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Indrakumar S, Dash TK, Mishra V, Tandon B, Chatterjee K. Silk Fibroin and Its Nanocomposites for Wound Care: A Comprehensive Review. ACS POLYMERS AU 2024; 4:168-188. [PMID: 38882037 PMCID: PMC11177305 DOI: 10.1021/acspolymersau.3c00050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 06/18/2024]
Abstract
For most individuals, wound healing is a highly organized, straightforward process, wherein the body transitions through different phases in a timely manner. However, there are instances where external intervention becomes necessary to support and facilitate different phases of the body's innate healing mechanism. Furthermore, in developing countries, the cost of the intervention significantly impacts access to treatment options as affordability becomes a determining factor. This is particularly true in cases of long-term wound treatment and management, such as chronic wounds and infections. Silk fibroin (SF) and its nanocomposites have emerged as promising biomaterials with potent wound-healing activity. Driven by this motivation, this Review presents a critical overview of the recent advancements in different aspects of wound care using SF and SF-based nanocomposites. In this context, we explore various formats of hemostats and assess their suitability for different bleeding situations. The subsequent sections discuss the primary causes of nonhealing wounds, i.e., prolonged inflammation and infections. Herein, different treatment strategies to achieve immunomodulatory and antibacterial properties in a wound dressing were reviewed. Despite exhibiting excellent pro-healing properties, few silk-based products reach the market. This Review concludes by highlighting the bottlenecks in translating silk-based products into the market and the prospects for the future.
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Affiliation(s)
- Sushma Indrakumar
- Department of Materials Engineering, Indian Institute of Science, Bangalore 560012, India
| | - Tapan Kumar Dash
- Fibroheal Woundcare Pvt. Ltd., Yelahanka New Town, Bangalore 560064, India
| | - Vivek Mishra
- Fibroheal Woundcare Pvt. Ltd., Yelahanka New Town, Bangalore 560064, India
| | - Bharat Tandon
- Fibroheal Woundcare Pvt. Ltd., Yelahanka New Town, Bangalore 560064, India
| | - Kaushik Chatterjee
- Department of Materials Engineering, Indian Institute of Science, Bangalore 560012, India
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Zhang QD, Duan QY, Tu J, Wu FG. Thrombin and Thrombin-Incorporated Biomaterials for Disease Treatments. Adv Healthc Mater 2024; 13:e2302209. [PMID: 37897228 DOI: 10.1002/adhm.202302209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/20/2023] [Indexed: 10/29/2023]
Abstract
Thrombin, a coagulation-inducing protease, has long been used in the hemostatic field. During the past decades, many other therapeutic uses of thrombin have been developed. For instance, burn treatment, pseudoaneurysm therapy, wound management, and tumor vascular infarction (or tumor vasculature blockade therapy) can all utilize the unique and powerful function of thrombin. Based on their therapeutic effects, many thrombin-associated products have been certificated by the Food and Drug Administration, including bovine thrombin, human thrombin, recombinant thrombin, fibrin glue, etc. Besides, several thrombin-based drugs are currently undergoing clinical trials. In this article, the therapeutic uses of thrombin (from the initial hemostasis to the latest cancer therapy), the commercially available drugs associated with thrombin, and the pros and cons of thrombin-based therapeutics (e.g., adverse immune responses related to bovine thrombin, thromboinflammation, and vasculogenic "rebounds") are summarized. Further, the current challenges and possible future research directions of thrombin-incorporated biomaterials and therapies are discussed. It is hoped that this review may provide a valuable reference for researchers in this field and help them to design safer and more effective thrombin-based drugs for fighting against various intractable diseases.
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Affiliation(s)
- Qiong-Dan Zhang
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 2 Southeast University Road, Nanjing, Jiangsu, 211189, P. R. China
| | - Qiu-Yi Duan
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 2 Southeast University Road, Nanjing, Jiangsu, 211189, P. R. China
| | - Jing Tu
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 2 Southeast University Road, Nanjing, Jiangsu, 211189, P. R. China
| | - Fu-Gen Wu
- State Key Laboratory of Digital Medical Engineering, School of Biological Science and Medical Engineering, Southeast University, 2 Southeast University Road, Nanjing, Jiangsu, 211189, P. R. China
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Brown KGM, Solomon MJ. Topical haemostatic agents in surgery. Br J Surg 2024; 111:znad361. [PMID: 38156466 PMCID: PMC10771136 DOI: 10.1093/bjs/znad361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Kilian G M Brown
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
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Sánchez Del Valle FJ, De Nicolás L, Fernández G, Fernández P, Gómez E, Aranaz Corral I. Comparison of a gelatin thrombin versus a modified absorbable polymer as a unique treatment for severe hepatic hemorrhage in swine. Sci Rep 2023; 13:20854. [PMID: 38012204 PMCID: PMC10682395 DOI: 10.1038/s41598-023-41983-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/04/2023] [Indexed: 11/29/2023] Open
Abstract
There are many surgical techniques (packing, Pringle maneuver, etc.) and hemostatic agents to manage hepatic bleeding in trauma surgery. This study compares the effectiveness of two different types of hemostatic agents, one is an active flowable hemostat and the other is a passive hemostat made of modified absorbable polymers [MAP]. Both surgical technique and hemostatic agents can be used together as a means of controlling bleeding. We have hypothesized that a single hemostatic agent might be as effective as a unique hemostatic surgical technique. Twenty swine were prospectively randomized to receive either active Flowable (Floseal) or passive MAP powder (PerClot) hemostatic agents. We used a novel severe liver injury model that caused exsanguinating hemorrhage. The main outcome measure was total blood loss volume. The total volume of blood loss, from hepatic injury to minute 120, was significantly lower in the Flowable group (407.5 cm3; IqR: 195.0-805.0 cm3) compared to MAP group (1107.5 cm3; IqR: 822.5 to 1544.5 cm3) (Hodges-Lehmann median difference: - 645.0 cm3; 95% CI: - 1144.0 to - 280.0 cm3; p = 0.0087). The rate of blood loss was significantly lower in the flowable group compared with the MAP group as measured from time of injury to minutes 3, 9, 12, and 120 (except for 6 min). The mean arterial pressure gradually recovered in the flowable group by 24 h, whereas in the MAP group, the mean arterial pressure was consistently stayed below baseline values. Kaplan-Meier survival analysis indicated similar rates of death between study groups (Logrank test p = 0.3395). Both the flowable and the MAP hemostatic agents were able to effectively control surgical bleeding in a novel severe liver injury model, however, the flowable gelatin-thrombin agent provided quicker and better bleed control.
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Affiliation(s)
- Francisco José Sánchez Del Valle
- Central Hospital of Defense, General and Digestive Unit, Spanish Ministry of Defense, Glorieta del Ejército, 1, 28047, Madrid, Spain.
| | - Luis De Nicolás
- Central Hospital of Defense, General and Digestive Unit, Spanish Ministry of Defense, Glorieta del Ejército, 1, 28047, Madrid, Spain
| | - Guillermo Fernández
- Central Hospital of Defense, General and Digestive Unit, Spanish Ministry of Defense, Glorieta del Ejército, 1, 28047, Madrid, Spain
| | - Pedro Fernández
- Central Hospital of Defense, Unit of Surgical Research, Spanish Ministry of Defense, Madrid, Spain
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Ng EPL, Tung KL, Yip SL, Tse MSH, Kwok TK, Wong KK. A prospective randomised controlled trial evaluating prophylactic Floseal, a gelatin and thrombin-based haemostatic matrix, in postoperative drain output and blood transfusion in transforaminal lumbar interbody fusion surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2282-2287. [PMID: 37148391 DOI: 10.1007/s00586-023-07748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/09/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To evaluate the prophylactic use of Floseal in reducing postoperative blood loss in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF). TLIF is a lumbar spine decompression and fusion procedure with potential for postoperative blood loss. Prophylactic application of Floseal, a gelatin and thrombin-based haemostatic matrix to the surgical wound before closure was shown to be effective in reducing postoperative drain output in anterior cervical discectomy and fusion. This study postulated that prophylactic use of Floseal before wound closure would reduce postoperative blood loss in patients who underwent TLIF. METHODS Randomised controlled trial comparing prophylactic use of Floseal and control in patients undergoing single level or two-level TLIF. Primary outcomes included postoperative drain output within 24 h and postoperative transfusion rate. Secondary outcomes included days of drain placement, length of stay and haemoglobin level. RESULTS A total of 50 patients was recruited. Twenty six patients were allocated to the Floseal group and 24 were allocated to the control group. There were no baseline characteristic differences between the groups. There were no statistically significant differences in primary outcomes which included postoperative drain output within 24 h and postoperative transfusion rate between patients who received prophylactic Floseal and control. There were no statistically significant differences in secondary outcomes which included haemoglobin level, days of drain placement and length of stay between the two groups. CONCLUSION Prophylactic use of Floseal was not shown to reduce postoperative bleeding in single level or two-level TLIF.
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Affiliation(s)
- Eugene Pak-Lin Ng
- Department of Orthopaedics & Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong.
| | - Kam-Lung Tung
- Department of Orthopaedics & Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong
| | - Siu-Leung Yip
- Department of Orthopaedics & Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong
| | - Michael Siu-Hei Tse
- Department of Orthopaedics & Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong
| | - Tik-Koon Kwok
- Department of Orthopaedics & Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong
| | - Kam-Kwong Wong
- Department of Orthopaedics & Traumatology, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong
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6
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Kim HH, Lee KJ, Kang DR, Lee JH, Youn YN. Hemostatic efficacy of a flowable collagen-thrombin matrix during coronary artery bypass grafting: a double-blind randomized controlled trial. J Cardiothorac Surg 2023; 18:193. [PMID: 37322537 PMCID: PMC10273500 DOI: 10.1186/s13019-023-02196-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/29/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Flowable hemostatic agents have the advantage of being able to be applied to irregular wound surfaces and difficult to reach areas. We sought to compare the effectiveness and safety of the flowable hemostatic sealants Collastat® (collagen hemostatic matrix, [CHM]) and Floseal® (gelatin hemostatic matrix, [GHM]) during off-pump coronary artery bypass (OPCAB). METHODS In this prospective, double-blind, randomized controlled trial, 160 patients undergoing elective OPCAB surgery were enrolled between March 2018 and February 2020. After primary suture of the aortocoronary anastomosis, an area of hemorrhage was identified, and patients received either CHM or GHM (n = 80, each). Study endpoints were the following: proportion of successful intraoperative hemostasis and time required for hemostasis overall postoperative bleeding, proportion of transfusion of blood products, and surgical revision for bleeding. RESULTS Of the total patients, 23% were female, and the mean age was 63 years (range 42-81 years). Successful hemostasis proportion within 5 min was achieved for 78 patients (97.5%) in the GHM group, compared to 80 patients (100%) in the CHM group (non-inferiority p = 0.006). Two patients receiving GHM required surgical revision to achieve hemostasis. There were no differences in the mean time required to obtain hemostasis [GHM vs. CHM, mean 1.49 (SD 0.94) vs. 1.35 (0.60) min, p = 0.272], as confirmed by time-to-event analysis (p = 0.605). The two groups had similar amounts of mediastinal drainage for 24 h postoperatively [538.5 (229.1) vs. 494.7 (190.0) ml, p = 0.298]. The CHM group required less packed red blood cells, fresh frozen plasma, and platelets for transfusion than the GHM group (0.5 vs. 0.7 units per patient, p = 0.047; 17.5% vs. 25.0%, p = 0.034; 7.5% vs. 15.0%, p = 0.032; respectively). CONCLUSIONS CHM was associated with a lower need for FFP and platelet transfusions. Thus, CHM is a safe and effective alternative to GHM. TRIAL REGISTRATION ClinicalTrials.gov, NCT04310150.
