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Oflaz Çapar A, Solguntekin E, Kökoğlu K, Şahin MI. An evaluation of the effect of the use of platelet-rich fibrin on tonsillectomy results. Adv Med Sci 2024; 69:428-433. [PMID: 39299368 DOI: 10.1016/j.advms.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/20/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE The aim of this study was to investigate the effect of liquid platelet-rich fibrin (PRF) during tonsillectomy on postoperative results. PATIENTS AND METHODS This study included 41 patients who underwent tonsillectomy between April 2022 and January 2023. Liquid-PRF at a dose of 1 cc was injected to three different points of one of the tonsil fossae, selected at random intraoperatively. The same amount of physiological saline was injected to the symmetrical points on the opposite tonsil fossa using the same size injector. Pain, wound healing, and bleeding were evaluated on postoperative days 1, 7, and 14. The data of both sides were compared statistically as the study and control sides. RESULTS The pain scores were the highest for both sides on postoperative day 1, and gradually decreased in the following days, with no significant difference determined between the sides (p > 0.05). Wound healing rates in the 1st week and 2 nd week were similar for both sides. Although there were more patients who have 100 % epithelization in the PRF group on the postoperative day 14, the difference between the groups was not statistically significant (p > 0.05). CONCLUSIONS The injection of PRF following tonsillectomy had no significant effect on postoperative pain, wound healing, or bleeding.
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Affiliation(s)
- Aslıhan Oflaz Çapar
- Department of Otolaryngology, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Emre Solguntekin
- Department of Otolaryngology, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Kerem Kökoğlu
- Department of Otolaryngology, School of Medicine, Erciyes University, Kayseri, Turkey.
| | - Mehmet Ilhan Şahin
- Department of Otolaryngology, School of Medicine, Erciyes University, Kayseri, Turkey
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Medical Adhesives and Their Role in Laparoscopic Surgery—A Review of Literature. MATERIALS 2022; 15:ma15155215. [PMID: 35955150 PMCID: PMC9369661 DOI: 10.3390/ma15155215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/15/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023]
Abstract
Laparoscopic surgery is undergoing rapid development. Replacing the traditional method of joining cut tissues with sutures or staples could greatly simplify and speed up laparoscopic procedures. This alternative could undoubtedly be adhesives. For decades, scientists have been working on a material to bond tissues together to create the best possible conditions for tissue regeneration. The results of research on tissue adhesives achieved over the past years show comparable treatment effects to traditional methods. Tissue adhesives are a good alternative to surgical sutures in wound closure. This article is a review of the most important groups of tissue adhesives including their properties and possible applications. Recent reports on the development of biological adhesives are also discussed.
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Liu L, Rodman C, Worobetz NE, Johnson J, Elmaraghy C, Chiang T. Topical biomaterials to prevent post-tonsillectomy hemorrhage. J Otolaryngol Head Neck Surg 2019; 48:45. [PMID: 31492172 PMCID: PMC6731608 DOI: 10.1186/s40463-019-0368-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022] Open
Abstract
Despite advances in surgical technique, postoperative hemorrhage remains a common cause of mortality and morbidity for patients following tonsillectomy. Application of biomaterials at the time of tonsillectomy can potentially accelerate mucosal wound healing and eliminate the risk of post-tonsillectomy hemorrhage (PTH). To understand the current state and identify possible routes for the development of the ideal biomaterials to prevent PTH, topical biomaterials for eliminating the risk of PTH were reviewed. Alternative topical biomaterials that hold the potential to reduce the risk of PTH were also summarized.
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Affiliation(s)
- Lumei Liu
- Center of Regenerative Medicine, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Cole Rodman
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Noah E Worobetz
- Center of Regenerative Medicine, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatric Otorhinolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Charles Elmaraghy
- College of Medicine, The Ohio State University, Columbus, OH, USA.,Department of Pediatric Otorhinolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Tendy Chiang
- Center of Regenerative Medicine, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. .,College of Medicine, The Ohio State University, Columbus, OH, USA. .,Department of Pediatric Otorhinolaryngology, Nationwide Children's Hospital, Columbus, OH, USA.
