Hemostatic Sponge Research Articles

Local application of collagen sponge Alvokon after tooth extraction surgery

After tooth extraction, it is necessary to create favorable conditions for the healing of the hole of the removed tooth. Dynamic observation of the patient by the attending physician is generally accepted to assess the condition of the postoperative wound and the patient’s implementation of recommendations for oral care. However, patients often note the presence of pain and swelling of the mucous membrane of the well of the removed tooth.Stude – a comparative assessment of the course of the early postoperative period in patients with local application of collagen sponges Alvokon and Alvostaz.Materials and methods. A prospective randomized study of 80 patients aged 20 to 59 years was conducted. The patients underwent a tooth extraction operation under local anesthesia. The patients were divided into 4 groups of 20 people. In patients of the first group, a collagen sponge Alvocon No. 3 was placed in the hole of the removed tooth, in patients of the second group – a collagen sponge Alvocon No. 5 in patients of the third group – a hemostatic collagen sponge «Alvostaz». Local medicines were not used in patients of the fourth group after tooth extraction. In the postoperative period, the presence of pain and the condition of the hole of the removed tooth were assessed.Results. Wound healing proceeded by secondary tension without complications in all patients. Comparing the nature of the course of the early postoperative period, pain after tooth extraction in patients of different groups varied from 5 to 50% of cases, and the presence of edema of the wound edges – from 5 to 100% of cases.Conclusions. Pain in the early postoperative period is expressed 2 times less when using the collagen sponge Alvokon No. 5. Edema of the marginal gum of the well of the removed tooth was 1.1 times less when using the collagen sponge Alvokon, 1.2 times when using the hemostatic collagen sponge Alvostaz in comparison with the group of patients without the use of a sponge.

A wet-adhesive carboxymethylated yeast β-glucan sponge with radical scavenging, bacteriostasis and anti-inflammatory functions for rapid hemostasis

Local hemostats still face obstacles to efficiently achieving hemostasis and promoting wound healing. Herein, a series of multifunctional well-degradable hemostatic sponges based-on carboxymethylated yeast β-glucan (CMYG) were fabricated by lyophilization. The porous CMYG sponge not only could absorb blood quickly (44.12 g/g), but also possessed unexpected tissue adhesion (∼30 kPa), and it represented good biocompatibility in vitro on fibroblasts and red blood cells. Notably, compared with the commercial Celox™, the CMYG sponge achieved more rapid hemostasis and significantly reduced blood loss in liver injury rat models by rapid wound block. Interestingly, the developed sponge showed an outstanding effect on antioxidant, anti-infection, anti-inflammatory, and cell proliferation, which are beneficial for further wound repair. Overall, these results suggest that the CMYG sponge is a promising candidate for the clinical management of uncontrollable hemorrhage and the further development of wound dressing materials throughout skin defect repair.

Gelatin/calcium chloride electrospun nanofibers for rapid hemostasis.

Blood coagulation is the body's main defense to bleeding caused by trauma and is divided into endogenous and exogenous pathways. Calcium ions play a very important role in the process of blood coagulation, as the ions activate the many enzymes that are required for coagulation. In this paper, gelatin hemostatic membranes containing calcium ions were prepared by electrospinning. The fibers were characterized with scanning electron microscopy, Fourier transform infrared spectroscopy, and X-ray diffraction. The biocompatibility and coagulation processes using the calcium ion-containing gelatin fibrous membranes were evaluated in vitro with dynamic whole-blood coagulation tests, hemolysis tests, coagulation time tests, and platelet adhesion tests. It was demonstrated that the calcium ion-containing gelatin membranes had lower hemolysis rates and shorter clotting times than commercially available hemostatic sponges and hemostatic gauzes. In vivo hemostasis experiments were also conducted on the tail vein and liver of mice. Animal experiments demonstrated that the incorporation of calcium ions into the electrospun gelatin membranes promoted platelet aggregation, ensured adhesion of the electrospun membrane to the wound and reduced the bleeding volume and hemostasis time. The composite calcium ion-gelatin electrospun membranes exhibited good in vivo and in vitro hemostatic abilities and accelerated blood clotting by stimulating the coagulation pathway to promote platelet aggregation at the wounds and the formation of mature blood clots for a new approach for acute trauma treatment.

