1
|
Baskar Murthy A, Palaniappan V, Karthikeyan K. Aluminium in dermatology - Inside story of an innocuous metal. Indian J Dermatol Venereol Leprol 2024; 0:1-9. [PMID: 38595024 DOI: 10.25259/ijdvl_188_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/23/2023] [Indexed: 04/11/2024]
Abstract
Aluminium, the third most abundant element in the earth's crust, was long considered virtually innocuous to humans but has gained importance in the recent past. Aluminium is ubiquitous in the environment, with various sources of exposure like cosmetics, the food industry, occupational industries, the medical field, transport and electronics. Aluminium finds its utility in various aspects of dermatology as an effective haemostatic agent, anti-perspirant and astringent. Aluminium has a pivotal role to play in wound healing, calciphylaxis, photodynamic therapy and vaccine immunotherapy with diagnostic importance in Finn chamber patch testing and confocal microscopy. The metal also finds significance in cosmetic procedures like microdermabrasion and as an Nd:YAG laser component. It is important to explore the allergic properties of aluminium, as in contact dermatitis and vaccine granulomas. The controversial role of aluminium in breast cancer and breast cysts also needs to be evaluated by further studies.
Collapse
Affiliation(s)
- Aravind Baskar Murthy
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry, India
| | - Vijayasankar Palaniappan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry, India
| | - Kaliaperumal Karthikeyan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry, India
| |
Collapse
|
2
|
Banasiewicz T, Machała W, Borejsza Wysocki M, Lesiak M, Krych S, Lange M, Hogendorf P, Durczyński A, Cwaliński J, Bartkowiak T, Dziki A, Kielan W, Kłęk S, Krokowicz Ł, Kusza K, Myśliwiec P, Pędziwiatr M, Richter P, Sobocki J, Szczepkowski M, Tarnowski W, Zegarski W, Zembala M, Zieniewicz K, Wallner G. Principles of minimize bleeding and the transfusion of blood and its components in operated patients - surgical aspects. POLISH JOURNAL OF SURGERY 2023; 95:14-39. [PMID: 38084044 DOI: 10.5604/01.3001.0053.8966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.
Collapse
Affiliation(s)
- Tomasz Banasiewicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Waldemar Machała
- Klinika Anestezjologii i Intensywnej Terapii - Uniwersytecki Szpital Kliniczny im. Wojskowej Akademii Medycznej - Centralny Szpital Weteranów, Łódź
| | - Maciej Borejsza Wysocki
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Maciej Lesiak
- Katedra i Klinika Kardiologii Uniwersytetu Medycznego im. K. Marcinkowskiego w Poznaniu
| | - Sebastian Krych
- Katedra i Klinika Kardiochirurgii, Transplantologii, Chirurgii Naczyniowej i Endowaskularnej SUM. Studenckie Koło Naukowe Kardiochirurgii Dorosłych. Śląski Uniwersytet Medyczny w Katowicach
| | - Małgorzata Lange
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Hogendorf
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Adam Durczyński
- Klinika Chirurgii Ogólnej i Transplantacyjnej, Uniwersytet Medyczny w Łodzi
| | - Jarosław Cwaliński
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Tomasz Bartkowiak
- Oddział Kliniczny Anestezjologii, Intensywnej Terapii i Leczenia Bólu, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu
| | - Adam Dziki
- Klinika Chirurgii Ogólnej i Kolorektalnej Uniwersytetu Medycznego w Łodzi
| | - Wojciech Kielan
- II Katedra i Klinika Chirurgii Ogólnej i Chirurgii Onkologicznej, Uniwersytet Medyczny we Wrocławiu
| | - Stanisław Kłęk
- Klinika Chirurgii Onkologicznej, Narodowy Instytut Onkologii - Państwowy Instytut Badawczy im. Marii Skłodowskiej-Curie, Oddział w Krakowie, Kraków
| | - Łukasz Krokowicz
- Klinika Chirurgii Ogólnej, Endokrynologicznej i Onkologii Gastroenterologicznej, Instytut Chirurgii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Krzysztof Kusza
- Katedra i Klinika Anestezjologii i Intensywnej Terapii, Uniwersytet Medyczny im K. Marcinkowskiego w Poznaniu
| | - Piotr Myśliwiec
- I Klinika Chirurgii Ogólnej i Endokrynologicznej, Uniwersytet Medyczny w Białymstoku
| | - Michał Pędziwiatr
- Katedra Chirurgii Ogólnej, Wydział Lekarski, Uniwersytet Jagielloński - Collegium Medicum, Kraków
| | - Piotr Richter
- Oddział Kliniczny Chirurgii Ogólnej, Onkologicznej i Gastroenterologicznej Szpital Uniwersytecki w Krakowie
| | - Jacek Sobocki
- Katedra i Klinika Chirurgii Ogólnej i Żywienia Klinicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawski Uniwersytet Medyczny, Warszawa
| | - Marek Szczepkowski
- Klinika Chirurgii Kolorektalnej, Ogólnej i Onkologicznej, Centrum Medyczne Kształcenia Podyplomowego, Szpital Bielański, Warszawa
| | - Wiesław Tarnowski
- Klinika Chirurgii Ogólnej, Onkologicznej i Bariatrycznej CMKP, Szpital im. Prof. W. Orłowskiego, Warszawa
| | | | - Michał Zembala
- Wydział Medyczny, Katolicki Uniwersytet Lubelski Jana Pawła II w Lublinie
| | - Krzysztof Zieniewicz
- Katedra i Klinika Chirurgii Ogólnej, Transplantacyjnej i Wątroby, Warszawski Uniwersytet Medyczny, Warszawa
| | - Grzegorz Wallner
