14) in favor of the collagen matrix was statistically significant (p < 0.009). The buccal soft tissue height was also statistically significantly higher for the collagen matrix (0.72 mm; 95% CI: 0.06-1.38; p = 0.034). A trend favoring the collagen matrix was found for the lingual soft tissue height (p = 0.066). No significant differences between the groups in terms of horizontal bone loss, buccal soft tissue profile changes, wound dimensions, and the SWHS were found. (4) Conclusions: The absence of significant differences in hard tissue outcomes suggests that both the collagen matrix and hemostatic gelatin sponge effectively sealed the extraction socket and supported bone preservation. However, the collagen matrix better maintained soft tissue dimensions. The clinical relevance of this finding with respect to the necessity for adjunctive soft tissue augmentation at the time of implant placement is yet to be studied.

A super hydrophilic and high strength chitosan hemostatic sponge prepared by freeze-drying and alkali treatment for rapid hemostasis

Excessive blood loss caused by natural accidents or major surgical procedures can be life-threatening and requires rapid hemorrhage management. Developing hemostatic materials with high water absorption capacity and high strength properties is still challenging. Super hydrophilic/high-strength chitosan hemostatic sponges (SHHS-CHS) were prepared by freeze-drying and alkali treatment. The freeze-drying technology formed a porous three-dimensional structure of sponges, and alkali treatment increased the hydrophilicity of sponges and the rigidity of the chitosan molecular chain, improving the hydrophilicity and mechanical properties of chitosan sponges. Characterization experiments revealed that SHHS-CHS had high water absorption capacity, rich pore structure, and excellent mechanical properties. The cytotoxicity and hemolysis experiments showed that SHHS-CHS had good biocompatibility. Compared to the commercial hemostatic gelatin sponges and chitosan hemostatic material, SHHS-CHS had better blood coagulation and red blood cell and platelet adhesion ability. Moreover, SHHS-CHS showed better hemostatic ability than gelatin sponges in rat-liver injury and rat leg vein rupture models, significantly reducing the hemostasis time and bleeding volume. In conclusion, SHHS-CHS has broad prospects for clinical application as a hemostatic material.

The Socket-Plug Technique and Materials Comparison in Atraumatic Extractions - A Multiple-Case Study

It is confirmed that tooth extraction with spontaneous healing may lead to degrees of alveolar bone resorption due to the bone remodelling phase. Reconstructive materials are proposed to insert into the socket during the extraction procedure preventing the loss of alveolar bone dimension. The “Socket Plug” technique is an alveolar ridge preservation (ARP) method saving both operational time and is easy to apply in clinical routines. The technique includes steps of atraumatic extraction, flapless design, biomaterial placement, and suturing. Four clinical cases are reported using the socket-plug technique placing hemostatic gelatin sponges as spontaneous healing and collagen plug in sockets as ARP with or without interradicular septum.

S2550 EUS-Guided Coil Embolization and Absorbable Hemostatic Gelatin Sponge Is a Safe and Efficacious Treatment of Rectal Varices

S2550 EUS-Guided Coil Embolization and Absorbable Hemostatic Gelatin Sponge Is a Safe and Efficacious Treatment of Rectal Varices

Hemostatic Efficacy of Absorbable Gelatin Sponges for Surgical Nail Matrixectomy after Phenolization-A Blinded Randomized Controlled Trial.

Background: Some studies have recommended combining germinal matrix excision with phenol ablation in the treatment of onychocryptosis. Matrixectomy after phenolization has been shown to be an effective modification to reduce the drawbacks associated with phenolization alone, although it increases the risk of minor postoperative bleeding. The present study aims to assess the effectiveness and safety of gelatin sponges as hemostatic agents in partial matrixectomy after phenolization. Methods: A comparative clinical trial in parallel groups was designed in 74 halluces (44 patients) with stage I, II, and III onychocryptosis. All participants were randomly assigned to 3 groups: Group A (control group), Group B (conventional gelatin sponge), and Group C (high porosity gelatin sponge). Results: The quantified mean blood loss in the first 48 h after surgery in patients in both experimental groups was significantly lower compared to the control group. The lowest mean blood loss was recorded in Group C (p < 0.001) and followed by Group B (p = 0.005). No adverse effects were recorded in any of the patients included in the experimental groups. Conclusions: Hemostatic gelatin sponges were demonstrated to be effective and safe devices for the control of minor postoperative bleeding associated with matrixectomy after segmental phenolization.

