Preparation, characterization, antibacterial properties, and hemostatic evaluation of ibuprofen-loaded chitosan/gelatin composite films

MXene-NH2/chitosan hemostatic sponges for rapid wound healing

Effective control of wound bleeding and sustained promotion of wound healing remain a major challenge for hemostatic materials. In this study, the hemostatic sponge with controllable antibacterial and adjustable continuous promotion of wound healing (CMNCu) was prepared by chitosan, aminated MXene and copper ion. Interestingly, the internal topological point-line-surface interaction endowed the CMN-Cu sponge longitudinal staggered tubular porous microstructure, combined with the lipophilic properties obtained by modified MXene, which greatly improved its flexibility, wet elasticity and blood enrichment capacity. In addition, the sponge achieved controlled release of active ingredients, which made it present highly effective antibacterial activity and long-lasting ability to promote wound healing. In vitro and in vivo experiments confirmed that CMN-Cu sponge presented high-efficient hemostatic performance. Last but not least, a series of cell experiments showed that the CMN-Cu sponge had excellent safety as a hemostatic material.

Hydrophobically modified hydrogel with enhanced tissue adhesion and antibacterial capacity for wound healing

The increasing emergence of drug-resistant bacteria and bacteria-infected wounds highlights the urgent need for new kinds of antibacterial wound dressing. Herein, we reported a novel bio-adhesive and antibacterial hydrogel consisting of hydrophobically modified gelatin, oxidized konjac glucomannan, and dopamine. This kind of functional hydrogel was endowed with developed stability in a liquid environment and strong tissue adhesion, even much higher than the commercial fibrin glue to wounds. The excellent bacteria-killing efficiency of hydrophobically modified hydrogel against S. aureus and E. coli was verified, as well as the low hemolysis ratio against erythrocytes in vitro. The hydrogel also exhibited good cytocompatibility in terms of supporting cell proliferation. Most importantly, these abovementioned properties could be customized by altering the substitution degree of hydrophobic groups during manufacturing, demonstrating its great potential in biomedical fields such as tissue adhesive and wound dressing.

A bacteriostatic hemostatic dressing prepared from l-glutamine-modified chitosan, tannic acid-modified gelatin and oxidized dextran

In this study, porous hemostatic sponges (CGS1, CGS2 and CGS3) with proper absorption (38-43×) and air permeability (2214 g/m²·day) were prepared from l-glutamine-modified chitosan (CG), tannic acid-modified gelatin (GTA), and oxidized dextran (ODEX) by Schiff base crosslinking reaction. Among them, CGS2 was proved to have high porosity (88.98 %), durable water retention (>6 h), strong antibacterial activity, proper mechanical quality, and suitable tissue adhesion. In addition, CGS2 had good biocompatibility, mainly manifested in low hemolysis rate (<0.4 %), low cytotoxicity (relative cell activity>90 %), and good biodegradability in vitro. The hemostatic time and blood loss in CGS2 group were much lower than those in commercial gelatin sponge group in three animal injury models. Moreover, the activated partial thromboplastin time (APTT) and the prothrombin time (PT) results indicated that CGS2 promoted coagulation by activating the endogenous coagulation pathway. These results suggested that CGS2 had great potential for rapid hemostasis and avoidance of wound infection.

A kaolin/calcium incorporated shape memory and antimicrobial chitosan-dextran based cryogel as an efficient haemostatic dressing for uncontrolled hemorrhagic wounds

Increased mortalities associated with uncontrolled and excessive bleeding is still of paramount concern in the clinics, caregivers and military medics. Herein, we designed a shape memory cryogel based on chitosan (C) and functionalized-dextran (D), incorporated with Kaolin (K) and calcium (Ca²⁺) as haemostatic agents. The developed cryogel (CDKCa) exhibits a uniform interconnected porous architecture with profound fluid absorption ability, rapid blood clotting, stable clot formation and good antibacterial activity. The CDKCa elucidates significantly less clotting time (~30 s; in-vitro) and increased aggregation and activation of platelets/red blood cells in comparison to the control groups and commercial dressings (Axiostat and QuikClot). The developed CDKCa also significantly reduced the aPTT and PT values by ~58 % and 31 % respectively, leading to the activation of intrinsic and extrinsic coagulation cascades. The CDKCa cryogel displays enhanced mechanical stability, flexibility and a good shape memory, a property quintessential to cease uncontrolled bleeding in irregular and non-compressible wounds. Further, the Kaolin and Ca²⁺ incorporated shape memory CDKCa cryogel demonstrates a rapid blood coagulation and stable clot formation in different compressible and non-compressible rat liver and femur hemorrhagic models. In summary, the endorsed results of CDKCa suggest that the design, fabrication and excellent clotting ability may attribute to high haemostatic efficiency of CDKCa dressing and have a great potential to prevent uncontrollable hemorrhages.

