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LyBarger KS. Review of Evidence Supporting the Arista™ Absorbable Powder Hemostat. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:173-188. [PMID: 38800552 PMCID: PMC11127658 DOI: 10.2147/mder.s442944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/21/2024] [Indexed: 05/29/2024] Open
Abstract
Background Uncontrolled and diffuse bleeding is a dreaded event during open and laparoscopic surgery that may lead to postoperative complications, obstruction of the surgical field that reduces visualization, and prolonged operating times. Powder hemostats can be used to control bleeding and are easy to use, have a safe profile, and can achieve broad coverage area at a low cost. Methods A strategic literature search of peer-reviewed, English language studies was conducted to capture evidence on the clinical efficacy and safety of a Microporous Polysaccharide Hemosphere (MPH) based Hemostat (Arista™ Absorbable Hemostat (Arista™ AH)). Results Six preclinical studies were found which supported the use of MPH in various animal models of laparoscopic and open surgery, all of which demonstrated its safety and efficacy. Five single-arm and 11 comparative clinical studies similarly supported the efficacy and safety of MPH in various surgery types, including cardiac, renal, and dermatologic surgery. Conclusion Published evidence supports the safe and effective use of MPH across a variety of surgical settings.
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Shinden Y, Nomoto Y, Nagata A, Eguchi Y, Yano H, Saho H, Hayashi N, Minami K, Hirashima T, Sasaki K, Yoshinaka H, Owaki T, Nakajo A, Ohtsuka T. Clinical effectiveness of microporous polysaccharide hemospheres in mastectomy for patients with breast cancer. Gland Surg 2024; 13:307-313. [PMID: 38601298 PMCID: PMC11002489 DOI: 10.21037/gs-23-297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/23/2024] [Indexed: 04/12/2024]
Abstract
Background Microporous polysaccharide hemospheres (MPH) are hydrophilic particles administered to reduce the incidence of seroma after mastectomy, but their clinical effectiveness remains controversial. Because a previous randomized, controlled study in a small cohort could not demonstrate the effectiveness of MPH in breast surgery, we evaluated their effectiveness in surgery for breast cancer in a larger cohort. Methods Medical records of 352 patients who underwent total mastectomy for breast cancer were retrospectively reviewed. Clinical data were compared between 126 patients who received MPH during surgery (MPH group) and 226 who did not (control group) according to surgical procedures. Patients were significantly older in the MPH group than in the control group because of selection bias, but other factors, such as body mass index and number of dissected lymph nodes, did not differ between groups. Results When analyzed by use of axillary manipulation, the drain placement period and drainage volume were significantly less in the MPH group than in the control group for patients with mastectomy and sentinel lymph node biopsy. Only drainage volume was significantly less in the MPH group for patients with mastectomy and axillary lymph node dissection. The frequency of total postoperative complications, such as seroma requiring puncture, did not differ between groups. Conclusions Use of MPH may decrease the postoperative drainage volume and drain placement period in mastectomy for patients with breast cancer.
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Affiliation(s)
- Yoshiaki Shinden
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
- Department of Breast and Thyroid Surgery, Kagoshima University Hospital, Sakuragoka, Kagoshima-City, Japan
| | - Yuki Nomoto
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
- Department of Breast Surgery, Kagoshima City Hospital, Kamiarata, Kagoshima-City, Japan
| | - Ayako Nagata
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
| | - Yuka Eguchi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
| | - Hanako Yano
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
| | - Hazuki Saho
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
| | - Naoki Hayashi
- Department of Breast Surgery, Kagoshima City Hospital, Kamiarata, Kagoshima-City, Japan
| | - Koji Minami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
| | - Tadahioro Hirashima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
| | - Ken Sasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
| | - Heiji Yoshinaka
- Department of Breast Surgery, Kagoshima City Hospital, Kamiarata, Kagoshima-City, Japan
| | - Tetsuhiro Owaki
- Department of Community-based Medicine Education Center for Doctors in Remote Island and Rural Areas, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
| | - Akihiro Nakajo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragoka, Kagoshima-City, Japan
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Jeon YD, Cha JR, Oh JM, Kim SG, Park KB. Comparison of blood loss between intra-articular microporous polysaccharide hemospheres powder and tranexamic acid following primary total knee arthroplasty. Sci Rep 2024; 14:5188. [PMID: 38431723 PMCID: PMC10908821 DOI: 10.1038/s41598-024-55871-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
Total knee arthroplasty (TKA) is associated with substantial blood loss and tranexamic acid (TXA) effectively reduces postoperative bleeding. Although it is known that there is no difference between intravenous or intra-articular (IA) injection, the general interest is directed towards topical hemostatic agents regarding thromboembolic events in high-risk patients. This study aimed to compare the blood conservation effects of IA MPH powder and TXA in patients undergoing primary TKA. We retrospectively analyzed 103 patients who underwent primary TKA between June 2020 and December 2021. MPH powder was applied to the IA space before capsule closure (MPH group, n = 51). TXA (3 g) was injected via the drain after wound closure (TXA group, n = 52). All patients underwent drain clamping for three postoperative hours. The primary outcome was the drain output, and the secondary outcomes were the postoperative hemoglobin (Hb) levels during the hospitalization period and the perioperative blood transfusion rates. An independent Student's t-test was used to determine differences between the two groups. The drain output in the first 24 h after surgery was significantly higher in the MPH group than in the TXA group. The postoperative Hb levels were significantly lower in the MPH group than in the TXA group. In patients with simultaneous bilateral TKA, there was a significant difference in the blood transfusion volumes and the rates between groups. It is considered that IA MPH powder cannot replace IA TXA because of an inferior efficacy in reducing blood loss and maintaining postoperative Hb levels in the early postoperative period after primary TKA. Moreover, in the case of simultaneous bilateral TKA, we do not recommend the use of IA MPH powder because it was notably less effective in the field of transfusion volume and rate.
