Severe Groin Research Articles

Mesanede taşlaşmış transobturator bant meşi: Olgu sunumu

Transobturator tape (TOT) technique is one of the most commonly used techniques in Stress Urinary Incontinence (SUI) treatment. The most common complications of this technique in the long term are pain and dyspareunia. Bladder perforation is not a common complication of the TOT technique but, regardless, it is a catastrophic complication, therefore, routine cystoscopy should be done in this technique. In this report, we present a woman who presented with severe groin pain and was diagnosed with lithified sling material in her bladder. The patient was managed with open cystolithotomy and mesh excision.

Does patient-reported perception of pain differ based on surgical approach in total hip arthroplasty?

Whether patient-reported pain differs among surgical approaches in total hip arthroplasty (THA) remains unclear. This study's purposes were to determine differences in pain based on surgical approach (direct anterior (DA) vs posterolateral (PL)) and PL approach incision length. This was a retrospective investigation from two centres and seven surgeons (three DA, three PL, one both) of primary THAs. PL patients were categorized for incision length (6 cm to 8 cm, 8 cm to 12 cm, 12 cm to 15 cm). All patients had cementless femoral and acetabular fixation, at least one year's follow-up, and well-fixed components. Patients completed a pain-drawing questionnaire identifying the location and intensity of pain on an anatomical diagram. Power analysis indicated 800 patients in each cohort for adequate power to detect a 4% difference in pain (alpha = 0.05, beta = 0.80). A total of 1848 patients (982 DA, 866 PL) were included. PL patients were younger (59.4 years, sd 12.9 vs 62.7 years, sd 9.7; p < 0.001) and had shorter follow-up (3.3 years, sd 1.3 vs 3.7 years, sd 1.3; p < 0.001). DA patients reported decreased moderate to severe trochanteric (14% vs 21%; p < 0.001) and groin pain (19% vs 24%; p = 0.004) than PL patients. There were no differences in anterior, lateral, or posterior thigh, back, or buttock pain between cohorts (p = 0.05 to 0.7). PL approach incision length did not impact the incidence or severity of pain (p = 0.3 to 0.7). A significant proportion of patients perceive persistent pain following THA regardless of approach. DA patients reported less trochanteric and groin pain versus PL patients. PL incision length did not influence the incidence or severity of patient-reported pain. Cite this article: Bone Joint J 2019;101-B(6 Supple B):31-36.

SUN-181 Case Report: Rare Complication of SGLT2 Inhibitors Can Occur Only 10 Days after Starting the Medication

Introduction: Fournier’s gangrene is an extremely rare infection that can occur in diabetic patients. The FDA recently issued a warning about patients taking sodium-glucose cotransporter-2 inhibitors stating that these patients are liable to develop Fournier gangrene. This complication usually occurs few months after starting the medication. Up to our knowledge, total 12 cases have been reported in literature from May 2013 to May 2018. We report another case of Fournier gangrene associated with the use of empagliflozin, however our case is unique as the presentation was only 10 days after starting the medication. Case report:We present a 57 years old Caucasian male with past medical history of uncontrolled type 2 diabetes diagnosed around 10 years ago and complicated by peripheral neuropathy, hashimoto’s hypothyroidism and morbid obesity who was following as outpatient with an endocrinologist. His hemoglobin A1C has been uncontrolled despite being on glipizide 10 mg BID, metformin 1gm BID and linagliptin 5mg daily so decision was made to start empagliflozin. After 10 days, patient complained of severe left groin pain for which he was initially treated as cellulitis in an outpatient facility however no improvement was noticed. He went to the ED. On physical examination, his weight 192 kilograms with BMI of 62.76kg/m2, he was afebrile and vitally stable. Perineal examination revealed a grossly swollen and indurated right scrotum with tender spermatic cord, epididymis and testicles. There was associated bilateral inguinal lymphadenopathy. CT abdomen and pelvis showed Fournier gangrene so patient was transferred to our facility for surgical intervention. We were consulted after surgical debridement to help inpatient management of diabetes. Empagliflozin was discontinued upon admission. Upon further questioning, patient denied any similar condition in the past and prior history of genital or urinary infections. Discussion:Several infections can occur in patient with uncontrolled diabetes including Fournier gangrene and other life threatening infection. SGLT2 inhibitors are known to increase risk of genitourinary infection. However given the recent FDA warning regarding the new side of effect of SGLT2 inhibitors, physician should be aware that Fournier gangrene can occur in diabetic patients especially the ones with potential risk of genital infection. As per the FDA report, from the 12 cases of Fournier gangrene in patients using SGLT2 inhibitors, 7 were men and 5 were women and it developed within several months after starting the medication. They were divided into 7 men and 5 women. All of them were hospitalized and required surgery similar to our patient. Conclusion: SGLT2 inhibitors has been commonly associated with urinary tract infection, however risk factors including diabetes, obesity may increase the risk of potentially more severe infections such as Fournier's gangrene.