Local hemostatic biomaterial based on native collagen

The article presents the results of obtaining a neutral biomaterial in the form of a sponge based on the aqueous mass of collagen isolated from the hide of cattle while maintaining the original fibrous structure. It has been established that at a concentration of water mass of collagen of 5-6%, a high porosity of the biomaterial is observed. With an increase in the porosity of the biomaterial, its sorption capacity increases. It is shown that the biomaterial “Hemogubka” with a porosity of 87% has a pronounced hemostatic effect in rabbits with increased bleeding, and also reduces the time of parenchymal bleeding of the liver, kidneys, and spleen in rabbits by 48-73%, respectively, and is superior in efficiency to the action of a hemostatic sponge and hemostatic gauze 1.2-1.5 times.

Organ–preserving operations for the gun–shot thoraco–abdominal and abdominal woundings with splenic injuries

Objective.To determine the expediency of the spleen–preserving operations performance for its injury due to gun–shot thoraco–abdominal and abdominal woundings.
 Materials and methods. Of 51wounded persons with the gun–shot penetrating abdominal woundings with splenic injuries 8 (15.7%) were operated on the II level of the medical help delivery, while on the ІІІ level – 43 (84.3%). Of 43 wounded persons, operated on the ІІІ level of the medical help delivery, in 35 (81.4%) splenectomy was performed, while in 8 (18.6%) – the organ–preserving operations. All the splenic injuries have been characterized as a shrapnel woundings. The splenic damage degree was estimated in accordance to Moore, taking into account its structure. In 5 (62.5%) wounded persons the open laparotomy organ–preserving operations were performed, and while using video–laparoscopic system– in 3 (37.5%).
 Results. Ultrasonographic investigation in accordance to the FAST–protocol was done in all the wounded persons, what have permitted to determine the blood abdominal outpouring volume as well as the splenic injury presence. The affection volume and further tactics were determined using video–laparoscopy. The Stage I splenic affection in accordance to Moore was diagnosed in 4 (50%) wounded persons, the Stage ІІ – in 3 (37.5%), and the Stage ІІІ – in 1 (12.5%). In all the patients, in whom organ–preserving interventions were performed, the surgical help volume consisted of coagulation, using the radiofrequency therapy apparatus MEDTRONICAEX and the hemostatic sponge application with drainage of the left subdiaphragmatic space, using silicone tube.
 Conclusion. Organ–preserving operations in splenic injury are expedient to be performed on ІІІ level of the medical help delivery, while presence of local conditions, such as the organ injury degrees І and ІІ,determined in accordance to Moore, as well as adequate time and equipment.

Sandwich-like scaffold for effective hemostasis and anti-adhesion in cardiac injury

Blood vessels are fully lined on the heart and sternum. Massive bleeding following heart surgery significantly reduces the effectiveness of anti-adhesion materials, resulting in severe tissue adhesion. Adverse outcomes in the follow-up surgery can also be brought on by post-operative adhesion. In this study, a sandwich-like scaffold was developed. Hemostatic sponges made of sodium carboxymethyl cellulose make up the top and bottom layers. An anti-adhesion fibrous membrane with poly-lactic-co-glycolic acid and polyethylene glycol-polylactic acid block copolymer made up the intermediate layer. As a physical barrier, the intermediate layer preserved the morphological integrity for more than a week. Following hemostasis, the layers of the sponges and the blood clot may degrade quickly, reducing the inflammation and fibrin deposition around the wound. This sandwich-like scaffold potentially has hemostasis and anti-adhesion properties that lower the activation level of coagulation factors and lessen bleeding.