Study of double-bonded carboxymethyl chitosan/cysteamine-modified chondroitin sulfate composite dressing for hemostatic application

Stanching severe traumatic bleeding requires hemostatic materials that can provide rapid and efficient hemostasis. However, most currently available hemostatic agents exhibit low efficiency and poor biocompatibility. In this study, a novel carboxymethyl chitosan modified with methacrylic anhydride (double-bonded carboxymethyl chitosan)/cysteamine-modified chondroitin sulfate (Me-CMC/CSS) rapid hemostatic dressing was developed using thiol-ene click chemistry. The freeze-dried Me-CMC/CSS dressings absorbed water rapidly and transformed into soft hydrogels that could seal wounds, achieving good hemostasis. The relative blood clotting index of the optimal Me-CMC/CSS dressing was decreased by 53% (p < 0.001) and 29% compared with a pure Me-CMC dressing and a commercial hemostatic gelatin sponge, respectively. In a rat liver hemorrhage model, the Me-CMC/CSS dressing stopped bleeding rapidly, and the total blood loss was significantly decreased by 92% (p < 0.0001) compared with the untreated group and was lower than that with gelatin sponge treatment. The Me-CMC/CSS dressing also exhibited a higher ability to adhere to platelets than the gelatin sponge. Furthermore, the Me-CMC/CSS dressing exhibited good hemocompatibility and cytocompatibility. The results indicate that the composite dressings can be potentially applied as rapid hemostatic materials.

Minimizing Post-Infusion Portal Vein Bleeding during Intrahepatic Islet Transplantation in Mice.

Although the liver is currently accepted as the primary transplantation site for human islets in clinical settings, islets are transplanted under the kidney capsule in most rodent preclinical islet transplantation studies. This model is commonly used because murine intrahepatic islet transplantation is technically challenging, and a high percentage of mice could die from surgical complications, especially bleeding from the injection site post-transplantation. In this study, two procedures that can minimize the incidence of post-infusion portal vein bleeding are demonstrated. The first method applies an absorbable hemostatic gelatin sponge to the injection site, and the second method involves penetrating the islet injection needle through the fat tissue first and then into the portal vein by using the fat tissue as a physical barrier to stop bleeding. Both methods could effectively prevent bleeding-induced mouse death. The whole liver section showing islet distribution and evidence of islet thrombosis post-transplantation, a typical feature for intrahepatic islet transplantation, were presented. These improved protocols refine the intrahepatic islet transplantation procedures and may help laboratories set up the procedure to study islet survival and function in pre-clinical settings.

A comparison of the early therapeutic effects of allogeneic bone marrow-derived mesenchymal stem cells and calcitonin on the healing of surgically induced mandibular bone defects in osteoporotic rats