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Affiliation(s)
- Hyo-Hyun Kim
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Department of Cardiothoracic Surgery, Ilsan Hospital, National Health Insurance Service, Goyang-si, 10444, Republic of Korea
| | - Kang Ju Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dae Ryong Kang
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wounju, Republic of Korea
| | - Jun Hyeok Lee
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wounju, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Haghniaz R, Kim HJ, Montazerian H, Baidya A, Tavafoghi M, Chen Y, Zhu Y, Karamikamkar S, Sheikhi A, Khademhosseini A. Tissue adhesive hemostatic microneedle arrays for rapid hemorrhage treatment. Bioact Mater 2023; 23:314-327. [PMID: 36439081 PMCID: PMC9692134 DOI: 10.1016/j.bioactmat.2022.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/06/2022] [Accepted: 08/20/2022] [Indexed: 11/26/2022] Open
Abstract
Blood loss by hemorrhaging wounds accounts for over one-third of ∼5 million trauma fatalities worldwide every year. If not controlled in a timely manner, exsanguination can take lives within a few minutes. Developing new biomaterials that are easy to use by non-expert patients and promote rapid blood coagulation is an unmet medical need. Here, biocompatible, and biodegradable microneedle arrays (MNAs) based on gelatin methacryloyl (GelMA) biomaterial hybridized with silicate nanoplatelets (SNs) are developed for hemorrhage control. The SNs render the MNAs hemostatic, while the needle-shaped structure increases the contact area with blood, synergistically accelerating the clotting time from 11.5 min to 1.3 min in vitro. The engineered MNAs reduce bleeding by ∼92% compared with the untreated injury group in a rat liver bleeding model. SN-containing MNAs outperform the hemostatic effect of needle-free patches and a commercial hemostat in vivo via combining micro- and nanoengineered features. Furthermore, the tissue adhesive properties and mechanical interlocking support the suitability of MNAs for wound closure applications. These hemostatic MNAs may enable rapid hemorrhage control, particularly for patients in developing countries or remote areas with limited or no immediate access to hospitals.
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Affiliation(s)
- Reihaneh Haghniaz
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, United States
- Terasaki Institute for Biomedical Innovation, 11570 W Olympic Boulevard, Los Angeles, CA, 90024, United States
| | - Han-Jun Kim
- California NanoSystems Institute, University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, United States
- Terasaki Institute for Biomedical Innovation, 11570 W Olympic Boulevard, Los Angeles, CA, 90024, United States
| | - Hossein Montazerian
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, United States
- Terasaki Institute for Biomedical Innovation, 11570 W Olympic Boulevard, Los Angeles, CA, 90024, United States
| | - Avijit Baidya
- California NanoSystems Institute, University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, United States
| | - Maryam Tavafoghi
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, United States
| | - Yi Chen
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, United States
- Terasaki Institute for Biomedical Innovation, 11570 W Olympic Boulevard, Los Angeles, CA, 90024, United States
| | - Yangzhi Zhu
- Terasaki Institute for Biomedical Innovation, 11570 W Olympic Boulevard, Los Angeles, CA, 90024, United States
| | - Solmaz Karamikamkar
- Terasaki Institute for Biomedical Innovation, 11570 W Olympic Boulevard, Los Angeles, CA, 90024, United States
| | - Amir Sheikhi
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, United States
- Department of Chemical Engineering, The Pennsylvania State University, University Park, PA, 16802, United States
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, United States
| | - Ali Khademhosseini
- Department of Bioengineering, University of California, Los Angeles, 410 Westwood Plaza, Los Angeles, CA, 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, 570 Westwood Plaza, Los Angeles, CA, 90095, United States
- Terasaki Institute for Biomedical Innovation, 11570 W Olympic Boulevard, Los Angeles, CA, 90024, United States
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Al-Attar N, Gaer J, Giordano V, Harris E, Kirk A, Loubani M, Meybohm P, Sayeed R, Stock U, Travers J, Whiteman B. Multidisciplinary paper on patient blood management in cardiothoracic surgery in the UK: perspectives on practice during COVID-19. J Cardiothorac Surg 2023; 18:96. [PMID: 37005650 PMCID: PMC10066978 DOI: 10.1186/s13019-023-02195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/29/2023] [Indexed: 04/04/2023] Open
Abstract
The coronavirus (COVID-19) pandemic disrupted all surgical specialties significantly and exerted additional pressures on the overburdened United Kingdom (UK) National Health Service. Healthcare professionals in the UK have had to adapt their practice. In particular, surgeons have faced organisational and technical challenges treating patients who carried higher risks, were more urgent and could not wait for prehabilitation or optimisation before their intervention. Furthermore, there were implications for blood transfusion with uncertain patterns of demand, reductions in donations and loss of crucial staff because of sickness and public health restrictions. Previous guidelines have attempted to address the control of bleeding and its consequences after cardiothoracic surgery, but there have been no targeted recommendations in light of the recent COVID-19 challenges. In this context, and with a focus on the perioperative period, an expert multidisciplinary Task Force reviewed the impact of bleeding in cardiothoracic surgery, explored different aspects of patient blood management with a focus on the use of haemostats as adjuncts to conventional surgical techniques and proposed best practice recommendations in the UK.
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Affiliation(s)
- Nawwar Al-Attar
- Golden Jubilee National Hospital, University of Glasgow, Agamemnon Street, Clydebank, Glasgow, G81 4DY, Scotland, UK.
| | - Jullien Gaer
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Vincenzo Giordano
- Department of Cardiothoracic Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Emma Harris
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Alan Kirk
- Department of Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Würzburg, Germany
| | - Rana Sayeed
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ulrich Stock
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jennifer Travers
- West of Scotland Cancer Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Becky Whiteman
- Cluster Medical Manager Advanced Surgery - UKI and Nordics Worldwide Medical, Baxter Healthcare Limited, Berkshire, UK
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The use of sealing hemostat patch (HEMOPATCH ®) in laparotomic myomectomy: a prospective case-control study. Arch Gynecol Obstet 2023; 307:1521-1528. [PMID: 36790464 DOI: 10.1007/s00404-023-06957-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Uterine myomas are the most common gynecological disease. In these cases, a myomectomy is performed traditionally laparotomically. However, alternatives have been widely used, including laparoscopic, endoscopic, and robotic surgery. During these techniques, diffuse parenchymatous bleeding remains one of the main intraoperative and postoperative complications and sometimes requires unplanned hysterectomies. Recently, hemostatic agents and sealants have been used to prevent excessive blood loss during surgical repair. METHODS We propose a prospective case-control study on the use of a sealing hemostat patch (HEMOPATCH®) on uterine sutures in laparotomic myomectomy. In the period between July 2016 and April 2017, 46 patients with symptomatic uterine fibromatosis underwent surgery. They were divided into two groups of 23 patients, with different treatments in the hemostatic phase of oozing bleeding. HEMOPATCH® is applied in group A, and spray electrocoagulation is applied in group B. RESULTS In group A, we achieve faster hemostasis (p < 0.05), than in group B. We report a significantly lower C-reactive protein value on the second and third days after surgery for group A compared to group B. CONCLUSIONS HEMOPATCH®, during laparotomic myomectomy, is a valid alternative solution for obtaining rapid hemostasis and consequently intraoperative and postoperative bleeding. Furthermore, we suggest that a lower inflammatory peritoneal state is probably correlated with the barrier effect of the patch on the suture.
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10
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Guo Y, Cheng N, Sun H, Hou J, Zhang Y, Wang D, Zhang W, Chen Z. Advances in the development and optimization strategies of the hemostatic biomaterials. Front Bioeng Biotechnol 2023; 10:1062676. [PMID: 36714615 PMCID: PMC9873964 DOI: 10.3389/fbioe.2022.1062676] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
Most injuries are accompanied by acute bleeding. Hemostasis is necessary to relieve pain and reduce mortality in these accidents. In recent years, the traditional hemostatic materials, including inorganic, protein-based, polysaccharide-based and synthetic materials have been widely used in the clinic. The most prominent of these are biodegradable collagen sponges (Helistat®, United States), gelatin sponges (Ethicon®, SURGIFOAM®, United States), chitosan (AllaQuixTM, ChitoSAMTM, United States), cellulose (Tabotamp®, SURGICEL®, United States), and the newly investigated extracellular matrix gels, etc. Although these materials have excellent hemostatic properties, they also have their advantages and disadvantages. In this review, the performance characteristics, hemostatic effects, applications and hemostatic mechanisms of various biomaterials mentioned above are presented, followed by several strategies to improve hemostasis, including modification of single materials, blending of multiple materials, design of self-assembled peptides and their hybrid materials. Finally, the exploration of more novel hemostatic biomaterials and relative coagulation mechanisms will be essential for future research on hemostatic methods.