Design of biopolymer-based hemostatic material: Starting from molecular structures and forms.

Uncontrolled bleeding remains as a leading cause of death in surgical, traumatic, and emergency situations. Management of the hemorrhage and development of hemostatic materials are paramount for patient survival. Owing to their inherent biocompatibility, biodegradability and bioactivity, biopolymers such as polysaccharides and polypeptides have been extensively researched and become a focus for the development of next-generation hemostatic materials. The construction of novel hemostatic materials requires in-depth understanding of the physiological hemostatic process, fundamental hemostatic mechanisms, and the effects of material chemistry/physics. Herein, we have recapitulated the common hemostatic strategies and development status of biopolymer-based hemostatic materials. Furthermore, the hemostatic mechanisms of various molecular structures (components and chemical modifications) are summarized from a microscopic perspective, and the design based on them are introduced. From a macroscopic perspective, the design of various forms of hemostatic materials, e.g., powder, sponge, hydrogel and gauze, is summarized and compared, which may provide an enlightenment for the optimization of hemostat design. It has also highlighted current challenges to the development of biopolymer-based hemostatic materials and proposed future directions in chemistry design, advanced form and clinical application.

Use of bupivacaine‐infused absorbable gelatin haemostatic sponge following eye enucleation in a corn snake

AbstractA 9‐year‐old, male, 0.69 kg, corn snake was referred for enucleation of its right eye. Pre‐anaesthetic medication consisted of butorphanol (1 mg/kg) and alfaxalone (10 mg/kg) intramuscularly. Orotracheal intubation was then performed. General anaesthesia was maintained with sevoflurane in 100% oxygen. During the general anaesthesia, the snake was manually ventilated. At the end of the surgery, the orbit was packed with a haemostatic sponge soaked in 0.75 mg/kg of 0.5% bupivacaine. Meloxicam (0.4 mg/kg) was administered subcutaneously as a part of the multimodal analgesic protocol. Total anaesthetic time was 90 minutes. Following 2 minutes of sevoflurane discontinuation, the snake started moving and the trachea was extubated. The snake displayed normal behaviour, although a short period of hypothermia was suspected in recovery. No other complications were encountered. The snake was discharged 4 hours after the end of surgery; meloxicam (0.2 mg/kg) was prescribed once daily, orally, for 14 days.

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

A Biodegradable Flexible Micro/Nano-Structured Porous Hemostatic Dental Sponge.

A biodegradable micro/nano-structured porous hemostatic gelatin-based sponge as a dentistry surgery foam was prepared using a freeze-drying method. In vitro function evaluation tests were performed to ensure its hemostatic effect. Biocompatibility tests were also performed to show the compatibility of the sponge on human fetal foreskin fibroblasts (HFFF2) cells and red blood cells (RBCs). Then, 10 patients who required the extraction of two teeth were selected, and after teeth extraction, for dressing, the produced sponge was placed in one of the extracavities while a commercial sponge was placed in the cavity in the other tooth as a control. The total weight of the absorbed blood in each group was compared. The results showed a porous structure with micrometric and nanometric pores, flexibility, a two-week range for degradation, and an ability to absorb blood 35 times its weight in vitro. The prepared sponge showed lower blood clotting times (BCTs) (243.33 ± 2.35 s) and a lower blood clotting index (BCI) (10.67 ± 0.004%) compared to two commercial sponges that displayed its ability for faster coagulation and good hemostatic function. It also had no toxic effects on the HFFF2 cells and RBCs. The clinical assessment showed a better ability of blood absorption for the produced sponge (p-value = 0.0015). The sponge is recommended for use in dental surgeries because of its outstanding abilities.

HEPATIC TO PULMONARY EMBOLISM OF ABSORBABLE GELATIN HEMOSTATIC SPONGE IN TWO EGYPTIAN FRUIT BATS (ROUSETTUS AEGYPTIACUS).