ObjectivesThis study aimed to evaluate and compare the early biological effects of allogeneic bone marrow-derived mesenchymal stem cells (BMSCs) versus salmon calcitonin (SC) on healing of surgically induced mandibular bone defects in osteoporotic rats. MethodsSixty-one female albino rats were included in this study, four of them were used for BMSCs isolation. The remaining 57 rats were divided into 4 groups. Group I (negative control), 12 rats received a vehicle injection after which a unilateral mandibular defect was created in each rat. Osteoporosis was induced in the remaining 45 rats then rats were randomly allocated into 3 equal groups (15 each). Surgical defects were created as in group I. The defects were left to heal spontaneously in group II; positive control. While in group III each defect was filled with an absorbable hemostatic gelatin sponge loaded by 10 IU of injectable SC and in group IV the sponge was seeded by 0.5 × 106 BMSCs. Rats were euthanized at 1st, 2nd, and 4th week postsurgically. Hematoxylin and eosin, Masson’s trichrome, picrosirius, and alizarin red s stains were used, followed by statistical analysis. ResultsBMSCs-treatment showed marked enhanced bone healing. Moreover, collagen fibers and calcium deposits area percentages were statistically significantly higher when compared to the other groups particularly at 2 and 4 weeks. ConclusionsLocal application of bone marrow-derived mesenchymal stem cells and salmon calcitonin may be an effective therapy for treatment of osteoporotic bone defects, with privilege to the stem cells in terms of quantity and quality of regenerated bone.

Alveolar ridge dimensional changes after two socket sealing techniques. A pilot randomized clinical trial.

This pilot study aimed to assess dimensional changes following two different alveolar socket sealing techniques. Twenty-one patients requiring tooth extraction and implant placement were randomly allocated to two different alveolar ridge preservation techniques. In the control group, demineralized bovine bone mineral (DBBM) and a gingival soft tissue punch were used to fill and seal the socket, whereas in the test group, the extraction socket was filled with DBBM and sealed with a hemostatic gelatin sponge. Digitalized impressions were taken before and 6months after tooth extraction. The comparison was made on horizontal and vertical dimensional changes. The mean vertical loss was 0.8 ± 0.6mm for the control group and 0.7 ± 0.5mm for the test one. No statistical difference was found between groups for the vertical shrinkage. The horizontal dimensional narrowing of the alveolar socket was respectively 7.1/4.0/2.5mm at levels 1, 3, and 5mm from a coronal reference level for the control group. The test group showed dimensional changes of 4.8/2.3/1.3mm at the three different levels, respectively. A significant difference was found at levels 3 and 5mm. Referring to a visual analog pain scale, patients reported more severe pain in the control group (5.7/10) when compared with the test group (2.8/10). The difference was statistically highly significant (P ≤ 0.001). A significant difference was found between control and test groups regarding the horizontal dimensional changes and the post-operative pain. Regarding this primary result, the socket sealing technique with a hemostatic sponge provides an effective and inexpensive protocol with less post-operative pain.

Endoscopic ultrasound-guided treatment of gastric varices with coil embolization and absorbable hemostatic gelatin sponge: a novel alternative to cyanoacrylate.

Background and study aims Bleeding from gastric varices (GV) carries high morbidity and mortality. Current endoscopic therapies are premised on cyanoacrylate injection which is technically challenging and carries risk of embolization. We present a case series of endoscopic ultrasound (EUS)-guided coil injection in combination with hemostatic absorbable gelatin sponge (AGS) for treatment of bleeding gastric varices. Patients and methods This was a retrospective review of EUS-guided coil injection for bleeding GV since November 2017. After EUS-guided needle puncture, hemostatic coils were serially injected until significant reduction of Doppler flow. Under fluoroscopic guidance, test contrast was injected to confirm absence of run-off, at which time AGS, converted into a liquid slurry, was injected as hemostatic reinforcement. Results Ten consecutive patients underwent EUS-guided coil embolization reinforced by AGS. Technical success, defined as uncomplicated injection of coils and sponge was achieved in 100 % (10/10). Mean follow-up was 6 months 73–397 days; No patients rebled or required reintervention on GV. The complication rate was 10 % (1/10; severe abdominal pain without radiographic findings); otherwise, there were no cases of systemic embolization. Nine of 10 patients (90 %) had follow-up EUS (mean 80 days); 100 % (9/9) revealed near-obliteration of GV. Conclusion EUS-guided coil embolization in combination with hemostatic AGS is a novel method for management of bleeding GV with high clinical and technical success rates, low risk for complications and favorable safety profile when compared to cyanoacrylate. This technique theoretically minimizes embolic complications and need for re-intervention. Further studies are required to compare this modality.