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie
| |
Collapse
|
3
|
Ohkura N. Potential applications of Chinese herbal medicines with hemostatic properties. Drug Discov Ther 2022; 16:112-117. [PMID: 35753799 DOI: 10.5582/ddt.2022.01037] [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: 11/05/2022]
Abstract
Various herbal medicines with hemostatic properties have been applied for centuries to accelerate hemostasis and control bleeding. However, the mechanisms of action and active constituents remain unknown. This report provides an overview of current clinical hemostatic agents and their disadvantages, then focuses on the clinical value of Chinese herbal medicines with unique hemostatic features that modern medicines lack. A comprehensive review of hemostatic agents derived from Chinese herbal medicines and their potential medical applications is also presented.
Collapse
Affiliation(s)
- Naoki Ohkura
- Laboratory of Host Defense, Department of Medical and Pharmaceutical Sciences, School of Pharma-Sciences, Teikyo University, Japan
| |
Collapse
|
4
|
Rezabeigi E, Schmitt C, Hadj Henni A, Barkun AN, Nazhat SN. In Vitro Evaluation of Real-Time Viscoelastic and Coagulation Properties of Various Classes of Topical Hemostatic Agents Using a Novel Contactless Nondestructive Technology. ACS APPLIED MATERIALS & INTERFACES 2022; 14:16047-16061. [PMID: 35352550 DOI: 10.1021/acsami.2c01741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Hemorrhaging is the main cause of death among combat and civilian injuries and has significant clinical and economic consequences. Despite their vital roles in bleeding management, an optimal topical hemostatic agent (HA) has yet to be developed for a particular scenario. This is partly due to a lack of an overarching quantitative testing technology to characterize the various classes of HAs in vitro. Herein, the feasibility of a novel, contactless, and nondestructive technique to quantitatively measure the shear storage modulus (G') and clotting properties of whole blood in contact with different dosages of eight topical HAs, including particulates and gauze-like and sponge-like systems, was assessed. The real-time G'-time profiles of these blood/HA systems revealed their distinct biomechanical behavior to induce and impact coagulation. These were analyzed to characterize the clot initiation time, clotting rate, clotting time, and apparent stiffness of the formed clots (both immediately and temporally), which were correlated with their reported hemostatic mechanisms of action. Moreover, the HAs that worked independently from the natural blood clotting cascade were identified and quantified through this technology. In sum, this study indicated that the nondestructive nature of the technology may offer a promising tool for accurate, quantitative in vitro measurements of the clotting properties of various classes of HAs, which may be used to better predict their in vivo outcomes.
Collapse
Affiliation(s)
- Ehsan Rezabeigi
- Department of Mining and Materials Engineering, McGill University, Montreal, Quebec H3A 0C5, Canada
| | - Cédric Schmitt
- Rheolution Inc., 5333 Avenue Casgrain, Suite 601, Montreal, Quebec H2T 1X3, Canada
| | - Anis Hadj Henni
- Rheolution Inc., 5333 Avenue Casgrain, Suite 601, Montreal, Quebec H2T 1X3, Canada
| | - Alan N Barkun
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, Montreal, Quebec H3G 1A4, Canada
| | - Showan N Nazhat
- Department of Mining and Materials Engineering, McGill University, Montreal, Quebec H3A 0C5, Canada
| |
Collapse
|
5
|
Xie Y, Gao P, He F, Zhang C. Application of Alginate-Based Hydrogels in Hemostasis. Gels 2022; 8:gels8020109. [PMID: 35200490 PMCID: PMC8871293 DOI: 10.3390/gels8020109] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 12/24/2022] Open
Abstract
Hemorrhage, as a common trauma injury and clinical postoperative complication, may cause serious damage to the body, especially for patients with huge blood loss and coagulation dysfunction. Timely and effective hemostasis and avoidance of bleeding are of great significance for reducing body damage and improving the survival rate and quality of life of patients. Alginate is considered to be an excellent hemostatic polymer-based biomaterial due to its excellent biocompatibility, biodegradability, non-toxicity, non-immunogenicity, easy gelation and easy availability. In recent years, alginate hydrogels have been more and more widely used in the medical field, and a series of hemostatic related products have been developed such as medical dressings, hemostatic needles, transcatheter interventional embolization preparations, microneedles, injectable hydrogels, and hemostatic powders. The development and application prospects are extremely broad. This manuscript reviews the structure, properties and history of alginate, as well as the research progress of alginate hydrogels in clinical applications related to hemostasis. This review also discusses the current limitations and possible future development prospects of alginate hydrogels in hemostatic applications.