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Hickman DA, Pawlowski CL, Sekhon UDS, Marks J, Gupta AS. Biomaterials and Advanced Technologies for Hemostatic Management of Bleeding. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:10.1002/adma.201700859. [PMID: 29164804 PMCID: PMC5831165 DOI: 10.1002/adma.201700859] [Citation(s) in RCA: 265] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/18/2017] [Indexed: 05/03/2023]
Abstract
Bleeding complications arising from trauma, surgery, and as congenital, disease-associated, or drug-induced blood disorders can cause significant morbidities and mortalities in civilian and military populations. Therefore, stoppage of bleeding (hemostasis) is of paramount clinical significance in prophylactic, surgical, and emergency scenarios. For externally accessible injuries, a variety of natural and synthetic biomaterials have undergone robust research, leading to hemostatic technologies including glues, bandages, tamponades, tourniquets, dressings, and procoagulant powders. In contrast, treatment of internal noncompressible hemorrhage still heavily depends on transfusion of whole blood or blood's hemostatic components (platelets, fibrinogen, and coagulation factors). Transfusion of platelets poses significant challenges of limited availability, high cost, contamination risks, short shelf-life, low portability, performance variability, and immunological side effects, while use of fibrinogen or coagulation factors provides only partial mechanisms for hemostasis. With such considerations, significant interdisciplinary research endeavors have been focused on developing materials and technologies that can be manufactured conveniently, sterilized to minimize contamination and enhance shelf-life, and administered intravenously to mimic, leverage, and amplify physiological hemostatic mechanisms. Here, a comprehensive review regarding the various topical, intracavitary, and intravenous hemostatic technologies in terms of materials, mechanisms, and state-of-art is provided, and challenges and opportunities to help advancement of the field are discussed.
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Affiliation(s)
- DaShawn A Hickman
- Case Western Reserve University School of Medicine, Department of Pathology, Cleveland, Ohio 44106, USA
| | - Christa L Pawlowski
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
| | - Ujjal D S Sekhon
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
| | - Joyann Marks
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
| | - Anirban Sen Gupta
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
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5
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Peng HT, Shek PN. Novel wound sealants: biomaterials and applications. Expert Rev Med Devices 2014; 7:639-59. [DOI: 10.1586/erd.10.40] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Mine T, Miyamoto H, Yoshikawa N, Fumoto S, Sasaki H, Nakamura J, Nishida K. Effect of absorption enhancers on the absorption of FD-4 as a poorly absorbable marker macromolecule from the liver surface in rats. J Drug Deliv Sci Technol 2014. [DOI: 10.1016/s1773-2247(14)50078-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Elessawy M, Schollmeyer T, Rajabi A, Wedel T, Mettler L, Jonat W, Alkatout I. Intraoperative splenic injury as a complication of the laparoscopic excision of uterine myoma. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2012. [DOI: 10.1016/s2305-0500(13)60102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Simo KA, Hanna EM, Imagawa DK, Iannitti DA. Hemostatic Agents in Hepatobiliary and Pancreas Surgery: A Review of the Literature and Critical Evaluation of a Novel Carrier-Bound Fibrin Sealant (TachoSil). ISRN SURGERY 2012. [PMID: 23029624 DOI: 10.5402/2012/729086.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background. Despite progress in surgical techniques applied during hepatobiliary and pancreas (HPB) surgery, bleeding and bile leak remain significant contributors to postoperative mortality and morbidity. Topical hemostatics have been developed and utilized across surgical specialties, but data regarding effectiveness remains inconsistent and sparse in HPB surgery. Methods. A comprehensive search for studies and reviews on hemostatics in HPB surgery was performed via an October 2011 query of Medline, EMBASE, and Cochrane Library. In-depth evaluation of a novel carrier-bound fibrin sealant (TachoSil) was also performed. Results. The literature review illustrates multiple attempts have been made at developing different topical hemostatics and sealants to aid in surgical procedures. In HPB surgery, efforts have been directed at decreasing bleeding, biliary leakage, and pancreatic fistula. Conflicting scientific evidence exists regarding the effectiveness of these agents. Critical evaluation of the literature demonstrates TachoSil is a valuable tool in achieving hemostasis, and possibly biliostasis and pancreatic fistula prevention. Conclusion. While progress has been made in topical hemostatics for HPB surgery, an ideal agent has not yet been identified. TachoSil is promising, but larger randomized, controlled clinical trials are required to more fully evaluate its efficacy in reducing bleeding, biliary leakage, and pancreatic fistulas in HPB surgery.