Cell migration of preosteoblast cells on a clinical gelatin sponge for 3D bone tissue engineering

Using three-dimensional (3D) bone engineering to fabricate bone segments is a better choice for repairing bone defects than using autologous bone. However, biomaterials for bone engineering are burdened with some clinical safety concerns. In this study, we layered commonly found clinical materials, hemostatic gelatin sponges, in a novel manner to create a 3D scaffold for bone engineering purposes. We further examined the comparable benefits of our design with both closed- and open-bottom holders. Cells in stacked layer disc systems were examined after a week of growth and differentiation. Osteoblasts in the outer layers of both closed- and open-bottom holder systems displayed gradually increased alkaline phosphatase (ALP) activity but decreased osteopontin (OPN) expression. Further, cell proliferation assays and LIVE/DEAD staining revealed decreased viable cell counts in the top layer with increased incubation time. However, while layered disc systems with closed-bottom holders underwent differentiation, they kept more differentiated cells alive within the gelatin sponge disc scaffold after 28 d of culturing. Whether cells were inoculated into the top, middle, or bottom portions of the layered disc stack, osteoblasts showed a preference for migrating to the top layer, in keeping with the oxygen and nutrients gradients. Regarding practical application, this study offers valuable information to promote the use of hemostatic gelatin sponges for bone engineering.

Plasmid BMP-2–embedded gelatin sponge as a gene-activated matrix for preosteoblast differentiation

Gene-activated matrices (GAM), a combination of scaffolds and plasmid delivery systems, are widely used in regenerative medicine, but few compared plasmid BMP-2 in hemostatic gelatin sponge. We compared the osteogenic differentiation ability of bone morphogenetic protein-2 (BMP-2)–transfected preosteoblasts cultured into a hemostatic gelatin sponge with that of non-transfected cells cultured into BMP-2–activated hemostatic gelatin sponge. GAM was prepared from hemostatic gelatin sponge embedded with complexes (plasmid BMP-2 mixed with TransIT-2020® transfection reagent). The standard transfection method using mouse preosteoblasts (MC3T3-E1) mixed with the complex loaded onto the scaffold was compared with the GAM group. Non-transfected cells were loaded onto the scaffold as the control group. Transmission and scanning electron microscopy results revealed that TransIT-2020®/plasmid BMP-2 complexes formed homogeneous non-aggregated structures, which were round in shape and 200–250 nm in size. Alkaline phosphatase activity, the marker of bone differentiation, was significantly higher in GAM group compared to that in standard and control groups on differentiation days 14, 21, and 28. The concentration of released BMP-2 was significantly higher in GAM group than that in standard group on days 3 and 7, consistent with confocal microscopy results.

The Use of Three Different Hemostatic Agents during Laparoscopic Partial Nephrectomy: A Comparison of Surgical and Early Renal Functional Outcomes.

This study aimed to compare the effects of three different hemostatic agents on surgical and early renal functional outcomes after laparoscopic partial nephrectomy (LPN). A total of 126 cases of LPN performed between November 2008 and September 2016 were enrolled in this study. Spongostan™ Absorbable Hemostatic Gelatin Sponge (Ethicon, Somerville, NJ, USA) or Surgicel® Original Absorbable Hemostat (Ethicon, Somerville, NJ, USA), or a total of 5 mL of Floseal® Hemostatic Matrix (Baxter Healthcare, Deerfield, IL) was used for additional hemostasis. According to the hemostatic agent used, patients were divided into three groups; and patient characteristics, body mass index (BMI), American Society of Anesthesiologists (ASA) score, tumor characteristics, perioperative parameters, serum creatinine levels, and complications were compared among these three groups. Age, BMI, ASA score, tumor characteristics, operative time, warm ischemia time, complication rates, and length of hospital stay were similar among the groups, whereas estimated blood loss was significantly lower in the Floseal Group (p=0.01). Postoperative serum creatinine levels and differences between preoperative and postoperative serum creatinine levels were also similar among the groups. The type of hemostatic agent used in LPN may affect the estimated blood loss. However, it has no substantial effect on other surgical parameters and early renal functional outcomes.