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Affiliation(s)
- Young-Dae Jeon
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 25 Daehakbyeongwon-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Jae-Ryong Cha
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 25 Daehakbyeongwon-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Jae-Min Oh
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 25 Daehakbyeongwon-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Sang-Gon Kim
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 25 Daehakbyeongwon-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Ki-Bong Park
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 25 Daehakbyeongwon-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
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Pidgaiska O, Niemann M, Braun K, Trampuz A, Goumenos S, Stöckle U, Meller S. The Safety and Efficacy of Microporous Polysaccharide Hemospheres in Terms of the Complication Rates in Total Hip Arthroplasty for Femoral Neck Fractures: A Control-Matched Retrospective Cohort. Life (Basel) 2024; 14:177. [PMID: 38398686 PMCID: PMC10890550 DOI: 10.3390/life14020177] [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: 12/28/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
AIMS This study aimed to assess the safety and efficacy of microporous polysaccharide hemospheres (MPSHs) in managing blood loss and reducing the risk of postoperative haematoma and early periprosthetic joint infection (PJI) following total hip arthroplasty (THA) for femoral neck fracture (FNF), in the context of the existing treatment challenges. METHODS A control-matched retrospective analysis of 163 patients undergoing unilateral primary THA for displaced FNF between 2020 and 2023 was performed. The study group consisted of 74 patients who received MPSH administered intraoperatively. The control group consisted of 89 patients who received no topical haemostatics. One-to-one case-control matching between groups was performed. The primary outcome was a perioperative change in the haematologic values (haemoglobin, red blood cell count, haematocrit, platelet concentration) and transfusion rate. The secondary outcomes were the incidence of postoperative local haematoma formation, prolonged wound secretion, surgical site infection (SSI), and PJI within 3 months of surgery. RESULTS Our analysis found no statistically significant differences in the haematologic parameters between the control and study cohorts. The changes in the haemoglobin concentration were not significant between the control group (3.18 ± 1.0 g/dL) and the treatment group (2.87 ± 1.15 g/dL) (p = 0.3). There were no significant differences (p = 0.24) in the haematocrit and red blood cell concentration (p = 0.15). The platelet levels did not significantly differ (p = 0.12) between the groups. Additionally, we found no significant discrepancy in the incidence of early PJI or blood transfusion rates between the groups. No adverse effects following MPSH use were recorded in the study group. CONCLUSIONS Routine use of MPSH in THA for FNF management appears to be safe, with no observed adverse events related to Arista® use. Although there was a tendency towards reduced blood loss in the Arista® AH group, MPSH did not significantly impact bleeding complications, local haematoma formation, or subsequent PJI.
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Affiliation(s)
- Olga Pidgaiska
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany; (O.P.); (M.N.); (A.T.); (S.G.); (U.S.)
- Sytenko Institute of Spine and Joint Pathology, Academy of Medical Science, Ukraine, Pushkinska Str. 80, 61024 Charkiw, Ukraine
| | - Marcel Niemann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany; (O.P.); (M.N.); (A.T.); (S.G.); (U.S.)
| | - Karl Braun
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany;
| | - Andrej Trampuz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany; (O.P.); (M.N.); (A.T.); (S.G.); (U.S.)
| | - Stavros Goumenos
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany; (O.P.); (M.N.); (A.T.); (S.G.); (U.S.)
| | - Ulrich Stöckle
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany; (O.P.); (M.N.); (A.T.); (S.G.); (U.S.)
| | - Sebastian Meller
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany; (O.P.); (M.N.); (A.T.); (S.G.); (U.S.)