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Affiliation(s)
- Yayuan Guo
- Faculty of Life Science, Northwest University, Xi’an, Shaanxi Province, China
| | - Nanqiong Cheng
- Faculty of Life Science, Northwest University, Xi’an, Shaanxi Province, China
| | - Hongxiao Sun
- Faculty of Life Science, Northwest University, Xi’an, Shaanxi Province, China
| | - Jianing Hou
- Faculty of Life Science, Northwest University, Xi’an, Shaanxi Province, China
| | - Yuchen Zhang
- Faculty of Life Science, Northwest University, Xi’an, Shaanxi Province, China
| | - Du Wang
- Faculty of Life Science, Northwest University, Xi’an, Shaanxi Province, China
| | - Wei Zhang
- Faculty of Life Science, Northwest University, Xi’an, Shaanxi Province, China,School of Medicine, Northwest University, Xi’an, Shaanxi Province, China
| | - Zhuoyue Chen
- Faculty of Life Science, Northwest University, Xi’an, Shaanxi Province, China,School of Medicine, Northwest University, Xi’an, Shaanxi Province, China,*Correspondence: Zhuoyue Chen,
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11
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Danker W, Kelkar SS, Marston XL, Aggarwal J, Johnston SS. Real-world economic and clinical outcomes associated with current hemostatic matrix use in spinal surgery. J Comp Eff Res 2022; 11:1231-1240. [PMID: 36306241 DOI: 10.2217/cer-2021-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: Bleeding during spine surgery is controlled using topical hemostatic agents. Studies have reported outcomes between Surgiflo® and Floseal, the most widely used flowable hemostatic matrices, but have not included the latest Surgiflo formulation which is more adherent to the bleeding surface than prior formulations. Materials & methods: A propensity score-matched analysis was conducted using the Premier Healthcare Database to compare economic and clinical outcomes of adults undergoing inpatient spinal surgery between 2013 and 2018 receiving current Surgiflo or Floseal. Results: This retrospective study included 28,910 patients in each group and found comparable outcomes for bleeding events, overall transfusion rate, inpatient mortality and readmissions between Surgiflo and Floseal. Surgiflo was associated with $430 (USD) lower hospitalization costs, shorter length of stay and shorter operating room time than Floseal.
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12
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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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Li J, Yu X, Martinez EE, Zhu J, Wang T, Shi S, Shin SR, Hassan S, Guo C. Emerging Biopolymer-Based Bioadhesives. Macromol Biosci 2021; 22:e2100340. [PMID: 34957668 DOI: 10.1002/mabi.202100340] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/23/2021] [Indexed: 12/13/2022]
Abstract
Bioadhesives have been widely used in healthcare and biomedical applications due to their ease-of-operation for wound closure and repair compared to conventional suturing and stapling. However, several challenges remain for developing ideal bioadhesives, such as unsatisfied mechanical properties, non-tunable biodegradability, and limited biological functions. Considering these concerns, naturally derived biopolymers have been considered good candidates for making bioadhesives owing to their ready availability, facile modification, tunable mechanical properties, and desired biocompatibility and biodegradability. Over the past several years, remarkable progress has been made on biopolymer-based adhesives, covering topics from novel materials designs and advanced processing to clinical translation. The developed bioadhesives have been applied for diverse applications, including tissue adhesion, hemostasis, antimicrobial, wound repair/tissue regeneration, and skin-interfaced bioelectronics. Here in this comprehensive review, recent progress on biopolymer-based bioadhesives is summarized with focuses on clinical translations and multifunctional bioadhesives. Furthermore, challenges and opportunities such as weak adhesion strength at the hydrated state, mechanical mismatch with tissues, and unfavorable immune responses are discussed with an aim to facilitate the future development of high-performance biopolymer-based bioadhesives.
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Affiliation(s)
- Jinghang Li
- School of Engineering, Westlake University, Hangzhou, Zhejiang Province, 310024, China.,School of Materials Science and Engineering, Wuhan Institute of Technology, Wuhan, Hubei Province, 430205, China
| | - Xin Yu
- School of Engineering, Westlake University, Hangzhou, Zhejiang Province, 310024, China
| | | | - Jiaqing Zhu
- School of Materials Science and Engineering, Wuhan Institute of Technology, Wuhan, Hubei Province, 430205, China
| | - Ting Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, China
| | - Shengwei Shi
- School of Materials Science and Engineering, Wuhan Institute of Technology, Wuhan, Hubei Province, 430205, China
| | - Su Ryon Shin
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Shabir Hassan
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Chengchen Guo
- School of Engineering, Westlake University, Hangzhou, Zhejiang Province, 310024, China
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Sabab A, Vreugde S, Jukes A, Wormald PJ. The potential of chitosan-based haemostats for use in neurosurgical setting - Literature review. J Clin Neurosci 2021; 94:128-134. [PMID: 34863426 DOI: 10.1016/j.jocn.2021.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 09/01/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022]
Abstract
Haemorrhage is a major nuance in neurosurgery since blood can distort the surgeon's field of view and increase the risk of post-operative complications. Currently a variety of commercially available haemostats have been approved for use in neurosurgery, but they have caveats to their use in the brain, including, localised tissue compression, neural toxicity, induce immune reaction or form thrombus within the vessel. Thus, there is a need for haemostats that are efficacious and safe for application on brain and spinal tissue. Chitosan is a naturally occurring bio-polymer that is found on the exoskeleton of arthropods and the cell wall of fungi. Chitosan has been shown to accelerate haemostasis through a myriad of physiological pathways. These findings have led to the development of multiple chitosan-based haemostats, for use in peripheral human tissue. Although, clinical data regarding the use of chitosan-based haemostats in the brain is lacking, a range on in vivo studies have proven chitosan to be efficacious and safe in managing neurosurgical bleeds. Similarly, literature comparing chitosan-based haemostats with commercial haemostats used commonly in neurosurgery, have all demonstrated chitosan to be the superior agent. Additionally, clinical trials of chitosan-based haemostat used in peripheral tissue have all demonstrated chitosan to be safe for human use. The marriage of these findings indicates that the safety and superior efficacy of chitosan-based haemostat, makes it a potentially suitable haemostat for use in neurosurgical setting. However, further research pertaining to the clinical use of chitosan-based haemostat within the central nervous system needs to be conducted.
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Affiliation(s)
- Ahad Sabab
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Alistair Jukes
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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15
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Kasapoglu MB, Cebi AT, Olgac NV, Keskin C. The sole and combined effects of gelatin-thrombin matrix and freeze-dried bone allograft on early bone healing. Niger J Clin Pract 2021; 24:1545-1550. [PMID: 34657024 DOI: 10.4103/njcp.njcp_41_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims Gelatin-thrombin matrix (GTM) is a hemostatic agent with applications in maxillofacial surgery consisting of human-derived thrombin and bovine-derived gelatin matrix. The aim of this study was to evaluate the efficacy of GTM alone or with freeze-dried bone allograft (FDBA) in improving early bone healing. Materials and Methods Forty-six adult male Sprague-Dawley rats were used. All animals were randomly assigned to a control group (n = 4) and three study groups (n = 14). Each group was divided into two subgroups for histomorphometric and histological analyses at weeks 1 and 4. The new bone formation, inflammation, fibrosis, necrosis, foreign body reaction, and bone healing scores were evaluated based on the histopathological findings. Multiple comparisons were performed using the Kruskal-Wallis test. Variables that were not normally distributed were evaluated using the Mann-Whitney U test. Results At 1 week, the GTM + FDBA group showed less bone formation (mean ± SD: 0.08 ± 0.03 mm2), compared with the study and control groups (FDBA: 0.15 ± 0.06 mm2; GTM: 0.13 ± 0.06 mm2). At 4 weeks, the GTM group (0.48 ± 0.1 mm2) showed more bone formation than the GTM + FDBA group (0.33 ± 0.17 mm2). Foreign body reactions were observed at weeks 1 and 4 in all GTM-containing groups. Conclusions Within the limitations of this study, GTM group did not show a significant difference in bone formation compared with the control group. GTM did not inhibit bone healing at 1 and 4 weeks, and no significant difference was observed compared with the control groups. GTM was more effective for bone healing when administered without FDBA. GTM is considered safe when bone hemorrhage is encountered.
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Affiliation(s)
- M B Kasapoglu
- Department of Oral and Maillofacial Surgery, Faculty of Dentistry, Istanbul University, Turkey
| | - A T Cebi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Karabuk University, Turkey
| | - N V Olgac
- Department of Oncology Institute, Clinical Oncology, Istanbul University, Turkey
| | - C Keskin
- Department of Oral and Maillofacial Surgery, Faculty of Dentistry, Istanbul University, Turkey
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Sabab A, Liu S, Javadiyan S, McAdam CJ, Hanton LR, Jukes A, Vreugde S, Wormald PJ. The effect of chemical and structural modifiers on the haemostatic process and cytotoxicity of the beta-chitin patch. Sci Rep 2021; 11:18577. [PMID: 34535704 PMCID: PMC8448852 DOI: 10.1038/s41598-021-97781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/30/2021] [Indexed: 12/03/2022] Open
Abstract
Beta-chitin patch has previously been proven to be an effective haemostat, but whether modifying the patch affects its efficacy and safety, remains unanswered. In this study, the patch was modified using polyethylene oxide, Pluronic-F127, calcium, increased thickness or polyphosphate, and their effect on the process of haemostasis and cytotoxicity was tested and compared with standard-of-care, Surgicel and FloSeal. Whole blood collected from volunteers was applied to the patches to test their whole blood clotting and thrombin generation capacities, whilst platelet isolates were used to test their platelet aggregation ability. The fluid absorption capacity of the patches was tested using simulated body fluid. Cytotoxicity of the patches was tested using AlamarBlue assays and PC12 cells and the results were compared with the standard-of-care. In this study, beta-chitin patch modifications failed to improve its whole blood clotting, platelet aggregation and thrombin generation capacity. Compared to non-modified patch, modifications with polyethylene oxide or calcium reduced platelet aggregation and thrombin generation capacity, while increasing the thickness or adding polyphosphate decreased platelet aggregation capacity. The cytotoxicity assays demonstrated that the beta-chitin patches were non-toxic to cells. In vivo research is required to evaluate the safety and efficacy of the beta-chitin patches in a clinical setting.