Comparision of two new hemostatic dressings in controlling hemorrhage in a severe groin injury model in swine

BackgroundHemorrhage is a leading cause of death from trauma. Polyacrylate Hemostatic Dressing (PHD) and Wrap Zeolite Hemostatic (WZH) are new hemostatic products touted to be effective in controlling severe extremity bleeding. This study compared the efficacy of two hemostatic dressings in a severe groin injury model in swine.MethodsTwelve swine received PHD and WZH for hemostasis. A reproducible femoral artery injury was created using a 6 mm aortic punch, and free bleeding was allowed for 5 seconds. The groin was packed with the randomized dressing followed by 2 minutes of manual compression. Hemostasis failure was defined as blood pooling outside the wound. Animals were monitored for 120 minutes. Endpoints were percent survival, survival time, blood loss and tissue histology.ResultsBaseline physiologic parameters were similar between groups. There were no differences in mortality was seen between groups. PHD resulted in less hemostasis failure (p &lt; 0.05), decreased postcompression blood loss (p &lt; 0.05). Histologic observations showed mild to moderate changes in treated vessels and muscles, WZH has caused more changes than PHD.ConclusionPHD performed significantly better than WZH in controlling hemorrhage from a severe groin injury in swine.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Abstract TP461: Predictors of Groin Punction Complication After Edovascular Therapies

Background: Endovascular therapies(EVT) have exponentially increased in the last few years. To maximize the benefits of EVT, complications related to the treatment need to be prevented or minimized with early detection and appropriate management. We implemented a specific registry to collect femoral post-puncture complications detected at different timepoints. Our aim was to identify factors associated with severe groin punction complications. Methods: Prospective study of consecutive patients treated with acute EVT or scheduled (angioplasty), admitted to our Stroke Unit from February2017-June2018. Post-catheterization femoral complications included: groin bleeding(GB), groin hematoma(GH), retroperitoneal hematoma(RH), femoral artery pseudoaneurysm(FAP), and artery dissection(AD). A specific registry was created for data collection at different timepoints: During or immediate post-EVT, at 24h post-compression and at discharge. Results: 384patients were treated with EVT(73%acute), mean age 71+/-13y.o, 69% men. Mynxgrip closure system was used in 346(91,8%). Compressive measures needed to be reinforced in 55 cases(14,5%)/changed in 15(4%). Early mobilization protocol(24-48h) was initiated in 335patients(92,3%). 9patients (2,8%) did not maintain the first 24h absolute rest. 57patients(15,1%) presented mild immediate complications(49GH,6GB). At 24h, 181(47,1%)patients presented GH(28,6%superficial, 18,2%internal) and 5GB(1,3%). At discharge, 29(8,1%)patients had presented clinically significant femoral complications: 16GH(13deep), 5FAP, 1AD, 4RH. 2 of those complications were fatal. Variables associated with severe complications at discharge were: age(p=0.037), non-use of mynxgrip(p=0.001), compressive replacement(p&lt;0.001), non-compliance of early mobilization protocol(p=0.014). Conclusion: In our series, we found a yield of 8,1% of clinically significant groin complications associated with the EVT (0,5% fatal). We indentified age, closure device, requirement to replace compressive and lack of accomplishment of the early mobilization protocol as predictors of these complications.