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Razali RA, Vijakumaran U, Fauzi MB, Lokanathan Y. Maximizing Postoperative Recovery: The Role of Functional Biomaterials as Nasal Packs-A Comprehensive Systematic Review without Meta-Analysis (SWiM). Pharmaceutics 2023; 15:pharmaceutics15051534. [PMID: 37242776 DOI: 10.3390/pharmaceutics15051534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Numerous biomaterials have been developed over the years to enhance the outcomes of endoscopic sinus surgery (ESS) for patients with chronic rhinosinusitis. These products are specifically designed to prevent postoperative bleeding, optimize wound healing, and reduce inflammation. However, there is no singular material on the market that can be deemed the optimal material for the nasal pack. We systematically reviewed the available evidence to assess the functional biomaterial efficacy after ESS in prospective studies. The search was performed using predetermined inclusion and exclusion criteria, and 31 articles were identified in PubMed, Scopus, and Web of Science. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess each study's risk of bias. The studies were critically analyzed and categorized into types of biomaterial and functional properties, according to synthesis without meta-analysis (SWiM) guidelines. Despite the heterogeneity between studies, it was observed that chitosan, gelatin, hyaluronic acid, and starch-derived materials exhibit better endoscopic scores and significant potential for use in nasal packing. The published data support the idea that applying a nasal pack after ESS improves wound healing and patient-reported outcomes.
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Affiliation(s)
- Rabiatul Adawiyah Razali
- Centre for Tissue Engineering & Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Ubashini Vijakumaran
- Centre for Tissue Engineering & Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering & Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering & Regenerative Medicine (CTERM), Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia
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Selfridge JM, Sinner HF, Whiting J, Sun W, Mallory MA, Hoover SJ, Kiluk JV, Khakpour N, Czerniecki BJ, Laronga C, Mo Q, Lee MC. Effect of Microporous Polysaccharide Particles in Patients Undergoing Mastectomy. Clin Breast Cancer 2022; 22:e922-e927. [PMID: 36055918 DOI: 10.1016/j.clbc.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Microporous polysaccharide particles (MPP, proprietary name "Arista AH"), derived from purified plant starch, are used to augment hemostasis at surgery. The effect of MPP regarding short-term complications after mastectomy remains an area of ongoing investigation. PATIENTS AND METHODS A single-institution, retrospective chart review of patients undergoing unilateral mastectomy without reconstruction from January 2019 to 2021 was performed. Primary endpoints included antibiotic prescription, seroma or abscess drainage, readmission, wound dehiscence, and time to drain removal within 30 days of initial surgery. Wilcoxon rank sum test or Student t test was used for group comparisons for continuous variables; Chi-square test or Fisher exact test was used to evaluate the associations among categorical variables. RESULTS One hundred ninety patients were included; 119 received MPP and 71 did not. There was no difference in antibiotic prescription, infection drainage, hematoma, readmission, dehiscence, or time to drain removal with regards to MPP use. MPP treated patients were older (65.8 years vs. 59.1, P < .001) and had lower albumin levels (4.1 g/dL vs. 4.3, P = .025). Patients who underwent abscess drainage had higher body mass index ( mean 36.1 vs. 30.1 P = .036). Patients requiring seroma drainage were more likely to be diabetic (12.8% vs. 4%, P = .035) and to have been treated with lymphovenous anastomosis (LVA, 15.6% vs. 3.8%, P = .009). Patients who had LVA were significantly less likely to receive MPP when compared to other groups (3.1% vs. 74.7% P < .001). CONCLUSION Consider utilizing MPP in patients at higher risk of seroma, such as those undergoing axillary surgery including LVA.
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Affiliation(s)
- Julia M Selfridge
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL.