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Affiliation(s)
- Ahad Sabab
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia.
| | - Sha Liu
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Shari Javadiyan
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - C John McAdam
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | - Lyall R Hanton
- Department of Chemistry, University of Otago, Dunedin, New Zealand
| | - Alistair Jukes
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Sarah Vreugde
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Peter-John Wormald
- Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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Park SM, Kang DR, Lee JH, Jeong YH, Shin DA, Yi S, Ha Y, Kim KN. Efficacy and Safety of a Thrombin-Containing Collagen-Based Hemostatic Agent in Spinal Surgery: A Randomized Clinical Trial. World Neurosurg 2021; 154:e215-e221. [PMID: 34246825 DOI: 10.1016/j.wneu.2021.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE When common hemostatic methods, such as suturing, cautery, and compression, fail to arrest bleeding during surgery, various local hemostatic agents are used. We aimed to evaluate the hemostatic efficacy and safety of CollaStat (Dalim Tissen Co. Ltd., Seoul, Korea), a novel thrombin-containing, collagen-based topical haemostatic agent used in spinal surgery, by comparing it with Floseal (Baxter Healthcare, Deerfield, Illinois, USA). METHODS We performed a randomized controlled trial in 78 patients who underwent spinal surgery. The participants were randomly assigned to either an intervention group (use of CollaStat) or a control group (use of Floseal). We compared successful haemostasis rate, time to hemostasis, length of hospital stay, amount of fluid drainage, and rate of adverse events between the 2 groups. RESULTS The hemostasis success rate was 94.87% in the intervention group and 97.44% in the control group. The hemostatic efficacy and safety of CollaStat were found to be noninferior to those of Floseal since the higher limit (11.09%) of the confidence interval (CI) for the difference with Floseal was greater than the prespecified noninferiority margin of -13%. There were no statistically significant differences at the 5% level in hemostasis time, number of hemostatic agents used, hospitalization period, and amount of drainage between the 2 groups. Also, there was no incidence of medical device-related serious adverse events or adverse events in both groups. CONCLUSIONS The hemostatic efficacy and safety of CollaStat were found to be noninferior to those of Floseal. Therefore CollaStat can be safely and effectively used in spinal surgery.
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Affiliation(s)
- Sang Man Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Dae Ryong Kang
- Department of Precision Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jun Hyeok Lee
- Department of Biostatistics, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Yeong Ha Jeong
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
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The role of hemostatic devices in neurosurgery. A systematic review. J Clin Neurosci 2021; 89:151-157. [PMID: 34119260 DOI: 10.1016/j.jocn.2021.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/15/2021] [Accepted: 05/02/2021] [Indexed: 11/23/2022]
Abstract
Hemostasis represents a fundamental step in every surgical procedure. During neurosurgical procedures, proper and robust hemostasis into confined spaces can significantly reduce the odds of perioperative complications. Over the decades, multiple methods have been applied, and several medical devices have been developed to promote and guarantee proper hemostasis. This study presents a systematic review of the most used intraoperative hemostatic methods and devices in neurosurgery. Insightful research was performed on the PubMed database according to the PRISMA guidelines. This comprehensive review of scientific literature represents a synoptic panel where the most used intraoperative hemostatic methods and devices available today in neurosurgery are classified and described.
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Zhong Y, Hu H, Min N, Wei Y, Li X, Li X. Application and outlook of topical hemostatic materials: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:577. [PMID: 33987275 DOI: 10.21037/atm-20-7160] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bleeding complications can cause significant morbidities and mortalities in both civilian and military conditions. The formation of stable blood clots or hemostasis is essential to prevent major blood loss and death from excessive bleeding. However, the body's self-coagulation process cannot accomplish timely hemostasis without the assistance of hemostatic agents under some conditions. In the past two decades, topical hemostatic materials and devices containing platelets, fibrin, and polysaccharides have been gradually developed and introduced to induce faster or more stable blood clot formation, updating or iterating traditional hemostatic materials. Despite the various forms and functions of topical hemostatic materials that have been developed for different clinical conditions, uncontrolled hemorrhage still causes over 30% of trauma deaths across the world. Therefore, it is important to fabricate fast, efficient, safe, and ready-to-use novel hemostatic materials. It is necessary to understand the coagulation process and the hemostatic mechanism of different materials to develop novel topical hemostatic agents, such as tissue adhesives and sealants from various natural and synthetic materials. This review discusses the structural features of topical hemostatic materials related to the stimulation of hemostasis, summarizes the commercially available products and their applications, and reviews the ongoing clinical trials and recent studies concerning the development of different hemostatic materials.
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Affiliation(s)
- Yuting Zhong
- Department of General Surgery, Chinese PLA Hospital & Chinese PLA Medical School, Beijing, China
| | - Huayu Hu
- School of Medicine, Nankai University, Tianjin, China
| | - Ningning Min
- School of Medicine, Nankai University, Tianjin, China
| | - Yufan Wei
- School of Medicine, Nankai University, Tianjin, China
| | - Xiangdong Li
- State Key Laboratory of Agrobiotechnology, College of Biological Sciences, China Agricultural University, Beijing, China
| | - Xiru Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
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Bal-Ozturk A, Cecen B, Avci-Adali M, Topkaya SN, Alarcin E, Yasayan G, Ethan YC, Bulkurcuoglu B, Akpek A, Avci H, Shi K, Shin SR, Hassan S. Tissue Adhesives: From Research to Clinical Translation. NANO TODAY 2021; 36:101049. [PMID: 33425002 PMCID: PMC7793024 DOI: 10.1016/j.nantod.2020.101049] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Sutures, staples, clips and skin closure strips are used as the gold standard to close wounds after an injury. In spite of being the present standard of care, the utilization of these conventional methods is precarious amid complicated and sensitive surgeries such as vascular anastomosis, ocular surgeries, nerve repair, or due to the high-risk components included. Tissue adhesives function as an interface to connect the surfaces of wound edges and prevent them from separation. They are fluid or semi-fluid mixtures that can be easily used to seal any wound of any morphology - uniform or irregular. As such, they provide alternatives to new and novel platforms for wound closure methods. In this review, we offer a background on the improvement of distinctive tissue adhesives focusing on the chemistry of some of these products that have been a commercial success from the clinical application perspective. This review is aimed to provide a guide toward innovation of tissue bioadhesive materials and their associated biomedical applications.
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Affiliation(s)
- Ayça Bal-Ozturk
- Department of Analytical Chemistry, Faculty of Pharmacy, Istinye University, 34010, Zeytinburnu, Istanbul, Turkey
- Department of Stem Cell and Tissue Engineering, Institute of Health Sciences, Istinye University, 34010 Istanbul, Turkey
| | - Berivan Cecen
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Cambridge, MA 02139, USA
| | - Meltem Avci-Adali
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tuebingen, Calwerstraße 7/1, 72076 Tuebingen, Germany
| | - Seda Nur Topkaya
- Department of Analytical Chemistry, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey
| | - Emine Alarcin
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Marmara University, 34668, Haydarpasa, Istanbul, Turkey
| | - Gokcen Yasayan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Marmara University, 34668, Haydarpasa, Istanbul, Turkey
| | - Yi-Chen Ethan
- Department of Chemical Engineering, Feng Chia University, Taichung, Taiwan
| | | | - Ali Akpek
- Institute of Biotechnology, Gebze Technical University, 41400, Gebze Kocaeli-Turkey
- Department of Bioengineering, Gebze Technical University, 41400, Gebze Kocaeli-Turkey
- Sabanci University Nanotechnology Research & Application Center, 34956, Tuzla Istanbul-Turkey
| | - Huseyin Avci
- Department of Metallurgical and Materials Engineering, Faculty of Engineering and Architecture Eskisehir Osmangazi University Eskisehir Turkey
| | - Kun Shi
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Cambridge, MA 02139, USA
| | - Su Ryon Shin
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Cambridge, MA 02139, USA
| | - Shabir Hassan
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Cambridge, MA 02139, USA
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Abstract
Polymeric tissue adhesives provide versatile materials for wound management and are widely used in a variety of medical settings ranging from minor to life-threatening tissue injuries. Compared to the traditional methods of wound closure (i.e., suturing and stapling), they are relatively easy to use, enable rapid application, and introduce minimal tissue damage. Furthermore, they can act as hemostats to control bleeding and provide a tissue-healing environment at the wound site. Despite their numerous current applications, tissue adhesives still face several limitations and unresolved challenges (e.g., weak adhesion strength and poor mechanical properties) that limit their use, leaving ample room for future improvements. Successful development of next-generation adhesives will likely require a holistic understanding of the chemical and physical properties of the tissue-adhesive interface, fundamental mechanisms of tissue adhesion, and requirements for specific clinical applications. In this review, we discuss a set of rational guidelines for design of adhesives, recent progress in the field along with examples of commercially available adhesives and those under development, tissue-specific considerations, and finally potential functions for future adhesives. Advances in tissue adhesives will open new avenues for wound care and potentially provide potent therapeutics for various medical applications.
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Affiliation(s)
- Sungmin Nam
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02134, United States.,Wyss Institute for Biologically Inspired Engineering, Cambridge, Massachusetts 02115, United States
| | - David Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02134, United States.,Wyss Institute for Biologically Inspired Engineering, Cambridge, Massachusetts 02115, United States
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Malik A, Rehman FU, Shah KU, Naz SS, Qaisar S. Hemostatic strategies for uncontrolled bleeding: A comprehensive update. J Biomed Mater Res B Appl Biomater 2021; 109:1465-1477. [PMID: 33511753 DOI: 10.1002/jbm.b.34806] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022]
Abstract
Uncontrolled bleeding remains the leading cause of morbidity and mortality across the entire macrocosm. It refers to excessive loss of blood that occurs inside of body, due to unsuccessful platelet plug formation at the injury site. It is not only limited to the battlefield, but remains the second leading cause of death amongst the civilians, as a result of traumatic injury. Startlingly, there are no effective treatments currently available, to cater the issue of internal bleeding, even though early intervention is of utmost significance in minimizing the mortality rates associated with it. The fatal issue of uncontrolled bleeding is ineffectively being dealt with the use of pressure dressings, tourniquet, and surgical procedures. This is not a practical approach in combat arenas or in emergency situations, where the traumatic injury inflicted is deep inside the body, and cannot be addressed externally, by the application of topical dressings. This review focuses on the traditional hemostatic agents that are used to augment the process of hemostasis, such as mineral zeolites, chitosan based products, biologically active agents, anti-fibrinolytics, absorbable agents, and albumin and glutaraldehyde, as well as the micro- and nano-based hemostatic agents such as synthocytes, thromboerythrocytes, thrombosomes, and the synthetic platelets.