Successful Treatment of Total Hip Arthroplasty to a Patient Associated with Alcoholic Cirrhosis and Severe Plated Deficiency with Preoperative Partial Splenic Embolization

Introduction: We present the first report of the successful treatment of Total Hip Arthroplasty (THA) to a patient associated with alcoholic cirrhosis and plated deficiency undergoing preoperative Partial Splenic Embolization. Case Report: A 45-year woman who had Liver Cirrhosis (LC) and alcohol residue heritage failure suffered from severe groin pain and had a difficulty in walking for a long period due to avascular necrosis of bilateral femoral head. She was referred to our orthopaedic service and THA was planned. Despite preoperative transfusion for her platelet deficiency coursed by LC, preoperative platelet count decreased less than a normal range. Therefore, Partial Splenic Embolization (PSE) was applied to her so as to increase platelet count. PSE could temporally reduce the portal vein pressure and prevent a hyperspleism and cytopenia. After the procedure, THA was performed to bilateral hip safely through a direct anterior approach. At the time of the latest follow-up, the patient had an excellent clinical result. Conclusion: Preoperative PSE may be a useful procedure to the patients with LC and severe plated deficiency who need arthroplasty including THA. Pre-existing physical and psychological factors have an effect on the outcome of arthroplasty and appropriate strategies might be needed.

Obturator Neuromodulation with Laparoscopic Placement of an Obturator Lead for the Treatment of Intractable Opioid-Dependent Chronic Pelvic Pain due to Obturator Neuralgia

Chronic pelvic pain (CPP) is a common condition in women that can have a devastating effect on quality of life. Some of the most severe forms of CPP are related to peripheral nerve injuries, causing persistent neuropathic pain. We present a case of a young woman with severe opioid-dependent chronic pelvic and right groin pain due to obturator neuralgia. She had failed amultitude of treatments, including multiple medications, manual physical therapy, nerve blocks, surgical neurolysis, and spinal cord stimulation, without significant benefit. She underwent a trial of peripheral neuromodulation of the obturator nerve with laparoscopic placement of a quadripolar lead. During the 6-day trial, she experienced almost complete relief of her pain; therefore, she underwent permanent implantation of an intermittent pulse generator. Over the next 6 months, she was completely weaned off chronic opioids. At 23 months postimplantation, she had essentially no pain and was no longer receiving any analgesic, antidepressant, or membrane-stabilizing medications.

Risk Factors for Groin Injury and Groin Symptoms in Elite-Level Soccer Players: A Cohort Study in the Dutch Professional Leagues.

Background Groin injury and groin symptoms are common in soccer players. The relationship of groin injury and groin symptoms to reduced hip range of motion (ROM) and previous injury is unclear. Objectives To conduct a retrospective assessment of associations between previous injury and preseason hip ROM and preseason prevalence of severe groin symptoms, and to prospectively identify risk factors for within-season groin injury. Methods During the period of 2015 to 2016, 190 players from 9 Dutch professional soccer clubs participated in this cohort study with prospective and retrospective elements. Univariate and multivariate logistic regressions were used to predict preseason severe groin symptoms, identified using the Copenhagen Hip and Groin Outcome Score, from a history of previous groin injury, general injury (minimum of 1 week in duration) in the previous season, and hip ROM. Cox regression was used to predict within-season groin injury. Results Point prevalence of severe groin symptoms was 24% and within-season incidence of groin injury was 11%. Total, training, and match groin injury incidences were 0.5, 0.2, and 2.6 injuries per 1000 playing hours, respectively. A history of more than 1 previous groin injury was associated with current severe groin symptoms (odds ratio = 3.0; 95% confidence interval: 1.0, 8.3; P = .038). General injury sustained in the previous season (ankle, knee, thigh, shoulder; median, 9 weeks of time loss) was a risk factor for groin injury (hazard ratio = 5.1; 95% confidence interval: 1.8, 14.6; P = .003). Conclusion Severe injuries in the previous season to locations other than the groin increase the risk of groin injury the next season. A history of groin injury is associated with current severe groin symptoms. Preseason hip ROM does not identify players at risk for groin injury. Level of Evidence Prevention, level 2b. J Orthop Sports Phys Ther 2018;48(9):704-712. Epub 23 May 2018. doi:10.2519/jospt.2018.7990.