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Affiliation(s)
- K A Simo
- Section of Hepatobiliary and Pancreas Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
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Simo KA, Hanna EM, Imagawa DK, Iannitti DA. Hemostatic Agents in Hepatobiliary and Pancreas Surgery: A Review of the Literature and Critical Evaluation of a Novel Carrier-Bound Fibrin Sealant (TachoSil). ISRN SURGERY 2012; 2012:729086. [PMID: 23029624 PMCID: PMC3458284 DOI: 10.5402/2012/729086] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/24/2012] [Indexed: 12/15/2022]
Abstract
Background. Despite progress in surgical techniques applied during hepatobiliary and pancreas (HPB) surgery, bleeding and bile leak remain significant contributors to postoperative mortality and morbidity. Topical hemostatics have been developed and utilized across surgical specialties, but data regarding effectiveness remains inconsistent and sparse in HPB surgery. Methods. A comprehensive search for studies and reviews on hemostatics in HPB surgery was performed via an October 2011 query of Medline, EMBASE, and Cochrane Library. In-depth evaluation of a novel carrier-bound fibrin sealant (TachoSil) was also performed. Results. The literature review illustrates multiple attempts have been made at developing different topical hemostatics and sealants to aid in surgical procedures. In HPB surgery, efforts have been directed at decreasing bleeding, biliary leakage, and pancreatic fistula. Conflicting scientific evidence exists regarding the effectiveness of these agents. Critical evaluation of the literature demonstrates TachoSil is a valuable tool in achieving hemostasis, and possibly biliostasis and pancreatic fistula prevention. Conclusion. While progress has been made in topical hemostatics for HPB surgery, an ideal agent has not yet been identified. TachoSil is promising, but larger randomized, controlled clinical trials are required to more fully evaluate its efficacy in reducing bleeding, biliary leakage, and pancreatic fistulas in HPB surgery.
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Affiliation(s)
- K A Simo
- Section of Hepatobiliary and Pancreas Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
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Duarte A, Coelho J, Bordado J, Cidade M, Gil M. Surgical adhesives: Systematic review of the main types and development forecast. Prog Polym Sci 2012. [DOI: 10.1016/j.progpolymsci.2011.12.003] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Cho JM, Ahn JY, Chang JH, Kim SH. Prevention of cerebrospinal fluid rhinorrhea after transsphenoidal surgery by collagen fleece coated with fibrin sealant without autologous tissue graft or postoperative lumbar drainage. Neurosurgery 2011; 68:130-6; discussion 136-7. [PMID: 21206312 DOI: 10.1227/neu.0b013e318207b4ea] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Autologous tissue grafting and postoperative lumbar cerebrospinal fluid (CSF) drainage (PLD) have been used to prevent CSF rhinorrhea after transsphenoidal surgery. OBJECTIVE To describe the technical details and efficacy of our techniques of using collagen fleece coated with fibrin sealant (TachoComb, Nycomed, Linz, Austria) instead of an autologous tissue graft and refraining from the use of PLD. METHODS We retrospectively reviewed 307 consecutive patients who underwent a transsphenoidal surgery for pituitary adenoma from November 2005 to February 2008. Among them, 90 cases of intraoperative CSF leaks were repaired with TachoComb without an autologous tissue graft or PLD. The repair procedures were tailored according to CSF leakage type, and we used only Bioglue (Cryolife Inc, Atlanta, Georgia) for sellar floor reconstruction. RESULTS The overall rate of CSF rhinorrhea was 2.2% (2 of 90 cases). The 2 cases of CSF rhinorrhea resulted from large arachnoid defects, and there were no adverse effects from TachoComb such as transmission of viral disease or infection. CONCLUSION Our technique is an alternative method to the traditional autologous tissue graft technique. PLD is not an essential procedure for the prevention of CSF rhinorrhea if the intraoperative CSF leak is completely sealed off during the transsphenoidal surgery. However, in cases of large arachnoid defects, aggressive repair of the arachnoid defect and sellar floor reconstruction with bone or bony substitutes should be considered in conjunction with our methods.