Collapse
Affiliation(s)
| | | | | | - Chun Zhang
- Correspondence: ; Tel.: +86-027-85726712
| |
Collapse
|
6
|
Dai K, Deng S, Yu Y, Zhu F, Wang J, Liu C. Construction of developmentally inspired periosteum-like tissue for bone regeneration. Bone Res 2022; 10:1. [PMID: 34975148 PMCID: PMC8720863 DOI: 10.1038/s41413-021-00166-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/19/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
The periosteum, a highly vascularized thin tissue, has excellent osteogenic and bone regenerative abilities. The generation of periosteum-mimicking tissue has become a novel strategy for bone defect repair and regeneration, especially in critical-sized bone defects caused by trauma and bone tumor resection. Here, we utilized a bone morphogenetic protein-2 (BMP-2)-loaded scaffold to create periosteum-like tissue (PT) in vivo, mimicking the mesenchymal condensation during native long bone development. We found that BMP-2-induced endochondral ossification plays an indispensable role in the construction of PTs. Moreover, we confirmed that BMP-2-induced PTs exhibit a similar architecture to the periosteum and harbor abundant functional periosteum-like tissue-derived cells (PTDCs), blood vessels, and osteochondral progenitor cells. Interestingly, we found that the addition of chondroitin sulfate (CS), an essential component of the extracellular matrix (ECM), could further increase the abundance and enhance the function of recruited PTDCs from the PTs and finally increase the regenerative capacity of the PTs in autologous transplantation assays, even in old mice. This novel biomimetic strategy for generating PT through in vivo endochondral ossification deserves further clinical translation.
Collapse
Affiliation(s)
- Kai Dai
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, P. R. China.,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai, P. R. China
| | - Shunshu Deng
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, P. R. China.,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai, P. R. China
| | - Yuanman Yu
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, P. R. China.,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai, P. R. China
| | - Fuwei Zhu
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, P. R. China.,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai, P. R. China
| | - Jing Wang
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, P. R. China. .,Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai, P. R. China.
| | - Changsheng Liu
- Engineering Research Center for Biomedical Materials of Ministry of Education, East China University of Science and Technology, Shanghai, P. R. China. .,Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai, P. R. China. .,Frontiers Science Center for Materiobiology and Dynamic Chemistry, East China University of Science and Technology, Shanghai, P. R. China.
| |
Collapse
|
7
|
Ghimire S, Sarkar P, Rigby K, Maan A, Mukherjee S, Crawford KE, Mukhopadhyay K. Polymeric Materials for Hemostatic Wound Healing. Pharmaceutics 2021; 13:2127. [PMID: 34959408 PMCID: PMC8708336 DOI: 10.3390/pharmaceutics13122127] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 02/04/2023] Open
Abstract
Hemorrhage is one of the greatest threats to life on the battlefield, accounting for 50% of total deaths. Nearly 86% of combat deaths occur within the first 30 min after wounding. While external wound injuries can be treated mostly using visual inspection, abdominal or internal hemorrhages are more challenging to treat with regular hemostatic dressings because of deep wounds and points of injury that cannot be located properly. The need to treat trauma wounds from limbs, abdomen, liver, stomach, colon, spleen, arterial, venous, and/or parenchymal hemorrhage accompanied by severe bleeding requires an immediate solution that the first responders can apply to reduce rapid exsanguinations from external wounds, including in military operations. This necessitates the development of a unique, easy-to-use, FDA-approved hemostatic treatment that can deliver the agent in less than 30 s and stop bleeding within the first 1 to 2 min at the point of injury without application of manual pressure on the wounded area.