Impact of postoperative complications on the risk for chronic groin pain after open inguinal hernia repair

Chronic pain is common after inguinal hernia repair and has become one of the most important outcome measures for this procedure. The purpose of this study was to determine whether or not there is a relationship between specific postoperative complications and risk for chronic pain after open inguinal hernia repair. A prospective cohort study was designed in which participants responded to the Inguinal Pain Questionnaire regarding postoperative groin pain 8years after inguinal hernia repair. Responses to the questionnaire were matched with data from a previous study regarding reported postoperative complications after open inguinal hernia repair. Participants were recruited originally from the Swedish Hernia Register. Response rate was 82.4% (952/1,155). The primary outcome was chronic pain in the operated groin at follow-up. Grading of pain was performed using the Inguinal Pain Questionnaire. A total of 170 patients (17.9%) reported groin pain and 29 patients (3.0%) reported severe groin pain. The risk for developing chronic groin pain was greater in patients with severe pain in the preoperative or immediate postoperative period (odds ratio 2.09; 95% confidence interval 1.28-3.41). Risk for chronic pain decreased for every 1-year increase in age at the time of operation (odds ratio 0.99, 95% confidence interval 0.98-1.00). Both preoperative pain and pain in the immediate postoperative period are strong risk factors for chronic groin pain. Risk factor patterns should be considered before operative repair of presumed symptomatic inguinal hernias. The problem of postoperative pain must be addressed regarding both pre-emptive and postoperative analgesia.

Obturator Neuralgia: Complete Resolution after Laparoscopic Retropubic Sling Removal: A Report of 2 Cases

Background: Groin pain has been reported more frequently with transobturator mesh tape slings (TOT) compared to retropubic mesh tape slings (RP) secondary to the position of the mesh in the groin relative to the obturator nerve. However, if the mesh of a RP sling is placed on or near the region of the obturator neurovascular bundle in the retropubic space, the potential for similar groin pain does exist. Cases: We report two cases of severe leg and groin pain following the placement of a RP mesh tape sling. Two premenopausal women suffered groin pain after RP sling insertion. The RP slings were successfully removed by a combined laparoscopic and vaginal approach and both patients’ pain resolved. Conclusion: Laparoscopic RP sling removal from the retropubic space is safe and should be consider in patient who has obturator neuralgia after RP sling insertion.

Validated prediction model for severe groin wound infection after lower extremity revascularization procedures

Groin wound infection is a costly and morbid event after lower extremity revascularization. To date, a comprehensive and validated method for identifying patients who are at greatest risk for this complication has yet to be developed. Our retrospective analysis included all patients at a single institution who underwent lower extremity revascularization using a groin incision from 2009 through 2012. Patients were randomly assigned to one of two groups: a test group, which was used to develop a predictive model for our primary outcome; and a validation group, which was used to test that model. The primary outcome for our analysis was severe groin wound infection, which we defined as postoperative groin infection that required operative intervention. Multimodel inference methods were used to evaluate all possible combinations, interactions, and transformations of potential predictor variables from the test group of patients. The resulting model that exhibited the lowest Akaike information criterion was then selected for testing with the validation group of patients. A total of 284 patients who underwent lower extremity revascularization procedures were included in our study (140 in the test group, 144 in the validation group). In the test group, 17 patients (12.1%) developed severe groin wound infection requiring operative intervention. The best-fit predictive model developed from this group identified the following independent risk factors for severe groin wound infection: prior ipsilateral groin incision, female gender, body mass index, end-stage renal disease, malnutrition, and urgent or emergency procedure status. The correct classification rate of this model in the test group was 88.6%. The incidence of severe groin wound infection in the validation group was 13.9%, and application of our predictive model to this group yielded a correct classification rate of 86.1%. We have developed and validated a statistical model that accurately predicts those patients who are likely to sustain severe groin wound infection after lower extremity revascularization.