Recent advances in biomimetic hemostatic materials

Although the past decade has witnessed unprecedented medical advances, achieving rapid and effective hemostasis remains challenging. Uncontrolled bleeding and wound infections continue to plague healthcare providers, increasing the risk of death. Various types of hemostatic materials are nowadays used during clinical practice but have many limitations, including poor biocompatibility, toxicity and biodegradability. Recently, there has been a burgeoning interest in organisms that stick to objects or produce sticky substances. Indeed, applying biological adhesion properties to hemostatic materials remains an interesting approach. This paper reviews the biological behavior, bionics, and mechanisms related to hemostasis. Furthermore, this paper covers the benefits, challenges and prospects of biomimetic hemostatic materials.

Recent advances in biopolymer-based hemostatic materials

Hemorrhage is the leading cause of trauma-related deaths, in hospital and pre-hospital settings. Hemostasis is a complex mechanism that involves a cascade of clotting factors and proteins that result in the formation of a strong clot. In certain surgical and emergency situations, hemostatic agents are needed to achieve faster blood coagulation to prevent the patient from experiencing a severe hemorrhagic shock. Therefore, it is critical to consider appropriate materials and designs for hemostatic agents. Many materials have been fabricated as hemostatic agents, including synthetic and naturally derived polymers. However, compared to synthetic polymers, natural polymers or biopolymers, which include polysaccharides and polypeptides, have greater biocompatibility, biodegradability, and processibility. Thus, in this review, we focus on biopolymer-based hemostatic agents of different forms, such as powder, particles, sponges, and hydrogels. Finally, we discuss biopolymer-based hemostats currently in clinical trials and offer insight into next-generation hemostats for clinical translation.

Nano‐silica/chitosan composite coatings on biodegradable magnesium alloys for enhanced corrosion resistance in simulated body fluid

Chitosan (CTS) coatings have been studied as a biocompatible coating on biodegradable magnesium (Mg) alloys to improve the corrosion resistance and bioactivity for medical implants. However, the loose structure of the CTS coating cannot provide ideal long‐time corrosion resistance in the physiological environment. In this study, a nano‐SiO2/CTS composite coating was applied on an Mg alloy substrate using the sol–gel method. The surface characteristics of the samples were examined by Fourier‐transform infrared analysis, X‐ray diffraction, scanning electron microscopy‐energy‐dispersive spectrometry, and contact angle measurements. The particle size and suitable dispersion of the SiO2 nanoparticles inside the composite coating were confirmed by transmission electron microscopy. Further, the corrosion protection behavior of the coatings was examined in a simulated body fluid using potentiodynamic polarization, electrochemical impedance spectroscopy, and scanning electrochemical microscopy analyses. Atomic force microscopy was used to determine the surface morphologies of the samples after the polarization test. The surface characteristics, electrochemical measurements, and immersion test revealed that the SiO2 nanoparticles effectively filled the voids of the CTS coating and significantly improved the corrosion resistance. The optimal concentration of nano‐SiO2 is 1.0 g/L.

Preparation and characterization of 3D printed bone scaffold for ibuprofen delivery

In this work, a blend of gelatin A (GA) and polyvinylpyrrolidone (PVP K30) was used for semi-solid 3D printing of bone scaffold for ibuprofen (IBU) delivery. The cross-linking of the obtained scaffold was performed with a 1% glutaraldehyde (GTA) solution, followed by lyophilization. The thermal and mechanical properties, as well as drug release profiles, and drug kinetics of prepared scaffolds were investigated. The cross-linked and lyophilized scaffold has shown good thermal stability, mechanical properties, and prolonged release of IBU following the Fickian diffusion process.