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Affiliation(s)
- Annum Malik
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Fiza Ur Rehman
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Syeda Sohaila Naz
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan
| | - Sara Qaisar
- Nanosciences and Technology Department, National Centre for Physics, Quaid-i-Azam University Campus, Islamabad, Pakistan
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Bomba HN, Sheets KT, Valdivia A, Khagi S, Ruterbories L, Mariani CL, Borst LB, Tokarz DA, Hingtgen SD. Personalized-induced neural stem cell therapy: Generation, transplant, and safety in a large animal model. Bioeng Transl Med 2021; 6:e10171. [PMID: 33532581 PMCID: PMC7823134 DOI: 10.1002/btm2.10171] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
In this study, we take an important step toward clinical translation by generating the first canine-induced neural stem cells (iNSCs). We explore key aspects of scale-up, persistence, and safety of personalized iNSC therapy in autologous canine surgery models. iNSCs are a promising new approach to treat aggressive cancers of the brain, including the deadly glioblastoma. Created by direct transdifferentiation of fibroblasts, iNSCs are known to migrate through the brain, track down invasive cancer foci, and deliver anticancer payloads that significantly reduce tumor burden and extend survival of tumor-bearing mice. Here, skin biopsies were collected from canines and converted into the first personalized canine iNSCs engineered to carry TNFα-related apoptosis-inducing ligand (TRAIL) and thymidine kinase (TK), as well as magnetic resonance imaging (MRI) contrast agents for in vivo tracking. Time-lapse analysis showed canine iNSCs efficiently migrate to human tumor cells, and cell viability assays showed both TRAIL and TK monotherapy markedly reduced tumor growth. Using intraoperative navigation and two delivery methods to closely mimic human therapy, canines received autologous iNSCs either within postsurgical cavities in a biocompatible matrix or via a catheter placed in the lateral ventricle. Both strategies were well tolerated, and serial MRI showed hypointense regions at the implant sites that remained stable through 86 days postimplant. Serial fluid sample testing following iNSC delivery showed the bimodal personalized therapy was well tolerated, with no iNSC-induced abnormal tissue pathology. Overall, this study lays an important foundation as this promising personalized cell therapy advances toward human patient testing.
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Affiliation(s)
- Hunter N. Bomba
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of PharmacyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kevin T. Sheets
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of PharmacyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Alain Valdivia
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of PharmacyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Simon Khagi
- Department of NeurosurgeryThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer CenterThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Laura Ruterbories
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Christopher L. Mariani
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
- Comparative Medicine InstituteNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Luke B. Borst
- Department of Population Health and Pathobiology, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Debra A. Tokarz
- Department of Population Health and Pathobiology, College of Veterinary MedicineNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Shawn D. Hingtgen
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of PharmacyThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Lineberger Comprehensive Cancer CenterThe University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Shin KH, Choe JH, Jang KM, Han SB. Use of bone wax reduces blood loss and transfusion rates after total knee arthroplasty. Knee 2020; 27:1411-1417. [PMID: 33010755 DOI: 10.1016/j.knee.2020.07.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/18/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unnecessary costs and complications can be reduced by minimizing blood loss and allogeneic blood transfusion in cases of total knee arthroplasty (TKA). This study evaluated the effectiveness of bone wax in reducing blood loss and transfusion rates after TKA. METHODS A total of 674 consecutive TKAs performed for degenerative osteoarthritis were retrospectively reviewed. Propensity score-matching and inverse probability of treatment weighting analyses were performed for demographics, comorbidities, use of medications, preoperative laboratory findings and radiologic prosthetic coverage of osteotomy surface. In the bone wax group, bone wax (2.5 g) was applied to the uncovered bone section around the prostheses along with the topical administration of tranexamic acid, whereas hemostasis was achieved in the control group with the topical administration of tranexamic acid. Intergroup comparisons of estimated blood loss, decreases in hemoglobin (Hb) levels, and transfusion rates were performed. RESULTS The mean estimated blood loss and volume of postoperative drainage were reduced in the bone wax group. The maximum decreases in Hb levels on postoperative days 1, 3, 5, and 7 were 1.8 ± 0.7 ml, 2.5 ± 0.8 ml, 2.7 ± 0.8 ml, and 2.8 ± 0.8 ml in the bone wax group and 2.1 ± 1.0 ml, 3.0 ± 1.2 ml, 3.1 ± 1.1 ml, and 3.2 ± 1.1 ml in the control group, respectively. The postoperative transfusion rates decreased markedly from 8.8% to 2.0% when bone wax was used. CONCLUSIONS The use of bone wax significantly reduced blood loss, decreased Hb levels, and the risk of transfusion. LEVEL OF EVIDENCE Level III, Therapeutic studies.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jeong-Hun Choe
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
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25
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Varshosaz J, Choopannejad Z, Minaiyan M, Kharazi AZ. Rapid hemostasis by nanofibers of polyhydroxyethyl methacrylate/polyglycerol sebacic acid: An in vitro
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in vivo study. J Appl Polym Sci 2020. [DOI: 10.1002/app.49785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jaleh Varshosaz
- Novel Drug Delivery Systems Research Center, Department of Pharmaceutics, School of Pharmacy and Pharmaceutical Sciences Isfahan University of Medical Sciences Isfahan Iran
| | - Zahra Choopannejad
- Novel Drug Delivery Systems Research Center, Department of Pharmaceutics, School of Pharmacy and Pharmaceutical Sciences Isfahan University of Medical Sciences Isfahan Iran
| | - Mohsen Minaiyan
- Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences Isfahan University of Medical Sciences Isfahan Iran
| | - Anousheh Zargar Kharazi
- Department of Biomaterials, Tissue Engineering and Nanotechnology School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences Isfahan Iran
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26
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Li D, Chen J, Wang X, Zhang M, Li C, Zhou J. Recent Advances on Synthetic and Polysaccharide Adhesives for Biological Hemostatic Applications. Front Bioeng Biotechnol 2020; 8:926. [PMID: 32923431 PMCID: PMC7456874 DOI: 10.3389/fbioe.2020.00926] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
Rapid hemostasis and formation of stable blood clots are very important to prevent massive blood loss from the excessive bleeding for living body, but their own clotting process cannot be completed in time for effective hemostasis without the help of hemostatic materials. In general, traditionally suturing and stapling techniques for wound closure are prone to cause the additional damages to the tissues, activated inflammatory responses, short usage periods and inevitable second operations in clinical applications. Especially for the large wounds that require the urgent closure of fluids or gases, these conventional closure methods are far from enough. To address these problems, various tissue adhesives, sealants and hemostatic materials are placed great expectation. In this review, we focused on the development of two main categories of tissue adhesive materials: synthetic polymeric adhesives and naturally derived polysaccharide adhesives. Research of the high performance of hemostatic adhesives with strong adhesion, better biocompatibility, easy usability and cheap price is highly demanded for both scientists and clinicians, and this review is also intended to provide a comprehensive summarization and inspiration for pursuit of more advanced hemostatic adhesives for biological fields.
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Affiliation(s)
- Dawei Li
- Eighth Medical Center of the General Hospital of the Chinese People’s Liberation Army, Beijing, China
| | - Jing Chen
- Department of Orthopedics, Aerospace Center Hospital, Beijing, China
| | - Xing Wang
- Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Mingming Zhang
- The People’s Liberation Army Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Chunlin Li
- Eighth Medical Center of the General Hospital of the Chinese People’s Liberation Army, Beijing, China
| | - Jin Zhou
- Eighth Medical Center of the General Hospital of the Chinese People’s Liberation Army, Beijing, China
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27
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Jang JH, Moon JH, Kim SG, Kim SY. Pulp regeneration with hemostatic matrices as a scaffold in an immature tooth minipig model. Sci Rep 2020; 10:12536. [PMID: 32719323 PMCID: PMC7385085 DOI: 10.1038/s41598-020-69437-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022] Open
Abstract
Control of blood clotting in root canal systems is one of the most critical and difficult concerns for regenerative endodontics therapy (RET). The purpose of this study was to investigate the effects of using gelatin- and fibrin-based hemostatic hydrogels as a scaffold on pulp regeneration in a minipig model. Cell viability of human dental pulp stem cells cultured three-dimensionally in gelatin-based and fibrin-based scaffolds was evaluated by MTT and live/dead assay. RET was performed on 24 immature premolars with an autologous blood clot (PC), gelatin-based and fibrin-based hemostatic matrices (GM and FM), or without the insertion of a scaffold (NC). The follow-up period was 12 weeks. Radiographic and histologic assessments for pulp regeneration were performed. Gelatin-based scaffolds exhibited significantly higher cell viability than fibrin-based scaffolds after 15 days (P < 0.05). The PC and GM groups showed favorable root development without inflammation and newly mineralized tissue deposited in the root canal system, while FM group presented inflammatory changes with the continuation of root development. The NC group exhibited internal root resorption with periapical lesions. The application of GM in RET led to favorable clinical outcomes of root development without inflammatory changes compared to conventional RET. Our results suggest that GM may serve as a viable regenerative scaffold for pulp regeneration.
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Affiliation(s)
- Ji-Hyun Jang
- Department of Conservative Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Joung-Ho Moon
- Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehakno, Jongno-gu, Seoul, 03080, Korea
| | - Sahng Gyoon Kim
- Division of Endodontics, College of Dental Medicine, Columbia University, New York, NY, USA.
| | - Sun-Young Kim
- Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehakno, Jongno-gu, Seoul, 03080, Korea.
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28
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A comprehensive review of topical hemostatic agents: The good, the bad, and the novel. J Trauma Acute Care Surg 2020; 88:e1-e21. [PMID: 31626024 DOI: 10.1097/ta.0000000000002508] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Uncontrolled exsanguination remains the leading cause of death for trauma patients, many of whom die in the pre-hospital setting. Without expedient intervention, trauma-associated hemorrhage induces a host of systemic responses and acute coagulopathy of trauma. For this reason, health care providers and prehospital personal face the challenge of swift and effective hemorrhage control. The utilization of adjuncts to facilitate hemostasis was first recorded in 1886. Commercially available products haves since expanded to include topical hemostats, surgical sealants, and adhesives. The ideal product balances efficacy, with safety practicality and cost-effectiveness. This review of hemostasis provides a guide for successful implementation and simultaneously highlights future opportunities.
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29
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Pacheco M, Barros AA, Aroso IM, Autorino R, Lima E, Silva JM, Reis RL. Use of hemostatic agents for surgical bleeding in laparoscopic partial nephrectomy: Biomaterials perspective. J Biomed Mater Res B Appl Biomater 2020; 108:3099-3123. [PMID: 32458570 DOI: 10.1002/jbm.b.34637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
Abstract
In recent years, there was an abrupt increase in the incidence of renal tumors, which prompt up the appearance of cutting-edge technology, including minimally invasive and organ-preserving approaches, such as laparoscopic partial nephrectomy (LPN). LPN is an innovative technique used to treat small renal masses that have been gaining popularity in the last few decades due to its promissory results. However, the bleeding control remains the main challenge since the majority of currently available hemostatic agents (HAs) used in other surgical specialities are inefficient in LPN. This hurried the search for effective HAs adapted for LPN surgical peculiarities, which resulted on the emergence of different types of topical HAs. The most promising are the natural origin HAs because of their inherent biodegradability, biocompatibility, and lowest toxicity. These properties turn them top interests' candidates as HAs in LPN. In this review, we present a deep overview on the progress achieved in the design of HAs based on natural origin polymers, highlighting their distinguishable characteristics and providing a clear understanding of their hemostat's role in LPN. This way it may be possible to establish a structure-composition properties relation, so that novel HAs for LPN can be designed to explore current unmet medical needs.