Groin Injury in a Collegiate Football Athlete

HISTORY: A 19-year-old Division 1 Collegiate football player presented to the Emergency Department four days following injury to his right groin during football practice. He complained of severe right groin pain accompanied by fatigue, fevers, nausea, and diarrhea. He was admitted to the hospital for pain control and MRI evaluation of psoas injury. On hospital day 1 he developed oliguria with acute kidney injury and rhabdomyolysis. Within hours he became febrile, tachypnic, and tachycardic and was transferred to the medical intensive care unit for sepsis and acute kidney injury. PHYSICAL EXAMINATION: T 101.3, HR 134, RR 40, BP 105/53 Ill-appearing male in moderate respiratory distress. Cardiovascular: Tachycardic with regular rhythm, new systolic murmur, grade 2/6 at the left upper sternal border, distal pulses 2+ and equal bilaterally. Respiratory: Tachypneic, clear to auscultation bilaterally. Abdomen: soft, tender to palpation right lower quadrant, no guarding or rebound. Extremities: No obvious deformities, significant pain with extension of right hip and knee. Skin: flushed. Neuro: alert and oriented to person, place, and time. DIFFERENTIAL DIAGNOSIS: Right psoas abscess Pyomyositis Appendicitis TEST AND RESULTS: Laboratory studies: Creatinine2.8 CPK1530 Procalcitonin57 Lactic acid3.1 CT Abd/Pelvis: Right iliopsoas muscle injury Possible acute avulsion fracture Soft tissue stranding suggestive of possible superinfection Normal appendix MRI: 14.2 x 5.7 x 5.3 cm abscess located in the right iliopsoas and distal myotendinous junction FINAL WORKING DIAGNOSIS: Myonecrosis of the right iliopsoas TREATMENT AND OUTCOMES: 1. Anterior thigh incision and debridement of necrotic right iliopsoas muscle with delayed primary closure 2. Targeted antibiotic therapy 3. Rehabilitation started 6 weeks post-injury 4. Returned to sport without limitation four months post-injury

Microendoscopic Excision of Osteoid Osteoma in the Pedicle of the Third Lumbar Vertebra.

We present a rare case of a patient who underwent complete microendoscopic excision of an osteoid osteoma, which induced radiculopathy without nerve root compression. A 20-year-old man presented severe right groin pain that was temporarily relieved by nonsteroidal anti-inflammatory drugs. A computed tomography (CT) scan showed typical features of a nidus located in the inferior cortex of the right L3 pedicle. We performed surgery using a posterior microendoscopic approach. We drilled vertically along the line of the cortex of the caudal pedicle using a high-speed drill. After identifying the tumor, en bloc resection of the nidus was achieved. Immediately after surgery, pain in the right groin disappeared. A CT scan showed that most of the right L3 pedicle remained. This minimally invasive technique preserves spinal structures, including the facet and pedicle, and is a viable option for the treatment of spinal osteoid osteomas located close to vital structures.

Incarcerated appendix within femoral hernia

Summary De Garengeot's hernia is a rare condition that involves acute appendicitis of an incarcerated femoral hernia. We report a 74-year-old female patient who presented with severe and painful right groin swelling. An incarcerated appendix within the femoral hernia was discovered.

Pedicled anterior lateral thigh flap in managing a bilateral groin contracture.