Epinephrine-entrapped chitosan nanoparticles covered by gelatin nanofibers: A bi-layer nano-biomaterial for rapid hemostasis

Uncontrolled hemorrhage accounts for significant death risk both in trauma and surgery. Various bleeding control techniques have been emerged to augment hemostasis, which still has several limitations and drawbacks. In this study, epinephrine-entrapped chitosan nanoparticles were electrosprayed on a base pad and covered by a gelatin nanofiber layer (E-CS-Gl. Physico-chemical characteristics, hemocompatibility, cytotoxicity, and blood coagulation tests were studied in-vitro, and blood coagulation and hemostasis potential tests were performed in-vivo. The in-vitro results showed that the prepared nano-biomaterial is cytocompatible against HuGu cells. Also, hemocompatibility studies showed that PT and aPTT times did not change in comparison with the controls. Further blood coagulation study indicated that E-CS-Gl provides an ultimate interface to induce red blood cell absorption and aggregation, resulting in augmented blood coagulation. E-CS-Gl also caused rapid clotting in rat models of ruptured femoral artery and liver compared to controls. Findings exhibited that E-CS-Gl is a safe and effective hemostatic agent and provides a new approach for fast and safe hemorrhage control.

Hemostatic materials in wound care

Blood plays an essential role in the human body. Hemorrhage is a critical cause of both military and civilian casualties. The human body has its own hemostatic mechanism that involves complex processes and has limited capacity. However, in emergency situations such as battlefields and hospitals, when the hemostatic mechanism of the human body itself cannot stop bleeding effectively, hemostatic materials are needed for saving lives. In this review, the hemostatic mechanisms and performance of the most commonly used hemostatic materials, (including fibrin, collagen, zeolite, gelatin, alginate, chitosan, cellulose and cyanoacrylate) and the commercial wound dressings based on these materials, will be discussed. These materials may have limitations, such as poor tissue adhesion, risk of infection and exothermic reactions, that may lessen their hemostatic efficacy and cause secondary injuries. High-performance hemostatic materials, therefore, have been designed and developed to improve hemostatic efficiency in clinical use. In this review, hemostatic materials with advanced performances, such as antibacterial capacity, superhydrophobicity/superhydrophilicity, superelasticity, high porosity and/or biomimicry, will be introduced. Future prospects of hemostatic materials will also be discussed in this review.

Multi-Functional Core-Shell Nanofibers for Wound Healing

Core-shell nanofibers have great potential for bio-medical applications such as wound healing dressings where multiple drugs and growth factors are expected to be delivered at different healing phases. Compared to monoaxial nanofibers, core-shell nanofibers can control the drug release profile easier, providing sustainable and effective drugs and growth factors for wound healing. However, it is challenging to produce core-shell structured nanofibers with a high production rate at low energy consumption. Co-axial centrifugal spinning is an alternative method to address the above limitations to produce core-shell nanofibers effectively. In this study, a co-axial centrifugal spinning device was designed and assembled to produce core-shell nanofibers for controlling the release rate of ibuprofen and hEGF in inflammation and proliferation phases during the wound healing process. Core-shell structured nanofibers were confirmed by TEM. This work demonstrated that the co-axial centrifugal spinning is a high productivity process that can produce materials with a 3D environment mimicking natural tissue scaffold, and the specific drug can be loaded into different layers to control the drug release rate to improve the drug efficiency and promote wound healing.

Physico-mechanical and biological evaluation of an injectable m-TG cross-linked thrombin loaded amended gelatin hemostat to heal liver trauma

Free flow hemostatic agents are dominating over non-flowable hemostats due to their ability to cover asymmetrical wound surfaces of any depth and easily remove excess materials with irrigation. The objective of this study was to evaluate the activation of a coagulation system both in vitro and in vivo. We assessed detailed physical characteristics of a microbial transglutaminase (m-TG) crosslinked thrombin (TB) laden Gelatin (Gel) hemostat sealant in vitro and its hemostatic efficacy for controlling bleeding caused by liver trauma in rats as well as its efficacy for organ regeneration after making a critical defect. The prepared hemostat gel showed almost seven times higher absorbance behavior than a negative control. Thrombogenicity of the prepared gel was determined based on platelet adhesion, whole blood clotting time, and total blood absorption behavior. In vivo blood absorption and hematological parameters were determined in an animal model after implantation. The prepared gel was able to lead to a fast post-operative recovery with a blood absorption at wound defect. High speed of homeostasis was achieved by a fast clotting time in about 1 min.