Comparison of Effects of Hemostatic Gelatin Sponge Impregnated with Ropivacaine versus Normal Saline Applied on the Transverse Process of the Operated Vertebrae on Postoperative Pain in Patients Undergoing Spinal Instrumentation Surgery: A Randomized Clinical Trial

Protocols for effective postoperative pain control in patients undergoing spinal surgery are not standardized. In our study, we compared the effects of hemostatic absorbable gelatin sponge impregnated with ropivacaine versus normal saline when applied to the transverse process of the operated vertebrae on the postoperative pain following instrumentation spine surgery. A prospective double-blind randomized study was conducted on 30 patients undergoing spine surgery. At the end of surgery, the hemostatic gelatin sponge was applied by the surgeon on the transverse process of the operated vertebra containing either ropivacaine 0.5% or normal saline NaCl 0.9. Pain was assessed using the visual analog scale (VAS) every 4 hours for 48 hours postoperatively in the 2 groups (ropivacaine vs. normal saline). The total amount of postoperative opioid use was also recorded. The VAS score was significantly lower in patients receiving hemostatic gelatin sponge impregnated with local anesthetics as compared with patients receiving gelatin sponge impregnated with normal saline 48 hours postoperatively; the mean total dose of meperidine given in the first 48 hours postoperatively was significantly lower (53.5 ± 51.0 mg) in patients receiving gelatin sponge impregnated with local anesthetics as compared with patients receiving hemostatic gelatin sponge impregnated with normal saline (140.5 ± 102 mg). Use of intraoperative hemostatic gelatin sponge impregnated with ropivacaine applied on the transverse process of the operated vertebrae intraoperatively resulted in decreasing the postoperative pain in patients undergoing lumbar instrumentation surgery as manifested by the decrease in the VAS score and the total dose of opioids.

Pocket related complications following cardiac electronic device implantation in patients receiving anticoagulation and/or dual antiplatelet therapy: prospective evaluation of different preventive strategies.

We sought to assess the safety and effectiveness of three different devices: (1) vacuum drainage system, (2) hemostatic gelatin sponge (Stypro®), and (3) compression device (Premofix®) compared to standard of care (control) in patients undergoing cardiac implantable electronic device (CIED) implantation receiving anticoagulation and/or dual antiplatelet therapy (DAPT). We enrolled all consecutive patients admitted for first permanent CIED implantation receiving anticoagulation and/or DAPT into a prospective registry. The primary endpoint (1°EP) was a composite of hematoma grade > 1 and pocket infection. We included 406 patients (median age 73years, 71% male) of whom 103 (25%) received a vacuum drainage system, 99 (24%) received Stypro®, 103 (25%) received Premofix®, and 101 (25%) were in the control group. One hundred eighty patients (44%) were treated with anticoagulation (median INR 2.0), 176 (43%) received DAPT, and 50 (12%) both. The occurrence of the 1°EP was reduced by Stypro® (hazard ratio (HR) 0.38 (95% confidence interval (CI) 0.16-0.94) and Premofix® (HR: 0.37 (95% CI 0.15-0.90)) compared to controls (p< 0.05 for both). The incidence of hematoma grade 2 or 3 was exclusively lowered by Premofix® compared to control (6% versus 15%; p< 0.05) and was not affected by the type of CIED, INR (≥ 2.5 versus < 2.5), body mass index (≥ 30 versus < 30), or CIED implantation under anticoagulation plus DAPT. The vacuum drainage system did not affect the 1°EP or the incidence of hematoma. In patients receiving anticoagulation and/or DAPT undergoing CIED implantation, the use of Premofix® and Stypro® significantly lowered the 1°EP occurrence compared to control. Premofix® additionally lowered the frequency of pocket hematomas >grade 1.