In a study on iron regulation, liver biopsies were collected at two time points from 34 adult Egyptian fruit bats (Rousettus aegyptiacus). An absorbable gelatin hemostatic sponge (GS) was inserted at biopsy sites for local hemostasis in 16 bats. In the subsequent 10 yr, 12 of these bats died or were euthanized, and 11 were examined histologically; in 2 bats, intravascular GS was identified in the lungs and in 1 bat, unabsorbed GS was also identified at the hepatic biopsy site. The remaining hepatic GS was associated with local abscessation and intralesional bacteria and fungi and remained at the hepatic biopsy site for a prolonged period after placement (1 yr). The findings of local hepatic abscessation and GS embolization in the lungs of these two bats highlights a potential adverse effect related to its use in zoologic species.

Biocompatible Carboxymethyl Chitosan/GO-Based Sponge to Improve the Efficiency of Hemostasis and Wound Healing.

Sponges with highly absorptive properties have been widely used in emergency hemostasis. Graphene oxide (GO) has been extensively investigated in biomedical applications and is a promising candidate for hemostatic sponges. However, GO has been demonstrated to have adverse effects on the human body. To overcome this problem, a hemostatic sponge based on modified GO and carboxymethyl chitosan (CMCS) is successfully prepared, which has excellent water absorption ability and mechanical strength. Importantly, hemostasis assays showed that the composite sponge exhibited high hemostatic efficiency, and the possible hemostatic mechanism is also discussed in this study. Moreover, the results of in vitro antibacterial tests reveal that the composite sponge also presents strong antimicrobial effects against Staphylococcus aureus and Escherichia coli. Significantly, the composited sponge used as hemostatic dressing can effectively promote cell proliferation, achieving a wound closure rate of 95% on day 12. Such a graphene-based sponge with multiple advantageous features would hold broad prospects in the hemostatic field.

Immunohistochemical evaluation for integrin binding sialoprotein on healing process of intrabony defect treated by bone sialoprotein

Background: Bone defect healing is a multidimensional procedure with an overlapping timeline that involves the regeneration of bone tissue. Due to bone's ability to regenerate, the vast majority of bone abnormalities can be restored intuitively under the right physiological conditions. The goal of this study is to examine the immunohistochemistry of bone sialoprotein in order to determine the effect of local application of bone sialoprotein on the healing of a rat tibia generated bone defect. Materials and Methods: In this experiment, 48 albino male rats weighing 300-400 grams and aged 6-8 months will be employed under controlled temperature, drinking, and food consumption settings. The animals will be subjected to a surgical procedure on the medial side of the tibiae bone, with the bone defect repaired with absorbable hemostatic material in the control group (12 rats). The experimental group (12 rats) will be treated with local administration of 30 μl bone sialoprotein fixed by absorbable hemostatic sponge. After surgery, the rats will be slaughtered at 7, 14, and 28 days (four rats for each period). Results: Immunohistochemical analysis of bone sialoprotein by stromal cells reveal a substantial difference between the bone sialoprotein group and the control group. Conclusion: The study concludes that local application of bone sialoprotein could be a successful therapeutic treatment for bone injuries; these findings are encouraging for future clinical use.

Preparation of methacrylated hyaluronate/methacrylated collagen sponges with rapid shape recovery and orderly channel for fast blood absorption as hemostatic dressing

Uncontrolled hemorrhage of deep, narrow, and non-compressible perforating wounds is responsible for many trauma deaths. In this study, a rapid hemostatic sponge with an orderly channel based on methacrylated collagen (ColMA) was prepared via directional freeze-drying technology. The methacrylated hyaluronate (HAMA) was added to further enhance the mechanical properties of the sponge. The sponge presents excellent mechanical strength, rapid shape recovery, and absorption speed, which was faster than those of many reported natural polymer hemostatic sponges. Moreover, ColMA/HAMA sponge showed much better blood-clotting capacity and superior hemostasis performance than commercially available collagen sponges in vitro and in the rat-liver injury model. This study demonstrated a feasible strategy to construct the rapid hemostatic sponge with an orderly channel for the deep and non-compressible perforating wound.