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Affiliation(s)
- Jin Mo Cho
- Department of Neurosurgery, Pituitary Tumor Clinic, Yonsei Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Carbon RT, Baer K, Simon S, Baar S, Huemmer HP. AMISA: Innovative tissue management in MIS. MINIM INVASIV THER 2009. [DOI: 10.3109/13645709909153185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Rickenbacher A, Breitenstein S, Lesurtel M, Frilling A. Efficacy of TachoSil a fibrin-based haemostat in different fields of surgery- a systematic review. Expert Opin Biol Ther 2009; 9:897-907. [DOI: 10.1517/14712590903029172] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Papp Z, Czakó T. [Ruptured cirrhotic nodulus treated with collagen patch]. Orv Hetil 2007; 148:2385-7. [PMID: 18055363 DOI: 10.1556/oh.2007.28069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors review the case of a fifty-three-year-old cirrhotic patient. He was admitted to the emergency unit with symptoms of acute abdomen and haemorrhagic shock. Abdominal bleeding of unknown origin was revealed by UH and CT imaging. After circulatory resuscitation, urgent abdominal exploration was indicated. During operation arterial bleeding of a ruptured cirrhotic nodulus was found. Tacho-Comb (a human fibrinogen/thrombin coated collagen patch) was applied onto the hepatic wound. Prompt haemostasis was achieved. The patient was discharged after an uneventful postoperative period.
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Affiliation(s)
- Zoltán Papp
- Dr. Bugyi István Kórház Sebészeti Osztály Szentes, Sima F. u. 44-58. 6600.
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Nakajima K, Yasumasa K, Endo S, Takahashi T, Kai Y, Nezu R, Nishida T. A Simple Application Technique of Fibrin-Coated Collagen Fleece (TachoComb) in Laparoscopic Surgery. Surg Today 2007; 37:176-9. [PMID: 17243043 DOI: 10.1007/s00595-006-3348-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Accepted: 08/04/2006] [Indexed: 11/25/2022]
Abstract
A fibrin-coated collagen fleece (TachoComb, Nycomed, Denmark) is a powerful topical hemostatic agent, which has been aggressively used in conventional open surgery with a favorable clinical outcome. However, the use of TachoComb in laparoscopic surgery has not yet gained wide clinical acceptance, because a simple and well-functioning application system is not available. The authors have newly developed a quick, simple, and effective laparoscopic TachoComb application technique: housing a small strip of TachoComb in a rubber tube, then conveying it into the peritoneal cavity, and applying it using standard laparoscopic forceps. The repeated application of TachoComb strips is feasible and of practical value especially in laparoscopic surgery, since a small TachoComb never compromises either the application procedure or laparoscopic visualization.
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Affiliation(s)
- Kiyokazu Nakajima
- Department of Surgery, Osaka University Graduate School of Medicine, 2-2 E-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Klingler CH, Remzi M, Marberger M, Janetschek G. Haemostasis in laparoscopy. Eur Urol 2006; 50:948-56; discussion 956-7. [PMID: 16647188 DOI: 10.1016/j.eururo.2006.01.058] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Accepted: 01/31/2006] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Adequate haemostasis is essential for advanced laparoscopic procedures since uncontrolled bleeding may cause significant complications and even required converting to laparotomy to obtain sufficient haemostasis. The aim of this review is to give insight into the most important tools and strategies to achieve sufficient haemostasis during advanced urologic laparoscopy. METHODS AND RESULTS Lowering the risk of haemorrhage may be achieved primarily by proper case selection, resulting in adequate laparoscopic preparation and dissection technique or the use of local compression by sponge stick to control local bleeding. For early bleeding control, laparoscopic clip appliers, staplers and suturing techniques may be utilised. Various energy sources such as monopolar and bipolar electrocautery, argon beam coagulators, laser or ultrasonic dissectors and topical sealing agents can be used to augment natural haemostasis. CONCLUSIONS A wide armamentarium for achieving haemostasis during laparoscopy is available. Consequently, laparoscopic surgeons must have detailed knowledge of the physical concepts of each surgical instrument or energy source and of proper use of tissue sealants for obtaining sufficient haemostasis. This knowledge will improve postoperative outcome, increase patient safety and guide laparoscopic techniques to further perspectives.
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Rothwell SW, Fudge JM, Chen WK, Reid TJ, Krishnamurti C. Addition of a propyl gallate-based procoagulant to a fibrin bandage improves hemostatic performance in a swine arterial bleeding model. Thromb Res 2002; 108:335-40. [PMID: 12676195 DOI: 10.1016/s0049-3848(03)00112-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fibrin bandages manufactured by Nycomed Austria (TC-S) were modified by the addition of Hemostyptin (HS), a proprietary platelet-activating reagent containing propyl gallate. HS was added as an additional layer to TC-S fibrin bandages and the bandages were tested for hemostatic efficacy in a swine femoral artery bleeding model. Injuries were treated with a TC-S+HS bandage preparation using HS lyophilized onto a bandage surface that was then attached to the fibrin dressing. This preparation qualitatively and quantitatively exhibited more robust blood clotting at the surgical site than the control bandages. TC-S+HS bandages were more effective than control bandages with a difference in blood loss of 251.8+/-66.5 g for TC-S bandage alone, n=12 vs. 121+/-40.7 g, n=13 for the TC-S+HS bandage, P=0.05. Bleeding times were shortened for animals treated with the HS fortified bandages and residual platelets counts in these animals were higher.