Minimizing Patient Morbidity Following Palatal Gingival Harvesting: A Randomized Controlled Clinical Study.

This clinical study was conducted to evaluate the impact of different hemostatic treatments following palatal gingival harvesting on patient discomfort. Fifty patients who needed a mucogingival surgery requiring gingival graft harvesting were enrolled and randomly assigned to one of five groups: (1) a control group in which only sutures were applied; (2) a cyanoacrylate group; (3) a periodontal dressing material group; (4) a hemostatic gelatin sponge group; and (5) a group in which the gelatin sponge and cyanoacrylate were combined. In the 2 weeks following the procedures, perception of pain, healing, consumption of drugs, and willingness to repeat the procedure were recorded through visual analog scale (VAS) by patients. Over the 2 weeks, lower pain (VAS) was found in all test groups compared to the control group (P < .01, value for time-group interaction). Notably, the gelatin sponge combined with cyanoacrylate group had very low pain (VAS ≤ 0.5 points) throughout the 14 days. The lowest healing scores at day 10 were associated with the control group (6.8 VAS points) in contrast to the four test groups (8.2 to 9.0 VAS points, P = .0001). Pain was inversely correlated with age (P < .05). Pain also depended on the apicocoronal dimension of the graft: the higher the graft, the more pain was experienced by the participants (0.4 VAS points per 1 mm, P < .05). Within the limitations of this study, palatal coverage appears to result in better outcomes when compared to suture alone. In particular, a double-layered protection of the palatal wound with a gelatin sponge combined with cyanoacrylate appeared to be the best option in reducing pain and postoperative discomfort.

EUS-Guided Coil Embolization with Absorbable Hemostatic Gelatin Sponge vs. Cyanoacrylate Injection for Treatment of Gastric Varices: Comparison of Clinical Outcomes and Health Care Utilization Presidential Poster Award

Introduction: Gastric variceal bleeding is an uncommon complication of cirrhosis but is associated with high rates of mortality and morbidity. Traditional endoscopic treatment options involve cyanoacrylate (CYA) injection which can be technically challenging. Coil embolization and absorbable gelatin sponge (Gelfoam®) are frequently used by interventional radiology for hemostasis. Recently, we have applied this combination therapy in EUS-guided management of gastric varices (GV) with high therapeutic success. We compared the outcome and health care utilization of endoscopic coil embolization with Gelfoam therapy versus CYA injection for treatment of GV.542_A Figure 1. Demographics and Patient Characteristics. Data are presented as number of cases (percentage) OR mean ± S.D. [ ] signify range of values. Abbreviations: NAFLD = non-alcoholic fatty liver disease; MELD = Model for End-stage Liver Disease; IGV = isolated gastric varices; GOV = gastroesophageal varices; UGIB = upper gastrointestinal bleed.542_B Figure 2. Comparison of Primary and Secondary Outcomes. *Two patients passed away prior to adequate follow-up evaluation of need for re-intervention (both due to HCC progression). Data are presented as number of cases (percentage) OR mean ± S.D. [ ] signify range of values. Abbreviations: CYA = cyanoacrylate; BRTO = balloon-occluded retrograde transvenous obliteration; HCC = hepatocellular carcinoma; HD = hemodynamic.Methods:Study Design: Matched cohort study using a prospective registry of over 10 yearsMatching: 5 consecutive patients undergoing EUS coil embolization with Gelfoam therapy for bleeding GV (10/2017-6/2018) were matched in 1:4 fashion to 20 patients who underwent cyanoacrylate injection. Matching criteria included age, Child-Pugh class, variceal type, and bleeding severity on admission. Primary outcome: Need for re-intervention at 3 months Secondary outcomes: All-cause mortality at 3 months, time spent in hospital post procedure, and post-procedural transfusion requirements Statistics: Student t-test and Fisher's exact test Results: 0% (0/5) patients in the coil embolization with Gelfoam cohort required re-intervention at 3-months, as compared to 56% (10/18) in the CYA cohort (p=0.046). Mortality at 3 months was 0% (0/5) for coil with Gelfoam versus 20% (4/20) for CYA (p=0.55), with 1 death directly attributed to ineffective intervention and uncontrolled GV bleeding. Post procedural hospitalization was higher for the CYA cohort (8.6±9.9 vs. 3.4±2.2 days; p=0.26). Post procedure transfusion requirements on average was higher for the CYA cohort (1.95±2.70 vs. 0.2±0.4 units of blood; p=0.17). Conclusion: EUS guided coil embolization with absorbable gelatin sponge therapy is a novel technique that appears to be highly effective in treating bleeding gastric varices. This technique lend itself to effective and sustained hemostasis compared to cyanoacrylate injection which requires re-intervention. There was a trend toward significance with post-procedural time spent in the hospital and transfusion requirements; larger studies in the future should help elucidate additional benefits and risks from this novel approach.