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Affiliation(s)
- Margarida Pacheco
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexandre A Barros
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ivo M Aroso
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Estêvão Lima
- School of Health Sciences, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal.,Surgical Sciences Research Domain, Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Joana M Silva
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Avepark-Parque de Ciência e Tecnologia, Barco Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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30
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Ortenzi M, Haji A. Safety and feasibility of PuraStat ® in laparoscopic colorectal surgery (Feasibility study). MINIM INVASIV THER 2020; 30:363-368. [PMID: 32174207 DOI: 10.1080/13645706.2020.1739711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Haemorrhage remains a major cause of morbidity and death in all surgical specialties. The aim of this study was to analyse the feasibility of PuraStat®, a new synthetic haemostatic device, made of self-assembling peptides in laparoscopic colorectal surgery.Material and methods: This was a prospective observational non-randomised study. Consecutive patients undergoing laparoscopic colorectal surgery were enrolled. Inclusion criterion was the need employ a secondary method of haemostasis when traditional methods such as conventional pressure or utilization of energy devices to control the bleeding were either insufficient or not recommended.Results: Twenty patients were enrolled. The mean time to apply the product was 40 secs (±17 secs), whereas the mean time to achieve haemostasis was 17.5 secs (±3.5 secs). There were no post-operative complications in this cohort of 20 patients. Mean operative time overall was 185 mins (±45.2 mins). None of the patients experienced delayed post-operative bleeding and the mean hospital stay was five days (±3,4).Conclusions: We demonstrated that PuraStat® can be easily used in laparoscopic surgery and it is a safe, effective haemostatic agent. This is a feasibility study and additional controlled studies would be useful in the future.
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Affiliation(s)
- Monica Ortenzi
- Clinica Chirurgica, Università Politecnica delle Marche, Ancona, Italy.,Colorectal Depertment, King's College Hopital, London, UK
| | - Amyn Haji
- Colorectal Depertment, King's College Hopital, London, UK
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31
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Kamamoto D, Kanazawa T, Ishihara E, Yanagisawa K, Tomita H, Ueda R, Jinzaki M, Yoshida K, Toda M. Efficacy of a topical gelatin-thrombin hemostatic matrix, FLOSEAL ®, in intracranial tumor resection. Surg Neurol Int 2020; 11:16. [PMID: 32123604 PMCID: PMC7049874 DOI: 10.25259/sni_272_2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/15/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Hemostasis plays an important role in safe brain tumor resection and also reduces the risk for surgical complications. This study aimed to evaluate the efficacy of FLOSEAL®, a topical hemostatic agent that contains thrombin and gelatin granules, in brain tumor resections. Methods: We evaluated the hemostatic effect of FLOSEAL by scoring the intensity of bleeding from 1 (mild) to 4 (life threatening). We assessed the rate of success of hemostasis with 100 patients who underwent intracranial tumor resection. We also investigated the duration of the operation, the amount of intra- and postoperative bleeding, the number of hospital stays, and adverse events in patients who used FLOSEAL compared with those who did not use FLOSEAL. Results: FLOSEAL was applied to a total of 109 bleeding areas in 100 patients. A total of 95 bleeding areas had a score of 1 and 91 (96%) showed successful hemostasis. Thirteen bleeding areas scored 2 and 8 (62%) showed hemostasis with the first application of FLOSEAL. The second application was attempted with five bleeding areas and four showed hemostasis. About 94% (103/109 areas) of bleeding points successfully achieved hemostasis by FLOSEAL. Moreover, FLOSEAL significantly decreased the amount of intraoperative bleeding and postoperative bleeding as assessed with computed tomography on 1 day postoperatively compared with no use of FLOSEAL. There were no adverse events related to FLOSEAL use. Conclusion: Our results indicate that FLOSEAL is a reliable, convenient, and safe topical hemostatic agent for intracranial tumor resection.
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Affiliation(s)
- Dai Kamamoto
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo
| | - Tokunori Kanazawa
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo
| | - Eriko Ishihara
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo
| | - Kaoru Yanagisawa
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo
| | - Hideyuki Tomita
- Department of Neurosurgery, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga city, Tochigi
| | - Ryo Ueda
- Department of Neurosurgery, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki city, Kanagawa
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo
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32
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Zhu H, Mei X, He Y, Mao H, Tang W, Liu R, Yang J, Luo K, Gu Z, Zhou L. Fast and High Strength Soft Tissue Bioadhesives Based on a Peptide Dendrimer with Antimicrobial Properties and Hemostatic Ability. ACS APPLIED MATERIALS & INTERFACES 2019; 12:4241-4253. [PMID: 31859475 DOI: 10.1021/acsami.9b18720] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Haofang Zhu
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
| | - Xingheng Mei
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
| | - Yiyan He
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
| | - Hongli Mao
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
| | - Wenbo Tang
- The Second Department of Hepato-Pancreato-Biliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing 100853, P.R. China
| | - Rong Liu
- The Second Department of Hepato-Pancreato-Biliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing 100853, P.R. China
| | - Jun Yang
- The Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Science, Nankai University, Tianjin 300071, P.R. China
| | - Kui Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and molecular imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Zhongwei Gu
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and molecular imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Lian Zhou
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
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33
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Lee JM, Wu V, Faughnan ME, Lasso A, Figol A, Kilty SJ. Prospective pilot study of Floseal® for the treatment of anterior epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT). J Otolaryngol Head Neck Surg 2019; 48:48. [PMID: 31615556 PMCID: PMC6794791 DOI: 10.1186/s40463-019-0379-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/24/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Epistaxis is the most common symptom of hereditary hemorrhagic telangiectasia (HHT), affecting more than 98% of adults with HHT, with significant impact on quality of life. Floseal® has been shown to be effective for the management of anterior epistaxis, but has yet to be thoroughly evaluated in this population. Our goal was to evaluate the efficacy of Floseal® for managing acute anterior epistaxis in patients with HHT. METHODS A pilot prospective clinical trial was conducted at two tertiary referral centres, St. Michael's Hospital, Toronto, Canada and The Ottawa Hospital, Ottawa, Canada. All patients with HHT presenting with acute anterior epistaxis to the two study centres, who enrolled in the study, received Floseal® treatment. The primary outcome measures were achievement of hemostasis and changes in the Epistaxis Severity Score (ESS) between baseline and one-month follow up. Secondary outcome measure included clinical assessment of the nasal cavity. RESULTS Seven patients were included in the final analysis. All patients underwent treatment of anterior epistaxis with Floseal® and achieved control of epistaxis within 15-min post-application. Application of Floseal® was well tolerated, with patients reporting a pain score of 3 ± 3.13 out of 10. There was no statistically significant difference noted in ESS scores pre-treatment and one-month follow up, 6.27 ± 2.42 vs. 4.50 ± 2.44, p = 0.179. There was a significant improvement clinically on exam of the nasal cavity between baseline and at one-month follow up, indicated by a decrease in the clinical assessment score, 17.29 ± 7.70 vs. 9.57 ± 7.81 (p = 0.0088). CONCLUSIONS Patients with HHT presenting with acute epistaxis were able to achieve hemostasis with one application of Floseal®, with the procedure being very well tolerated with minimal pain. Although there was no significant change in ESS scores, clinical assessment of the nasal cavity revealed significant improvement at one-month follow up post treatment with Floseal®. TRIAL REGISTRATION This multi-centered prospective clinical trial was registered with ClinicalTrials.gov ( NCT02638012 ). Registered on December 22, 2015.
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Affiliation(s)
- John M Lee
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, 190 Elizabeth Street, Rm 3S-438, TGH RFE Building, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Vincent Wu
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, 190 Elizabeth Street, Rm 3S-438, TGH RFE Building, Toronto, Canada.
| | - Marie E Faughnan
- Toronto HHT Centre, Division of Respirology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Andrea Lasso
- Department of Otolaryngology - Head and Neck Surgery, Ottawa Hospitals, University of Ottawa, Ottawa, Canada
| | - Andrea Figol
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, University of Toronto, 190 Elizabeth Street, Rm 3S-438, TGH RFE Building, Toronto, Canada
| | - Shaun J Kilty
- Department of Otolaryngology - Head and Neck Surgery, Ottawa Hospitals, University of Ottawa, Ottawa, Canada
- Dr. S. Kilty Medicine Professional Corporation, Ottawa, Canada
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34
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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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35
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Lied GA, Lund KB, Storaas T. Intraoperative anaphylaxis to gelatin-based hemostatic agents: a case report. J Asthma Allergy 2019; 12:163-167. [PMID: 31354307 PMCID: PMC6590631 DOI: 10.2147/jaa.s202784] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/22/2019] [Indexed: 11/23/2022] Open
Abstract
Surgiflo Haemostatic Matrix is an absorbable gelatin matrix hemostatic material that has been widely used in various surgical operations to assist hemostasis. Nonetheless, as biologically active agents (contains porcine gelatin), there is potential for allergic reactions to these products. Here, we report the case of a 71-year-old man who had intraoperative anaphylaxis with cardiovascular events to gelatin associated with the use of a topical hemostatic agent (Surgiflo). The patient reported a history of red meat allergy and tick bites during his allergological examination after anaphylaxis. He also had high levels of specific IgE antibodies towards alpha-gal. Special consideration should be given before administering bovine- or porcine-derived gelatin products during surgery to patients with animal-related allergies, such as alpha-gal or gelatin allergy and an atopic background.
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Affiliation(s)
- Gülen Arslan Lied
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Section of Clinical Allergy, Department of Occupational Diseases
- Section of Gastroenterology, Department of Medicine
| | - Kjetil Børve Lund
- Department for Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Torgeir Storaas
- Section of Clinical Allergy, Department of Occupational Diseases
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36
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Abstract
Uncontrolled surgical bleeding can have significant clinical and economic consequences including advanced medical expenses and impairment of the outcomes. Effective and safe local hemostatic agents based on a fluid active hemostatic matrix are reviewed in the article. The use of this agent is followed by reduced hospital-stay, number of redo interventions for bleeding, reduced time of surgery, intra- and postoperative complication rate and high economic efficiency.