Antibiotic-Loaded Psyllium Husk Hemicellulose and Gelatin-Based Polymeric Films for Wound Dressing Application

Wound infections are one of the major reasons for the delay in the healing of chronic wounds and can be overcome by developing effective wound dressings capable of absorbing exudate, providing local antibiotic release, and improving patient comfort. Arabinoxylan (AX) is a major hemicellulose present in psyllium seed husk (PSH) and exhibits promising characteristics for developing film dressings. Herein, AX-gelatin (GL) films were prepared by blending AX, gelatin (GL), glycerol, and gentamicin (antibiotic). Initially, the optimal quantities of AX, GL, and glycerol for preparing transparent, bubble-free, smooth, and foldable AX-GL films were found. Physiochemical, thermal, morphological, drug release, and antibacterial characteristics of the AX-GL films were evaluated to investigate their suitability as wound dressings. The findings suggested that the mechanical, water vapor transmission, morphological, and expansion characteristics of the optimized AX-GL films were within the required range for wound dressing. The results of Fourier-transform infrared (FTIR) analyses suggested chemical compatibility among the ingredients of the films. In in vitro drug release and antibacterial activity experiments, gentamicin (GM)-loaded AX-GL films released approximately 89% of the GM in 24 h and exhibited better antibacterial activity than standard GM solution. These results suggest that AX-GL films could serve as a promising dressing to protect against wound infections.

Blood-clotting model and simulation analysis of polyvinyl alcohol-chitosan composite hemostatic materials

The blood-clotting performance and characteristics of hemostatic materials are critical for their development and actual application. Based on the theory of porous media and characteristics of a non-Newtonian fluid, this study proposed an adsorption factor to characterize the porosity generation and blood coagulation process of hemostatic materials. On this basis, we constructed a physical model of blood coagulation in a porous medium integrated with the power-law fluid model to study the proposed poly(vinyl alcohol)-chitosan (PVA-CS) composite hemostatic material. Moreover, we simulated the dynamic blood flow process and blood coagulation process in the PVA-CS hemostatic material by introducing the physical model. The simulation results show that the blood begins to coagulate, which affects the porosity and permeability of the blood-containing area, resulting in changing the porosity after blood flowed into the hemostatic material. The porosity, permeability, and blood flow rate will approach zero until the generated blood coagulation entirely blocked the porous medium. Besides, simulation can provide the pressure and velocity distribution varying in the coagulation process of hemostatic materials. The temperature will also influence the hemostatic performance of the PVA-CS material. In all, the proposed simulation method enabled the coagulation mechanism of PVA-CS to be revealed from the perspective of blood flow in porous media combined with the adsorption factor.

A glimpse on the function of chitosan as a dental hemostatic agent

Managing a bleeding patient can be a challenge during dental surgery. Profuse hemorrhage due to platelet defects, coagulation disorders, vascular anomalies, medication-induced patients, as well as inherited bleeding ailments result in soft tissue hematoma, septic shock, compromised airway, and in some severe cases, death could occur. A vast array of surgical hemostatic agents are available to stop bleeding, including chitosan-based hemostatic agents. Chitosan has an advantage over other topical hemostatic materials for its ability to promote shorter bleeding times and assist in healing. Massive behind-the-scene research and development efforts are ongoing to increase the performance of chitosan as a hemostatic agent. Numerous studies on chitosan use in dental hemostasis have registered it as being safe, biodegradable, biocompatible, promoting healing, antimicrobial and bioactive. This article reviews the application of chitosan in managing hemostasis in dental patients.

Injectable, self-healing, antibacterial, and hemostatic N,O-carboxymethyl chitosan/oxidized chondroitin sulfate composite hydrogel for wound dressing

Biodegradable and injectable hydrogels derived from natural polysaccharides have attracted extensive attention in biomedical applications due to their minimal invasiveness and ability to accommodate the irregular wound surfaces. In this work, we report the development of an in-situ-injectable, self-healing, antibacterial, hemostatic, and biocompatible hydrogel derived from the hybrid of N,O-carboxymethyl chitosan (N,O-CMC) and oxidized chondroitin sulfate (OCS), which did not require any chemical crosslinking. The N,O-CMC/OCS hydrogel could be readily produced under physiological conditions by varying the N,O-CMC-to-OCS ratio, relying on the Schiff base reaction between the -NH- functional groups of N,O-CMC and the -CHO functional groups of OCS. The results showed that the N,O-CMC2/OCS1 hydrogel had relatively long gelation time (133 s) and stable performances. The viability of NIH/3T3 cells and endothelial cells cultured with the N,O-CMC2/OCS1 hydrogel extract was roughly 85%, which demonstrated its low cell toxicity. Besides, the N,O-CMC2/OCS1 hydrogel revealed excellent antibacterial properties due to the inherent antibacterial ability of N,O-CMC. Importantly, the hydrogel tightly adhered to the biological tissue and demonstrated excellent in vivo hemostatic performance. Our work describing an injectable, self-healing, antibacterial, and hemostatic hydrogel derived from polysaccharides will likely hold good potential in serving as an enabling wound dressing material.