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Affiliation(s)
- Stephen W Rothwell
- Department of Blood Research, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
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Rothwell SW, Fudge JM, Reid TJ, Krishnamurti C. Epsilon-amino caproic acid additive decreases fibrin bandage performance in a swine arterial bleeding model. Thromb Res 2002; 108:341-5. [PMID: 12676196 DOI: 10.1016/s0049-3848(03)00111-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
epsilon -Amino caproic acid (EACA), a lysine analog that inhibits the activity of plasmin, was added to Nycomed (TC-S) fibrin bandages, and the bandages were tested for hemostatic efficacy in a swine femoral artery bleeding model. The blood loss using the bandage with EACA (TC-S+EACA; 728.8+/-132 g, n=5) was much greater as compared to the TC-S bandage alone (TC-S; 237.8+/-47.9 g, n=6, p=.02). The time to "cessation of bleeding" (T(b)) was also increased for animals treated with TC-S+EACA bandages compared to the TC-S controls (33.6+/-10.8 min vs. 9.2+/-2.2 min; p=.05). Although plasma fibrinogen concentration decreased in animals treated with the TC-S+EACA bandage, activated partial thromboplastin times (aPTT) and thrombin times (TT) were decreased. Animals treated with the TC-S control bandage exhibited no changes in fibrinogen, aPTT or TT. Prothrombin times (PT) were unchanged in either group. In conclusion, addition of EACA to the Nycomed product decreased fibrin bandage efficiency.
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Affiliation(s)
- Stephen W Rothwell
- Department of Blood Research, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA.
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Abstract
A variety of agents are available to improve hemostasis and reduce blood loss in multiple clinical settings. These agents are most commonly used to reduce bleeding when an underlying hemostatic defect is present. Some new agents offer the potential to decrease blood loss even in the absence of an obvious underlying hemostatic defect. The authors discuss the use of a variety of products to reduce bleeding and minimize transfusion of blood products in the setting of clotting factor deficiency or inhibition, platelet deficiency and/or dysfunction, increased fibrinolysis, therapeutic anticoagulation, and coagulopathies caused by dilution and consumption in the setting of trauma and surgery. The authors primarily focus on the available pharmaceuticals.
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Carbon RT, Baar S, Waldschmidt J, Huemmer HP, Simon SI. Innovative minimally invasive pediatric surgery is of therapeutic value for splenic injury. J Pediatr Surg 2002; 37:1146-50. [PMID: 12149690 DOI: 10.1053/jpsu.2002.34460] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE Until now, minimally invasive surgery (MIS) has not had any therapeutic status for operable splenic trauma, because reliable sealing of larger defects is not possible with general techniques. METHODS Fleece-bound sealing allows rapid, large-area sealing of erosions and defects, so that with the aid of an MIS applicator system (AMISA), this method of tissue management can be transferred to MIS. RESULTS An in vitro evaluation showed that liquid fibrin sealing (FS) exhibits incomplete selective leak closure and low adhesive strength (4.1 hPa) and is not suitable for challenging surfaces. Fleece-bound sealing (ready-to-use v. prepare-to-use) showed reliable sealing and higher adhesive strength for collagen fleeces that are ready coated with fibrinogen-based sealant (TachoComb H; Nycomed, Linz, Austria) compared with various carrier systems that had to be impregnated on the spot (prepare-to-use; 50.2 v 23 hPa; P <.0001). Between October 1993 and October 2001, 19 of 87 children with splenic rupture were treated with the AMISA system (AMISA + TachoComb H) (21.8%), and 3 of these children had multiple trauma. The operation was indicated because of circulatory instability despite adequate volume replacement therapy. Splenic repair always was possible with the AMISA system, a changeover and splenectomy was not necessary, and the postoperative course was complication free. The mean stay in the hospital was 9.2 days. CONCLUSIONS The AMISA system efficiently expands the indications for emergency laparoscopy and can be used successfully in emergency laparoscopy for splenic rupture management.
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Affiliation(s)
- Roman Th Carbon
- Department of Pediatric Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
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