| | - Heather F Sinner
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Weihong Sun
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL
| | - Melissa A Mallory
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL
| | - Susan J Hoover
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL
| | - John V Kiluk
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL
| | - Nazanin Khakpour
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL
| | - Brian J Czerniecki
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL
| | - Christine Laronga
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL
| | - Qianxing Mo
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Marie C Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center, Moffitt Cancer Center, Tampa, FL
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Nagrath M, Bince D, Rowsell C, Polintan D, Rezende-Neto J, Towler M. Porcine liver injury model to assess tantalum-containing bioactive glass powders for hemostasis. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:53. [PMID: 35670885 PMCID: PMC9174136 DOI: 10.1007/s10856-022-06674-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
This study evaluates compositions of tantalum-containing mesoporous bioactive glass (Ta-MBG) powders using a porcine fatal liver injury model. The powders based on (80-x)SiO2-15CaO-5P2O5-xTa2O5 compositions with x = 0 (0Ta/Ta-free), 1 (1Ta), and 5 (5Ta) mol% were made using a sol-gel process. A class IV hemorrhage condition was simulated on the animals; hemodynamic data and biochemical analysis confirmed the life-threatening condition. Ta-MBGs were able to stop the bleeding within 10 min of their application while the bleeds in the absence of any intervention or in the presence of a commercial agent, AristaTM (Bard Davol Inc., Rhode Island, USA) continued for up to 45 min. Scanning electron microscopy (SEM) imaging of the blood clots showed that the presence of Ta-MBGs did not affect clot morphology. Rather, the connections seen between fibrin fibers of the blood clot and Ta-MBG powders point towards the powders' surfaces embracing fibrin. Histopathological analysis of the liver tissue showed 5Ta as the only composition reducing parenchymal hemorrhage and necrosis extent of the tissue after their application. Additionally, 5Ta was also able to form an adherent clot in worst-case scenario bleeding where no adherent clot was seen before the powder was applied. In vivo results from the present study agree with in vitro results of the previous study that 5Ta was the best Ta-MBG composition for hemostatic purposes. Graphical abstract.
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Affiliation(s)
- Malvika Nagrath
- Biomedical Engineering, Faculty of Engineering and Architectural Science (FEAS), Ryerson University, Toronto, M5B 2K3, ON, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada.
| | - Danielle Bince
- Research Vivarium, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada
| | - Corwyn Rowsell
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, M5S 1A1, ON, Canada
| | - Deanna Polintan
- Biomedical Engineering, Faculty of Engineering and Architectural Science (FEAS), Ryerson University, Toronto, M5B 2K3, ON, Canada
| | - Joao Rezende-Neto
- Trauma and Acute Care, General Surgery, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada
- Department of Surgery, University of Toronto, Toronto, M5S 1A1, ON, Canada
| | - Mark Towler
- Biomedical Engineering, Faculty of Engineering and Architectural Science (FEAS), Ryerson University, Toronto, M5B 2K3, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, M5B 1W8, ON, Canada
- Department of Mechanical and Industrial Engineering, FEAS, Ryerson University, Toronto, M5B 2K3, ON, Canada
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David AP, Zebolsky AL, Park AM, Heaton CM, Knott PD, Seth R. Effect of microporous polysaccharide hemospheres on anterolateral thigh free flap donor site complications. Laryngoscope Investig Otolaryngol 2022; 7:380-387. [PMID: 35434322 PMCID: PMC9008183 DOI: 10.1002/lio2.770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/31/2022] [Indexed: 12/21/2022] Open
Abstract
Background Postoperative seroma is the most common donor site complication following anterolateral thigh (ALT) free flap harvest for head and neck reconstruction. The utility of novel microporous polysaccharide hemospheres (MPH) has not been studied as a hemostatic agent in this setting. Methods Prospective, single‐blind, randomized controlled trial of patients undergoing fasciocutaneous ALT harvest for head and neck reconstruction at a tertiary academic medical center between April 2018 and February 2020. The intervention (MPH) group received 3 g of topical MPH to the ALT donor site prior to closure whereas the control group did not receive application of MPH. Outcomes included total drain output (ml), drain output during postoperative days (POD) 1–3 alone, drain duration (days), and incidence of donor site hematoma, seroma, or infection. Results Twenty‐nine patients were randomized to the MPH group and 26 to the control group. For MPH and control groups, mean total drain output was 284.7 ± 153.0 ml versus 317.9 ± 177.6 ml (p = .527), mean POD 1–3 drain output alone was 169.3 ± 88.8 ml versus 157.9 ± 78.7 ml (p = .749), and drain duration was 5.9 ± 1.5 days versus 6.5 ± 1.6 days (p = .144), respectively. There was no significant difference in seroma (p = .733), hematoma (p = .492), or infection (p = 1.000). Drain output was not significantly influenced by gender, age, body weight, or smoking habits. Conclusion MPH administration to ALT free flap donor sites did not significantly improve drain output, hematoma formation, or seroma formation. Level of Evidence 2
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Affiliation(s)
- Abel P. David
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology‐Head & Neck Surgery University of California San Francisco California USA
| | - Aaron L. Zebolsky
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology‐Head & Neck Surgery University of California San Francisco California USA
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology‐Head & Neck Surgery University of California San Francisco California USA
| | - Andrea M. Park
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology‐Head & Neck Surgery University of California San Francisco California USA
| | - Chase M. Heaton
- Division of Head and Neck Oncologic Surgery, Department of Otolaryngology‐Head & Neck Surgery University of California San Francisco California USA
| | - P. Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology‐Head & Neck Surgery University of California San Francisco California USA
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology‐Head & Neck Surgery University of California San Francisco California USA
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