RISK FACTORS FOR POST-EXODONTIA BLEEDING IN PATIENTS WITH TERMINAL HEPATIC DISEASE: A STROBE-GUIDED PROSPECTIVE COHORT

<h3>Objectives</h3> To assess the incidence and risk factors to post-exodontia bleeding in patients with terminal hepatic disease (THD) . <h3>Study Design</h3> This cohort study prospectively evaluated patients before liver transplant needing exodontia. All exodontias were performed using a hemostatic sponge or a local compress with a gauze pad soaked in tranexamic acid, according to the size of the alveolus. Bleeding was assessed according to the presence and bleeding period criteria in the first 30 minutes and during the next 7 days. Fisher's exact test, chi-square test, and multinomial regression models were performed (SPSS; <i>P</i> < .05). <h3>Results</h3> Postoperative bleeding reduced significantly from first (56%), second (16%), third (8%) and fourth (4%) postoperative days and type of hemostatic, and the number (1, 2, or 3) and distribution (distant or contiguous) of teeth did not influence this outcome. Low blood cell count (<i>P</i> = .037), hemoglobin (<i>P</i> = .004), hematocrit (<i>P</i> = .037) and international normalized ratio (<i>P</i> = .013) predicted postoperative bleeding, such as ascites (<i>P</i> = .006), peritonitis (<i>P</i> < .001), and encephalitis (<i>P</i> = .004), but in multivariate analysis the risk factors were male sex (<i>P</i> = .004) and previous gingival bleeding (<i>P</i> = .038). <h3>Conclusions</h3> A low incidence of post-exodontia bleeding was observed during local hemostatic agents use, and gingival bleeding is the most important risk factor for post-exodontia bleeding in patients with THD.

A rapid hemostasis for incompressible wounds by microwave-assisting construction of cellulose sponge with chitosan

Rapid hemostasis in incompressible wounds using cellulose sponge, coupled with environmentally friendly and low-cost preparation, remains a challenge. Herein, cellulose sponges loaded with chitosan with abundant rich pore structure and high water absorption capacity were prepared with cellulose carbamate by using gas foaming method. Animal experiments showed that the blood loss and hemostasis time can be significantly shortened from 225 s to 39 s by the plug the incompressible wound using adaptable composite sponges. Scanning electron microscope results showed that the chitosan formed a porous network structure on the surface and between the pores of the cellulose sponge. An obvious inhibitory effects of composite sponge on Escherichia coli and Staphylococcus aureus could effectively reduce wound infection. And the rapid shape recovery ability of the composite sponge was beneficial to sealing the bleeding wound quickly. The results of in vitro hemolytic activity, cytotoxicity and live-dead cell staining showed the composite hemostatic sponges have excellent biocompatibility. In particular, the preparation of cellulose sponge by microwave-assisted method can effectively improve the environmental pollution and cumbersome steps caused by current industrial production. It is expected to be used for rapid hemostasis of non-compressible hemorrhagic wounds.

Biocompatible Hemostatic Sponge Exhibiting Broad-Spectrum Antibacterial Activity.

Hemorrhage during accidents or surgery is a significant challenge that can contribute to mortality. This is further aggravated due to bacterial infections at the injured site. Therefore, rapid application of a hemostatic and antibacterial material is highly necessary as a pretreatment for patients' survival. Herein, we have developed a hemostatic sponge (Hemobac) through amide crosslinking of gelatin and an N-(2-hydroxy) propyl-3-trimethylammonium chitosan (HTCC)-silver chloride nanocomposite (QAm1-Ag0.1) to mitigate bacterial infections, while aiding hemostasis. This Hemobac sponge completely eradicated (∼4-5 log) a wide range of Gram-positive and Gram-negative bacteria encompassing various clinical isolates within 6 h. The antihemorrhagic ability of Hemobac was ascertained through SEM images, which exhibited the presence of agglomerated blood cells onto the sponge with a significantly low blood-clotting index value (∼23 ± 1). Notably, Hemobac reduced the blood loss by ∼70-80% in the liver puncture model and femoral vein injury model in mice, displaying its improved hemostatic ability over a marketed gelatin-based sponge. Negligible hemolytic activity (∼6%) and retained healthy morphology of mammalian cells were observed upon exposure to the Hemobac sponge. Minimal immune response was noticed at the Hemobac-treated wound in mice through histopathology analysis. Collectively, these findings indicate that this biocompatible Hemobac sponge can stop the bleeding instantaneously and combat bacterial infections.

