Management of haemostasis in surgery: sealant and glue applications

An in vitro analysis of the hemostatic efficacy of fibrinogen precipitation with varied keratin fraction compositions

In preclinical studies, human hair has demonstrated effective hemostatic properties, potentially attributed to keratin proteins facilitating rapid conversion of fibrinogen to fibrin during coagulation. However, the rational use of human hair keratin for hemostasis remains unclear, given its complex mixture of proteins with diverse molecular weights and structures, leading to variable hemostatic capacity. To optimize the rational utilization of human hair keratin for hemostasis, we investigated the effects of different keratin fractions on keratin-mediated fibrinogen precipitation using a fibrin generation assay. Our study focused on high molecular weight keratin intermediate filaments (KIFs) and lower molecular weight keratin-associated proteins (KAPs) combined in various ratios during the fibrin generation. Scanning electron microscope analysis of the precipitates revealed a filamentous pattern with a broad distribution of fiber diameters, likely due to the diversity of keratin mixtures involved. An equal proportion of KIFs and KAPs in the mixture yielded the most extensive precipitation of soluble fibrinogen in an in vitro study, potentially due to structure-induced exposure of active sites. However, all hair protein samples exhibited diverse catalytic behaviors compared to thrombin, highlighting the potential of utilizing specific hair fractions to develop hair protein-based hemostatic materials with optimized capacity.

Hydrogel transformed from sandcastle-worm-inspired powder for adhering wet adipose surfaces

Normally, hydrogel adhesives do not perform well on adipose matters that are covered with bodily fluids. Besides, the maintenance of high extensibility and self-healing ability in fully swollen state still remains challenging. Based on these concerns, we reported a sandcastle-worm-inspired powder, which was made of tannic acid-functionalized cellulose nanofiber (TA-CNF), polyacrylic acid (PAA) and polyethyleneimine (PEI). The obtained powder can rapidly absorb diverse bodily fluids and transform into a hydrogel, displaying fast (＜3 s), self-strengthening and repeatable wet adhesion to adipose tissues. Due to the dense physically cross-linked network, the formed hydrogel still showed excellent extensibility (∼14 times) and self-healing ability after being immersed in water. Moreover, excellent hemostasis, antibacterial ability and biocompatibility make it suitable for numerous biomedical applications. With combined advantages of powders and hydrogels, such as good adaptability to irregular sites, efficient drug loading capacity and tissue affinity, the sandcastle-worm-inspired powder offers significant promise as tissue adhesive and repair materials. This work may open new avenues for designing high-performance bioadhesives with efficient and robust wet adhesiveness to adipose tissues.

Palmieri's double suture skin repair: a new double suture approach to cases of skin cancer and ulcerative lesions

We describe two case reports to assess the efficacy of a new method suitable to close small-sized pressure ulcers and cancer-related skin lesions.

Hemostatic strategies for traumatic and surgical bleeding

Wide interest in new hemostatic approaches has stemmed from unmet needs in the hospital and on the battlefield. Many current commercial hemostatic agents fail to fulfill the design requirements of safety, efficacy, cost, and storage. Academic focus has led to the improvement of existing strategies as well as new developments. This review will identify and discuss the three major classes of hemostatic approaches: biologically derived materials, synthetically derived materials, and intravenously administered hemostatic agents. The general class is first discussed, then specific approaches discussed in detail, including the hemostatic mechanisms and the advancement of the method. As hemostatic strategies evolve and synthetic-biologic interactions are more fully understood, current clinical methodologies will be replaced.