A fifteen-year-old female patient presented with a severe bilateral groin contracture for the last 8 years. She had sustained burns at the age of seven years. Three attempts to release the contracture with split thickness skin grafts had been done without success. A pedicled anterior lateral thigh flap was raised and advanced into the defect after the contracture had been released. Postoperatively the patient healed well without any complications and was able to achieve hip abduction of about 130 degrees.

A radical procedure of circumferential spinal cord decompression through a modified posterior approach for thoracic myelopathy caused by severely impinging anterior ossification

Background contextThoracic myelopathy caused by an anterior, massive ossified plaque is often progressive and responds poorly to conservative treatment. Direct removal of the compressing ossification is the optimal procedure for a spinal cord that is severely impinged anteriorly. However, both anterior and posterior decompressive manipulations have caused catastrophic iatrogenic spinal cord injuries. A comprehensive treatment method for severe thoracic myelopathy that enables a sufficient and safe decompression of the spinal cord is needed. PurposeThe purpose of this study is to demonstrate the efficacy, safety, and results of a one-stage circumferential decompressive procedure using a modified posterior approach in patients with severe thoracic myelopathy resulting from anterior spinal compression. Study designA modified procedure of circumferential spinal cord decompression for thoracic myelopathy is described. A retrospective study was conducted to investigate the clinical outcomes of 23 sequentially treated patients. Patient sampleTwenty-three patients were treated sequentially with a modified procedure for circumferential spinal cord decompression for thoracic myelopathy. Outcome measuresOutcomes were assessed using the Japanese Orthopedic Association (JOA) score, modified Frankel classification, Hirabayashi recovery rate, and a general assessment of complications. MethodsTwenty-three patients with thoracic myelopathy caused by a massive, anterior ossified structure were treated with an extensive posterior laminectomy, anterior removal of the ossification, and interbody fusion with kyphosis-reversing stabilization through a modified posterolateral approach. The neurologic outcomes are evaluated according to the JOA and the modified Frankel classification before surgery, 2 weeks after surgery, 1 year after surgery, and at the final follow-up visit. The surgical outcomes are also described using the Hirabayashi recovery rate. Radiographs, computed tomography (CT), and magnetic resonance imaging were performed before and after surgery. A postoperative CT scan was obtained to determine the efficacy of the decompression. Operative time, intraoperative blood loss, and complications were reviewed from the medical records. In addition, a 48-year-old man who presented with severe thoracic myelopathy resulting from anterior impingement with multiple osteophytes is described as an illustrative patient. ResultsThe sites of ossification in this series were distributed widely, from T4–T12. The anterior ossified plaques of all patients were resected completely. Five patients who had intraoperative evidence of dural ossification required resection of the ossified dura matter. The average operating time was 276 minutes. Mean intraoperative blood loss was 1,350 mL. The postoperative follow-up ranged from 2.5 to 6 years, with an average of 4.6 years. The average preoperative JOA score was 4.3±1.5 points, and it improved to 6.1±1.9 points 2 weeks postoperatively, to 8.1±1.8 points 1 year postoperatively, and to 8.5±1.9 points at the most recent follow-up. The overall Hirabayashi recovery rate at the final examination averaged 63.6±22.4%. Eight patients were graded as excellent, 10 as good, 4 as fair, and 1 as unchanged. No patient was graded as deteriorated. The paralysis improved by at least 1 grade in 22 patients (95.7%). Transient deterioration of thoracic myelopathy occurred immediately after surgery in three patients (13%). Cerebrospinal fluid leakage occurred in six patients (26.1%). One patient sustained severe bilateral groin pain, three had unilateral intercostal neuralgia, and pleura tear occurred in one patient. ConclusionOne-stage posterior decompression, anterior extirpation of the ossification, and interbody fusion with instrumentation via a modified posterior approach is a safe and effective treatment for severe thoracic myelopathy resulting from prominent anterior impingement. This procedure is technically demanding, and the indications are limited to thoracic myelopathy caused by severe anterior impingement of various etiologies from T4–T12.