Endoscopic Ultrasound-Guided Treatment of Gastric Varices With Coil Embolization and Absorbable Hemostatic Gelatin Sponge

Endoscopic Ultrasound-Guided Treatment of Gastric Varices With Coil Embolization and Absorbable Hemostatic Gelatin Sponge

Gelfoam Interposition Minimizes Risk of Fistula and Postoperative Bleeding in Modified-Furlow Palatoplasty.

Failure to accomplish a tension-free, watertight closure predisposes the palatoplasty patient to fistula formation. Perioperative bleeding also places the patient at risk for adverse airway events (AAE). This study introduces the incorporation of a hemostatic gelatin sponge (Gelfoam) into layered palatoplasty to minimize adverse postoperative bleeding and fistula formation. A retrospective chart review was performed to identify subjects who underwent Furlow palatoplasty with insertion of Gelfoam from 2010 to 2015. Exclusion criteria include age >3 years, prior palate surgery, <30-day follow-up, immunosuppressive state, and diagnosis of Treacher-Collins or Apert Syndrome. Demographic data include age, sex, cleft laterality, prior surgeries, Veau classification, Pierre Robin status, and tracheostomy dependence. Primary outcome was fistula formation. Secondary outcomes included perioperative metrics and AAE.One hundred subjects met criteria, 45% female. Average age was 14.6 months. Subjects with syndromes comprised 28%, with 16% diagnosed with Pierre Robin. Two subjects were tracheostomy-dependent. Prior cleft and mandibular procedures were performed in 55%. Isolated palatal defects were seen in 46%, unilateral lip and palate in 41%, and bilateral lip and palate in 13%. The majority of defects were Veau II and III (35% and 34%, respectively). Adverse airway events occurred in 2%, one of which resulted in reintubation. One subject (1%) was found to have a postoperative fistula.The incorporation of Gelfoam in the modified-Furlow palatoplasty results in a low rate of oronasal fistula (1%) and low perioperative risk of AAE. Further prospective comparison of this method to others will be the focus of future work.

Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study

ObjectiveAlthough hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient’s subjective symptoms, hemostasis, and wound healing following septoplasty. Subjects and methodsSeventy six adult patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with hemostatic gelatin sponge and the other one with polyvinyl acetate. Patients’ subjective symptoms while the packing was in situ, hemostatic properties, patients’ pain on removal, degree of bleeding on removal of the packing, time for hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated. ResultsBoth packs were equally effective in the control of postoperative bleeding following septoplasty. However, hemostatic gelatin sponge packing was significantly more comfortable while in situ and less painful on removal of the pack. The polyvinyl acetate packing was associated with significantly more bleeding on removal, therefore much time was needed to control hemorrhage. There was no significant difference in the cost of the pack used and outcome of wound healing. ConclusionThe use of hemostatic gelatin sponge after septoplasty results in significantly less discomfort and greater patient satisfaction with no adverse reactions when compared with polyvinyl acetate packing. Therefore, hemostatic gelatin sponge may be a useful packing material after septoplasty.