Expandable carboxymethyl chitosan/cellulose nanofiber composite sponge for traumatic hemostasis

Uncontrolled hemorrhage poses a severe life-threatening situation. However, traditional hemostats still have various limitations. It is urgent to develop a material with excellent biocompatibility and hemostatic ability. Evidence has shown that carboxymethyl chitosan (CMCS) has hemostatic properties and good compatibility. Herein, we develop an expandable hemostatic sponge by modifying CMCS with cellulose nanofibrils (CNFs) through the CO-NH cross-linking method. We verified its potential as a hemostatic agent both in vivo and in vitro. The results demonstrated that the prepared carboxymethyl chitosan/cellulose nanofiber composite (CNF-CMCS) sponges could absorb blood, quickly expand to exert pressure in the wound, and exhibit an excellent coagulation ability. The CNF-CMCS sponges significantly decreased the bleeding time and blood loss in several hemorrhage models and possessed a significant advantage in treating the deep penetrating injury hemorrhage. Therefore, the sponges provide a unique application prospect and potential as a penetrating trauma hemostatic agent.

Assessment of the hemostatic activity of "hemoben" in the model of liver damage on hypocoagulation

In the article, the authors present the results of experimental studies on the hemostatic properties assessment of the new domestic hemostatic implant Hemoben under artificial hypocoagulation using medications on a model of a planar wound in the liver of rats. An attempt was made to stop bleeding using gauze strips and balls and a hemostatic sponge in the control group of animals. Experimental and morphological studies have convincingly proved that under drug hypocoagulation, Hemoben provides fine and stable hemostasis, which significantly exceeds the parameters of a hemostatic sponge.

A novel pullulan oxidation approach to preparing a shape memory sponge with rapid reaction capability for massive hemorrhage

Traditional hemostatic materials on the market have considerable limitations for coping with massive bleeding. Herein, we developed an injectable hemostatic sponge via a pullulan oxidation approach. After an oxidation using NaIO4 at room temperature, the resulting oxidized pullulan provides aldehyde groups to cross-link with the residual hydroxyl groups via the acetal reaction, leading to a hydrogel for lyophilization, thereby producing a porous sponge having highly interconnected macro-pores 89.4–195.4 μm in size. Experimental results show that the oxidized pullulan (OP) sponge possesses good biocompatibility and hemocompatibility. The optimized sponge, OP@0.5 (prepared using 0.5:1 mass ratio of NaIO4 and pullulan), exhibited a high fluid absorption ratio, excellent shape memory property, and robust mechanical elasticity. In addition, the OP@0.5 sponge realized a remarkable hemostatic property, which can be reflected by a lower whole blood clotting index and better aggregation capacities of both blood cell and platelet when compared to commercial gelatin sponge and medical gauze. Furthermore, in vivo hemostatic results demonstrate that OP@0.5 sponge can accomplish rapid hemostasis times for a rat femoral artery injury model (mean value of 40 s) and liver volume defect injury model (mean value of 33.8 s). In contrast, the commercial gelatin sponges presented 230 s and 100 s under the same test condition, respectively. Our data also show that the OP@0.5 sponge provides a good antibacterial effect on both Escherichia coli and Staphylococcus aureus. This study demonstrated a great application potential using pullulan-based material for massive hemorrhage cases.