Chronic common femoral vein occlusion secondary to endometriosis.

Venous occlusion is sometimes caused by external compression due to adjacent masses. Endometriosis, the presence of functioning endometrial tissue outside the uterine cavity, is a rare cause of venous occlusion. We report a case of chronic common femoral vein occlusion due to endometrioma causing severe leg edema and groin pain that was treated with resection and venous bypass.

Safety of full-dose intravenous recombinant tissue plasminogen activator followed by multimodal endovascular therapy for acute ischemic stroke

Background and purposeThe optimal management of stroke patients who fail treatment with intravenous recombinant tissue plasminogen activator (rt-PA) remains unknown. A study was undertaken to establish whether treatment with a...

Differential diagnosis and early management of rapidly progressing hip pain in a 59-year-old male

Objective and importanceRapidly progressing degeneration of the hip joint is an uncommon condition presenting to physical therapy. Differential diagnosis can often be difficult, as clinical and radiographic findings do not always coincide leaving clinicians with difficult decision making regarding course of treatment. The purpose of this case report was to describe the differential diagnosis and early management of a patient with rapidly progressing hip pain.Clinical presentationA 59-year-old male with a complicated medical history was referred with a diagnosis of severe bilateral hip osteoarthritis. Clinical presentation of insidious onset, severe bilateral groin and anterior thigh pain with rapid progression of functional decline lead to the differential diagnosis of bilateral avascular necrosis.InterventionThe patient received seven manual physical therapy sessions over the course of one month.ConclusionDuring this time, the patient’s Lower Extremity Functional Scale score worsened from 33 to 21. The persistence of the patient’s painful symptoms and continued functional decline helped determine cessation of manual therapy and referral back to his GP for further diagnostic testing and eventual correct diagnosis. This case highlights the importance of monitoring patient prognosis using outcome measures leading to a change in patient management strategies.

Determination of efficacy of novel modified chitosan sponge dressing in a lethal arterial injury model in swine

Chitosan is a functional biopolymer that has been widely used as a hemostat. Recently, its efficacy has been questioned due to clinical failures as a result of poor adhesiveness. The purpose of this study was to compare, in a severe groin injury model in swine, the hemostatic properties of an unmodified standard chitosan sponge with standard gauze dressing and a novel hydrophobically modified (hm) chitosan sponge. Previous studies have demonstrated that hm-chitosan provides greatly enhanced cellular adhesion and hemostatic effect via noncovalent insertion of hydrophobic pendant groups into cell membranes. Twenty-four Yorkshire swine were randomized to receive hm-chitosan (n = 8), unmodified chitosan (n = 8), or standard Accu-Sorb gauze dressing (n = 8) for hemostatic control. A complex groin injury involving arterial puncture (4.4-mm punch) of the femoral artery was made after splenectomy. After 30 seconds of uncontrolled hemorrhage, the randomized dressing was applied and compression was held for 3 minutes. Fluid resuscitation was initiated to achieve and maintain the baseline mean arterial pressure and the wound was inspected for bleeding. Failure of hemostasis was defined as pooling of blood outside the wound. Animals were then monitored for 180 minutes and surviving animals were killed. Blood loss before treatment was similar between groups (p < 0.1). Compared with the hm-chitosan sponge group, which had no failures, the unmodified chitosan sponge group and the standard gauze group each had eight failures over the 180-minute observation period. For the unmodified chitosan sponge failures, six of which provided initial hemostasis, secondary rebleeding was observed 44 minutes ± 28 minutes after application. Standard gauze provided no initial hemostasis after the 3-minute compression interval. Hm-chitosan is superior to unmodified chitosan sponges (p < 0.001) or standard gauze for controlling bleeding from a lethal arterial injury. The hm-chitosan technology may provide an advantage over native chitosan-based dressings for control of active hemorrhage.