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Affiliation(s)
- A B Zemlyanoy
- Pirogov National Medical and Surgical Center of Ministry of Health of Russia, Moscow, Russia
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37
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Effects of Combined Use of Ultrasonic Bone Scalpel and Hemostatic Matrix on Perioperative Blood Loss and Surgical Duration in Degenerative Thoracolumbar Spine Surgery. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6286258. [PMID: 31236410 PMCID: PMC6545750 DOI: 10.1155/2019/6286258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/28/2019] [Indexed: 02/07/2023]
Abstract
How to decrease intraoperative bleeding, shorten surgical time, and increase safety in spinal surgery is an important issue. Ultrasonic bone removers and FloSeal have been proven to increase safety, reduce the surgical duration, and decrease intraoperative bleeding in skull base surgery. Therefore, we aimed to compare the surgical duration, blood loss, and complications during spinal surgery with or without the use of FloSeal and an ultrasonic bone scalpel. Therefore, we retrospectively reviewed 293 patients who underwent thoracolumbar spinal surgery with decompression and instrumented fusion performed by a single surgeon. We divided these patients into three groups, including nonuse of FloSeal nor a bone scalpel (group A), use of FloSeal only (group B), and use of FloSeal and a bone scalpel (group C) intraoperatively after pairing in terms of age, sex, and surgical level. The surgical duration, blood loss, and occurrence of complications were all recorded. The mean surgical duration in group A was 160 mins, in group B it was 167 mins, and in group C it was 134 mins. The mean blood loss was 700 ml in group A, 682 ml in group B, and 383 ml in group C. Six patients sustained intraoperative dura injuries in total, 3 in group A, 2 in group B, and 1 in group C. No postoperative neurologic defects or occurrences of hematoma were recorded. According to our results, we concluded that combined use of FloSeal and bone scalpels is recommended during primary thoracolumbar spinal surgery to reduce the intraoperative blood loss and shorten the surgical duration.
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Paulo D, Semonche A, Choudhry O, Al-Mufti F, Prestigiacomo CJ, Roychowdhury S, Nanda A, Gupta G. History of Hemostasis in Neurosurgery. World Neurosurg 2018; 124:S1878-8750(18)32837-7. [PMID: 30579020 DOI: 10.1016/j.wneu.2018.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 11/17/2022]
Abstract
Control of bleeding in the confined area of the skull is imperative for successful neurosurgery and the prevention of devastating complications such as postoperative hemorrhage. This paper reviews the historical evolution of methods to achieve successful hemostasis in neurosurgery from the early1800s to today. The major categories of hemostatic agents (mechanical, chemical and thermal) are delineated and discussed in chronological order. The significance of this article is in its detailed history of the kinds of hemostatic methods that have evolved with our accumulating medical and surgical knowledge, which may inform future innovations and improvements.
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Affiliation(s)
- Danika Paulo
- Rutgers Robert Wood Johnson Medical School, Department of Neurosurgery, Clinical Academic Building Suite 2100, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Alexa Semonche
- Rutgers Robert Wood Johnson Medical School, Department of Neurosurgery, Clinical Academic Building Suite 2100, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Osamah Choudhry
- New York University, Department of Neurological Surgery, 550 1st Avenue, Skirball, Suite 8R, New York, NY 10016, United States
| | - Fawaz Al-Mufti
- University Hospital, Department of Neurology, 90 Bergen Street, Suite 5200, Newark, NJ 07101, United States
| | - Charles J Prestigiacomo
- Rutgers New Jersey Medical School, Department of Neurosurgery, Doctor's Office Center 90 Bergen Street, Newark, NJ 07101, United States
| | - Sudipta Roychowdhury
- Robert Wood Johnson University Hospital, Department of Radiology, Medical Education Building Suite #04, 1 Robert Wood Johnson Pl, New Brunswick, NJ 08901, United States
| | - Anil Nanda
- Robert Wood Johnson Medical School, Department of Neurosurgery, Clinical Academic Building Suite 2100, 125 Paterson St, New Brunswick, NJ 08901, United States
| | - Gaurav Gupta
- Robert Wood Johnson Medical School, Department of Neurosurgery, Clinical Academic Building Suite 2100, 125 Paterson St, New Brunswick, NJ 08901, United States.
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Mutascio LM, Breur GJ, Moore GE, Simons MC. Effects of a surgical sealant on leakage pressure and circumference of fresh canine cadaver small intestinal anastomoses. Am J Vet Res 2018; 79:1335-1340. [DOI: 10.2460/ajvr.79.12.1335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pereira BM, Bortoto JB, Fraga GP. Agentes hemostáticos tópicos em cirurgia: revisão e perspectivas. Rev Col Bras Cir 2018; 45:e1900. [DOI: 10.1590/0100-6991e-20181900] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023] Open
Abstract
RESUMO A hemostasia tem papel crítico e importância fundamental em todos os procedimentos cirúrgicos. Seu manejo possui diversos pontos chaves, que se iniciam por boa técnica operatória e adequado suporte anestésico. Determinadas situações, como hemorragias graves resultantes de trauma penetrante, por exemplo, não dependem exclusivamente do controle da equipe cirúrgica e necessitam do apoio de novas soluções que diminuam ou controlem a hemorragia. Desde os tempos antigos, um marco da medicina é atuar no controle da hemorragia e, mais recentemente, na facilitação da hemostasia pela aplicação de agentes tópicos, seja por compressão manual ou agentes modernos. Na última década, o número de diferentes agentes hemostáticos tópicos cresceu drasticamente. Para que o cirurgião moderno escolha o agente correto no momento correto, é essencial que conheça o mecanismo de ação, entenda a eficácia e os possíveis efeitos adversos relacionados a cada agente. Assim, a grande variedade de hemostáticos tópicos, somada à ausência de um artigo de revisão na literatura nacional sobre este tópico, nos estimulou a elaborar este manuscrito. Aqui relatamos uma revisão detalhada sobre os agentes hemostáticos tópicos mais comumente utilizados nas especialidades cirúrgicas.
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Ramirez MG, Deutsch H, Khanna N, Cheatem D, Yang D, Kuntze E. Floseal only versus in combination in spine surgery: a comparative, retrospective hospital database evaluation of clinical and healthcare resource outcomes. Hosp Pract (1995) 2018; 46:189-196. [PMID: 29986148 DOI: 10.1080/21548331.2018.1498279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Flowable agents such as Floseal® (F) are often reserved as adjuncts to non-flowable agents (i.e. gelatin (G) sponges and thrombin (T)) when bleeding is not sufficiently controlled. Based on their perceived positive impact, it is postulated that flowable agents alone may result in better clinical and resource utilization outcomes. Clinical and health-care utilization outcomes were compared in this retrospective analysis of spine surgery cases with charges for Floseal only (FO) and F + G/T. METHODS The United States Premier Hospital Database was searched for adult spine surgeries performed between October 2010 and September 2015 with FO or F and G/T charges. To obtain an unbiased treatment estimate, 1:1 propensity-score matching was used to identify FO and F + G/T cohorts. The cohorts were compared for rates of intraoperative, perioperative, postoperative and transfusion; blood loss-related, serious and other complications; hospital length-of-stay (LOS), surgical time, and volume of hemostat charged. RESULTS Among 40,335 spine surgeries, 15,105 FO and F + G/T matched pairs were compared. Significantly (p < 0.0001) lower percentages of FO than F + G/T cases received intraoperative (1.4% vs. 2.5%), perioperative (1.6% vs. 2.8%), postoperative (1.6% vs 3.0%), and any transfusion (2.3% vs. 4.3%). FO cases had significantly less blood loss complications than F + G/T cases (0.5% vs. 0.8%, p = 0.0022) and significantly (p < 0.0001) shorter hospital LOS (-0.45 days), surgical time (-39.0 min), and used less hemostat (-12.5 mL). CONCLUSIONS Results from this observational hospital database analyses indicate that FO use in spine surgery is associated with lower blood transfusion use and blood loss complications compared to its use with adjunct non-flowable hemostatic agents. The shorter hospital stay, reduced surgical time, and less hemostat volume health-care utilization outcomes that favored FO versus combination use may translate to health system cost savings. Further validation of these findings using controlled clinical trials and cost-consequence studies is warranted. CLINICAL RELEVANCE The use of flowable hemostatic agents alone may result in better clinical and possibly economic outcomes in spine surgery.
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Affiliation(s)
| | - Harel Deutsch
- b Department of Neurosurgery , Rush University , Chicago , IL , USA
| | - Nitin Khanna
- c Department of Orthopedics , Indiana University School of Medicine , Munster , IN , USA
| | | | - Dongyan Yang
- a Baxter Healthcare Corporation , Deerfield , IL , USA
| | - Erik Kuntze
- a Baxter Healthcare Corporation , Deerfield , IL , USA
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Mısırlıoğlu S, Türkgeldi E, Yağmur H, Urman B, Ata B. Use of a gelatin-thrombin hemostatic matrix in obstetrics and gynecological surgery. Turk J Obstet Gynecol 2018; 15:193-199. [PMID: 30202631 PMCID: PMC6127479 DOI: 10.4274/tjod.90217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/24/2018] [Indexed: 12/28/2022] Open
Abstract
Gelatin-thrombin matrix (GTM) is a hemostatic sealant consisting of bovine-derived gelatin matrix and human-derived thrombin, combining both mechanical and active mechanisms to achieve hemostasis. It was approved by the Food and Drug Administration in 1999. GTM has been used by several surgical specialties; however, it is a possibly an under-used tool in obstetrics and gynecology. A limited number of studies have been performed on its use during laparoscopic endometrioma excision and myomectomy. It may prove useful in endometrioma excision in reproductive aged women because it is likely to harm ovarian reserve less than electrocautery; however, this conclusion needs to be validated. The only study on GTM use in myomectomy included 50 women randomized into GTM and control groups, and showed decreased blood loss and shorter hospital stays in the GTM group. In gynecologic oncology, it was successfully used to reduce lymphocele cases in a cohort study. GTM has been used successfully in obstetrics in a handful of cases of uncontrolled bleeding from caesarean scar, placental site, ectopic pregnancy, rectovaginal hematoma, and venous plexus over the vaginal vault after emergency postpartum hysterectomy. Risk of viral transmission is a major concern about GTM, yet there are no reports on disease transmission with GTM use to date. Rare but serious adverse effects and complications have been reported such as fatal or near-fatal thromboembolism and small bowel obstruction. Although GTM is mostly a safe product, it is still not free of complications and risks. In conclusion, although routine use of GTM cannot be recommended due to concerns about its safety, cost, and availability, it may prove useful when conventional hemostatic methods such as suturing and electrocauterization fail or are not appropriate.