High Efficiency Fabrication of Chitosan Composite Nanofibers with Uniform Morphology via Centrifugal Spinning

While electrospinning has been widely employed to spin nanofibers, its low production rate has limited its potential for industrial applications. Comparing with electrospinning, centrifugal spinning technology is a prospective method to fabricate nanofibers with high productivity. In the current study, key parameters of the centrifugal spinning system, including concentration, rotational speed, nozzle diameter and nozzle length, were studied to control fiber diameter. An empirical model was established to determine the final diameters of nanofibers via controlling various parameters of the centrifugal spinning process. The empirical model was validated via fabrication of carboxylated chitosan (CCS) and polyethylene oxide (PEO) composite nanofibers. DSC and TGA illustrated that the thermal properties of CCS/PEO nanofibers were stable, while FTIR-ATR indicated that the chemical structures of CCS and PEO were unchanged during composite fabrication. The empirical model could provide an insight into the fabrication of nanofibers with desired uniform diameters as potential biomedical materials. This study demonstrated that centrifugal spinning could be an alternative method for the fabrication of uniform nanofibers with high yield.

Polyelectrolyte vs Polyampholyte Behavior of Composite Chitosan/Gelatin Films

Composite films of proteins and polysaccharides have a broad range of biomedical and food packaging applications, in which they are frequently exposed to fluid environments with varying ionic strengths. In the present work, we report the behavior of biopolymer films derived from chitosan (Ch), gelatin (GEL), and Ch/GEL mixture in salt solutions with varying concentrations and ion charges. The swelling and dissolution of the Ch films reduced with increasing salt concentration due to the polyelectrolyte behavior of this biopolymer, while the GEL films displayed a polyampholyte behavior, in which film swelling and dissolution were enhanced in salt solutions. Composite Ch/GEL films followed the behavior of GEL. The release of small ionic and zwitter-ionic molecules from the films was enhanced in ionic solutions due to the screened attraction between these molecules and the polymer matrix. These results provide insight into the behavior of protein/polysaccharide films in varying ionic environments, thus enabling enhanced design of biomaterials for a broad range of applications.

Polyvinylpyrrolidone/cellulose acetate electrospun composite nanofibres loaded by glycerine and garlic extract with in vitro antibacterial activity and release behaviour test

The antibacterial activity of garlic (Allium sativum) is believed to be due to its organosulfur compounds, which can supposedly be used further in biomedical applications. This paper reported the use of electrospinning to encapsulate a garlic extract and glycerine in nanofibrous mats. Polyvinylpyrrolidone (PVP) and cellulose acetate (CA) were the building blocks of the composite fibres that served as the hydrophilic matrix to encapsulate the garlic extract with glycerine added mainly to improve the mechanical characteristics of the composite fibres. The combinations of the fibres were PVP/CA, PVP/CA/garlic, PVP/CA/glycerine, and PVP/CA/glycerine/garlic. The characterizations included the morphology, chemical interaction, swelling degree, weight loss, acidity level, wettability, in vitro antibacterial test, and release behaviour test. The composite nanofibrous mats were uniform, bead-free with a size ranging from 350 nm to 900 nm. The Fourier-transform infrared spectra proved the presence of the garlic extract and glycerine in the fibres. The swelling degree test showed that the fibrous mats generally did have maximum swelling degrees above 100% except for the PVP/CA fibrous mat, whose maximum value was not achieved within 48 hours. The fibrous mat with glycerine showed generally larger weight loss compared to the fibrous mats without glycerine. The result of the contact angle measurement proved that the composite fibres are all hydrophilic with the PVP/CA/glycerine/garlic fibres being the least hydrophilic. The pH level of the fibre mats was from 3.7 to 4.0 due to the use of acetic acid. The Young's modulus and ultimate tensile strength of the mats were significantly reduced due to the presence of glycerine. The encapsulation of the garlic extract in the fibres did not eliminate the antibacterial activity of the garlic extract, as proven in the in vitro antibacterial test. The release of the garlic extract from the composite PVP/CA/glycerine/garlic fibres was found to be the largest due to the large diameter of the fibres, while the blend of PVP with CA successfully reduced the rate of release due to the insolubility of CA. We successfully encapsulated the garlic extract and glycerine in the PVP/CA nanofibrous mats with antibacterial activity.