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Affiliation(s)
- Selim Mısırlıoğlu
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Engin Türkgeldi
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Hande Yağmur
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Bülent Urman
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Barış Ata
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Chung JPW, Leung TY. Uses of FloSeal © in obstetric hemorrhage: Case series and literature review. Taiwan J Obstet Gynecol 2018; 56:827-830. [PMID: 29241928 DOI: 10.1016/j.tjog.2017.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE FloSeal© has been shown to be an alternative and effective method of hemostasis. The current study examines the various uses of FloSeal© in obstetric hemorrhage and gives an overview of the literature. CASE REPORTS In this retrospective case review, a total of 11 cases with obstetric hemorrhage were reviewed throughout a period of one year. All but one case was successful in using FloSeal© in arresting the bleeding with hysterectomy avoided. FloSeal© can be considered when bleeding occurs locally at the placental bed, bladder base, adhesiolysis site, vaginal tears or at suture holes. CONCLUSION FloSeal© was a quick and effective alternative for hemostasis and should be considered when conventional hemostatic techniques fails or is impractical.
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Affiliation(s)
- Jacqueline Pui-Wah Chung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N. T., Hong Kong.
| | - Tak-Yeung Leung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N. T., Hong Kong
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Sakoda M, Kaneko M, Ohta S, Qi P, Ichimura S, Yatomi Y, Ito T. Injectable Hemostat Composed of a Polyphosphate-Conjugated Hyaluronan Hydrogel. Biomacromolecules 2018; 19:3280-3290. [DOI: 10.1021/acs.biomac.8b00588] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Megumu Sakoda
- Department of Bioengineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | | | | | | | - Shigetoshi Ichimura
- Department of Applied Bioscience, Kanagawa Institute of Technology, 1030 Shimo-ogino, Atsugi, Kanagawa 243-0292, Japan
| | | | - Taichi Ito
- Department of Bioengineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
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Murray S, Mendez A, Hopkins A, El-Hakim H, Jeffery CC, Côté DWJ. Management of Persistent Epistaxis Using Floseal Hemostatic Matrix vs. traditional nasal packing: a prospective randomized control trial. J Otolaryngol Head Neck Surg 2018; 47:3. [PMID: 29310703 PMCID: PMC5759868 DOI: 10.1186/s40463-017-0248-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epistaxis is the most common emergent consultation to otolaryngology-head & neck surgery (OHNS) and with 60% of the population having experienced an episode and 1.6 in 10,000 requiring hospitalization in their lifetime. In preliminary studies Floseal® (Baxter, USA) Hemostatic Matrix has shown efficacy in up to 80% of persistent anterior epistaxis. We sought to evaluate the clinical efficacy and cost-effectiveness of Floseal® (Baxter, USA) compared to traditional nasal packing for persistent epistaxis. METHODS A prospective, randomized controlled trial was conducted on all adult patients consulted to the OHNS service at the tertiary referral centers of the University of Alberta Hospital and Royal Alexandra Hospital for persistent epistaxis. Patients were randomized to the Floseal® (Baxter, USA) or traditional packing study arms. Our main clinical outcome measures were: 1) Hemostasis directly following treatment and at 48 h post-treatment, and 2) self-reported patient comfort at 48 h post-treatment. Further, trial data was used for a formal cost-effectiveness analysis to determine incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis and uncertainty analysis were performed. RESULTS There were no significant differences between groups for initial hemostasis (76.9% vs. 84.6%, p = 1.000) or, hemostasis at 48 h (76.9% vs. 69.2%, p = 1.000), requirement for admission (15.4% vs. 46.1%, p = 0.2016) or 30-day re-presentation rates (15.4% vs. 46.1%, p = 0.2016). Floseal® (Baxter, USA) was superior for decreased pain during placement (2.42 vs. 7.77, p = 0.0022), treatment (0.50 vs. 4.46, p = 0.0007) and removal (0 vs. 3.85, p = 0.0021). Floseal® (Baxter, USA) provides an average $1567.61 per patient savings from the single-payer system point of view and has an ICER of - $11,891 per re-bleed prevented (95% CI: -$37,658 to +$473). Uncertainty analysis shows that Floseal® has >90% chance of not only being cost-effective, but the dominant (preferred) treatment. CONCLUSIONS Floseal® (Baxter, USA) was demonstrated to be an effective, comfortable and cost-effective alternative treatment of persistent epistaxis when compared to traditional packing methods for patients referred to OHNS with a normal coagulation profile. TRIAL REGISTRATION Trial registration number: NCT02488135 . Date registered: June 26, 2015.
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Affiliation(s)
- Scott Murray
- University of Alberta, Faculty of Medicine, Edmonton, AB, Canada. .,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Adrian Mendez
- University of Alberta, Faculty of Medicine, Edmonton, AB, Canada.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Hamdy El-Hakim
- University of Alberta, Faculty of Medicine, Edmonton, AB, Canada.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - Caroline C Jeffery
- University of Alberta, Faculty of Medicine, Edmonton, AB, Canada.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - David W J Côté
- University of Alberta, Faculty of Medicine, Edmonton, AB, Canada.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
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Synergy in thrombin-graphene sponge for improved hemostatic efficacy and facile utilization. Colloids Surf B Biointerfaces 2018; 161:27-34. [DOI: 10.1016/j.colsurfb.2017.10.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 11/21/2022]
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Hangge P, Stone J, Albadawi H, Zhang YS, Khademhosseini A, Oklu R. Hemostasis and nanotechnology. Cardiovasc Diagn Ther 2017; 7:S267-S275. [PMID: 29399530 DOI: 10.21037/cdt.2017.08.07] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hemorrhage accounts for significant morbidity and mortality. Various techniques have been employed to augment hemostasis from simple tourniquets to self-assembling nanoparticles. A growing understanding of the natural clotting cascade has allowed agents to become more targeted for potential use in different clinical scenarios. This review discusses current and developing hemostatic techniques, including matrix agents, external agents, biologically inspired agents, and synthetic and cell-derived nanoparticles.
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Affiliation(s)
- Patrick Hangge
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Jonathan Stone
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Yu Shrike Zhang
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Rahmi Oklu
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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Wang G, Li ZB, Cao CL. Methods of hemostasis in abdominal surgery. Shijie Huaren Xiaohua Zazhi 2017; 25:2866-2872. [DOI: 10.11569/wcjd.v25.i32.2866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hemorrhage is one of the common concomitant conditions during abdominal surgeries, and it is also the main cause of non-planed secondary surgery. There are various methods for abdominal surgical hemostasis. How to adopt reasonable methods to manage intraoperative bleeding promptly and effectively has bothered surgeons for a long time. With the development of minimally invasive technology and surgical instruments, laparoscopy and more hemostasis techniques have been widely used during abdominal surgery. This article summarizes the methods of hemostasis during abdominal surgery.
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Affiliation(s)
- Gang Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Zong-Bei Li
- Department of General Surgery, Beijing Chuiyangliu Hospital, Beijing 100022, China
| | - Cheng-Liang Cao
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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Abstract
Spine procedures are associated with high rates of blood loss which can result in a greater need for transfusions. Repeated exposure to blood products is associated with risks and adverse reactions such as transfusion-related acute lung injury, fluid shifting, and infections. With the higher number of spine procedures and the increasing open surgery times associated with difficult procedures, excessive blood loss has become more prevalent. Perioperative methods have been established to combat the excessive blood loss and decrease the need for blood products. Preoperatively, anemia and coagulopathy screening is standard at least 4 weeks before elective procedures. Erythropoietin, iron loading or transfusions are used to decrease preoperative anemia, a predisposing factor for blood loss. Autologous predonation of blood has been shown to be ineffective and decreases preoperative hemoglobin levels. Intraoperatively, antifibrinolytics such as tranexamic acid and aminocaproic acid are used to decrease blood loss. In addition, fibrinogen concentrates, thromboelastometry, acute normovolemic hemodilution, controlled hypotension, and temperature regulation are some of the techniques used to decrease blood loss and the need for transfusions. Postoperatively, fibrin sealants, shed blood salvage, and erythropoietin or intravenous iron are used in management of blood loss, especially in instances when the patient refuses blood products.
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Martorana E, Rocco B, Kaleci S, Pirola GM, Bevilacqua L, Bonetti LR, Puliatti S, Micali S, Bianchi G. Does topical hemostatic agent (Floseal ®) have a long-term adverse effect on erectile function recovery after nerve-sparing robot-assisted radical prostatectomy? Int Urol Nephrol 2017; 49:1519-1526. [PMID: 28677091 DOI: 10.1007/s11255-017-1645-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the long-term effects of Floseal® on erectile function recovery (EFR) after nerve-sparing robot-assisted radical prostatectomy (RALP). METHODS We prospectively collected results of the self-administered International Index Erectile Function Questionnaire 1-5 and 15 (IIEF 1-5 and 15) of 532 consecutive patients who underwent RALP for prostate cancer in our institution between October 2007 and December 2015. Patients were divided into two groups according to Floseal® application after prostatectomy. They were enrolled according to the following criteria: (a) bilateral nerve-sparing procedure; (b) preoperative IIEF ≥ 17; adherence to our erectile rehabilitation protocol; (c) 1-year follow-up. Outcomes were measured as mean IIEF score, EFR (IIEF < 17 or ≥17), grade of ED: severe (IIEF < 17), moderate (17-21), mild (22-25) and no ED (>25). RESULTS A total of 120 patients were enrolled. Group A included 40 consecutive patients who received traditional hemostasis, and Group B included 80 consecutive patients in which Floseal® was additionally used. No differences were observed in terms of preoperative mean IIEF score (p = 0.65). Group B patients showed a trend toward a higher mean IIEF score 3 months after surgery (p = 0.06) but no differences in terms of EFR (p = 1.000). Long-term results (6, 9, 12 months after surgery) showed a significantly and progressively higher mean IIEF score (p = 0.04, 0.003, 0.003) and EFR (p = 0.043, 0.027, 0.004) in Group A patients. Comparison between the groups in terms of severe, moderate, mild and no ED becomes significant at 9 and 12 months (p = 0.002, 0.006). CONCLUSION The results of our study suggest that local use of Floseal® worsens the long-term erectile function recovery in patients selected for nerve-sparing RALP.
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Affiliation(s)
- Eugenio Martorana
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Department of Medical Statistic, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Maria Pirola
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy. .,Department of Urology, Policlinico di Modena, Via del Pozzo, 71, 41124, Modena, Italy.
| | - Luigi Bevilacqua
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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