The in-depth analysis of the characteristics of garlic-loaded nanofibers mats.

Investigation of the Effects of Molecular Parameters on the Hemostatic Properties of Chitosan

Hemorrhea is one of the major problems in war, trauma care, and surgical operation that threaten the life of the injured and patients. As a novel polymeric hemostatic agent, biodegradable chitosan can stop bleeding through a variety of approaches. In this paper, chitosan with various molecular parameters was prepared from chitin as raw material through deacetylation, oxidative degradation, hydrophilic modification, and salt formation reactions. The influence of different polymer parameters on the hemostatic effects of chitosan was investigated by in vitro coagulation time and dynamic coagulation assay. The results showed that when the molecular weights were high (10⁵⁻10⁶) and approximate, the coagulation effect of chitosan improved with a decrease of the deacetylation degree and achieved a prominent level in a moderate degree of deacetylation (68.36%). With the same degree of deacetylation, the higher the molecular weight of chitosan, the better the procoagulant effect. The substituent derivatives and acid salts of chitosan showed significant procoagulant effects, especially the acid salts of chitosan. In addition, the hemostasis mechanism of chitosan with various parameters was preliminarily explored by analyzing the plasma recalcification time (PRT). The efforts in this paper laid a basis for further study of the structure⁻activity relationship and the mechanism of chitosan hemostasis.

Injectable negatively charged gelatin microsphere-based gels as hemostatic agents for intracavitary and deep wound bleeding in surgery

Gelatin, as natural macromolecular material, has been used in biomedical fields widely. In this study, various injectable gelatins A, B, and their compound AB microsphere-based gels (A-GMGs, B-GMGs and AB-GMGs) were prepared through water-in-oil emulsion method for hemostasis, and the effects of blood coagulation in vitro and surgical hemostasis (a deep liver wound model) in vivo were evaluated. Furthermore, the influences of gelatin sorts, the size of microsphere, zeta potential (ZP) and viscoelastic properties on hemostasis were also assessed. Results showed that the gelatin microspheres (GMs) exhibited smooth surface, good sphericity and the particle size of a rough normal distribution. GMs carried negative charges and their electronegativity was stronger than that of gelatin A (GA) and gelatin B (GB) raw materials. Rheological analysis showed that a decreasing particle size of the microspheres led to stronger gel strength, and solid-like gels were exhibited under low stress conditions and liquid-like gels were exhibited under high stress conditions. The blood clotting time of B-GMGs was within 60 s, which exhibited a significantly higher blood clotting effect compared with control groups. The hemostasis assay in vivo showed that the gels had better hemostatic effect on a deep liver wound bleeding model compared with control groups, especially B-GMGs. However, in vivo and vitro hemostatic experiments, particle size of GMs had no obvious influence on the hemostatic effect of the gels. In addition, the CCK-8 assay of bone marrow mesenchymal stem cells of murine (mMSCs) indicated non-cytotoxicity of GMs for cells. These results demonstrated that the gelatin microsphere-based gels (GMGs) had potential to be an effective hemostatic material for intracavitary and deep wound bleeding in surgery.

Chitosan-Based Composite Materials for Prospective Hemostatic Applications

Effective hemostasis is vital to reduce the pain and mortality of patients, and the research and development of hemostatic materials are prerequisite for effective hemostasis. Chitosan (CS), with good biodegradability, biocompatibility and non-toxicity, has been widely applied in bio-medicine, the chemical industry, the food industry and cosmetics. The excellent hemostatic properties of CS have been extensively studied. As a result, chitosan-based composite hemostatic materials have been emerging. In this review, the hemostatic mechanism of chitosan is briefly discussed, and then the progress of research on chitosan-based composite hemostatic materials with multiple forms such as films, sponges, hydrogels, particles and fibers are introduced. Finally, future perspectives of chitosan-based composite hemostatic materials are given. The objective of this review is to provide a reference for further research and development of effective hemostatic materials.

Design and development of polysaccharide hemostatic materials and their hemostatic mechanism

The formation of stable blood clots or hemostasis is essential to prevent major blood loss and death from excessive bleeding.