Collapse
Affiliation(s)
- Suvash Ghimire
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
| | - Pritha Sarkar
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
| | - Kasey Rigby
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
| | - Aditya Maan
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
- Department of Chemistry, University of Central Florida, Orlando, FL 32816, USA
| | - Santanu Mukherjee
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
| | - Kaitlyn E. Crawford
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
- Department of Chemistry, University of Central Florida, Orlando, FL 32816, USA
- NanoScience Technology Center, University of Central Florida, Orlando, FL 32816, USA
- Biionix Cluster, University of Central Florida, Orlando, FL 32816, USA
| | - Kausik Mukhopadhyay
- Department of Materials Science and Engineering, University of Central Florida, Orlando, FL 32816, USA; (S.G.); (P.S.); (K.R.); (A.M.); (S.M.)
| |
Collapse
|
8
|
Kushwah H, Sandal N, Chauhan M, Mittal G. Pharmacological comparison of four biopolymeric natural gums as hemostatic agents for management of bleeding wounds: preliminary in vitro and in vivo results. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00237-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
Background
Uncontrolled bleeding is one of the primary reasons for preventable death in both civilian trauma and military battle field. This study evaluates in vitro and in vivo hemostatic potential of four biopolymeric natural gums, namely, gum tragacanth, guar gum, xanthan gum, and gum acacia. In vitro evaluation of whole blood clotting time and erythrocyte agglutination assay were carried out. In vitro cytotoxicity studies with respect to each gum were done in human lymphocytes to ascertain percent cell viability. In vivo hemostatic potential of each gum (as sponge dressing and powder form) was evaluated in Sprague Dawley rats using tail bleeding assay and compared with commercially available hemostatic sponge. Other important parameters like (a) time taken for complete hemostasis, (b) amount of blood absorbed, (c) adherence strength of developed hemostatic dressing(s), (d) incidence of re-bleeding, and (e) survival of animals were also studied.
Results
Of the four test gums studied, xanthan gum (@3mg/ml of blood) and gum tragacanth (@35mg/ml of blood) were able to clot blood in least time (58.75±6.408 s and 59.00±2.082 s, respectively) and exhibited very good hemostatic potential in vitro. Except for xanthan gum, all other test gums did not exhibit any significant cytotoxicity at different time points till 24 h. In rat tail bleeding experiments, gum tragacanth sponge dressing and powder achieved hemostasis in least time (156.2±12.86 s and 76±12.55 s, respectively) and much earlier than commercially available product (333.3±38.84 s; p˂0.01).
Conclusion
Results indicate potential of gum tragacanth to be developed into a suitable hemostatic product.
Collapse
|
9
|
Topical hemostatic agents in neurosurgery, a comprehensive review: 15 years update. Neurosurg Rev 2021; 45:1217-1232. [PMID: 34734343 DOI: 10.1007/s10143-021-01684-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/26/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022]
Abstract
Hemostasis in neurosurgery is of utmost importance. Bleeding management is one of the crucial steps of each neurosurgical procedure. Several strategies, namely thermal, mechanical, electric, and chemical, have been advocated to face blood loss within the surgical field. Over time, countless hemostatic agents and devices have been proposed. Furthermore, the ever-growing recent technological innovation has made available several novel and interesting tools. Pursuant to their impact on surgical practice, we perceived the imperative to update our previous disclosure paper. Therefore, we reviewed the literature and analyzed technical data sheets of each product in order to provide an updated and comprehensive overview in regard to chemical properties, mechanisms of action, use, complications, tricks, and pitfalls of topical hemostatic agents.
Collapse
|
10
|
Maevskaia EN, Shabunin AS, Dresvyanina EN, Dobrovol’skaya IP, Yudin VE, Paneyah MB, Fediuk AM, Sushchinskii PL, Smirnov GP, Zinoviev EV, Morganti P. Influence of the Introduced Chitin Nanofibrils on Biomedical Properties of Chitosan-Based Materials. NANOMATERIALS 2020; 10:nano10050945. [PMID: 32429114 PMCID: PMC7279343 DOI: 10.3390/nano10050945] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 12/26/2022]
Abstract
Hemorrhage occurring during and after surgery still remains one of the biggest problems in medicine. Although a large number of hemostatic products have been created, there is no universal preparation; thus, the development of new materials is an urgent task. The aim of this research is to increase hemostatic properties of chitosan by introducing chitin nanofibrils (ChNF). The blood absorbance by ChNF-containing chitosan sponges and time-until-arrest of bleeding were studied. Non-woven materials containing 0.5% of ChNF and materials without chitin were obtained. The studies of ζ-potential showed that the material containing 0.5% ChNF had relatively a high positive charge, but efficiencies of both materials for hemorrhage arrest were comparable to those of commercial hemostatic products (Surgicel and TachoComb). To investigate the interaction between the materials and living organism, histological studies and optical microscopy studies were conducted after implantation of fibers. Despite bioinertness of fibers, implantation of non-woven materials led to formation of significant granulomas.
Collapse
Affiliation(s)
- Ekaterina N. Maevskaia
- Department of Medical Physics, Peter the Great St. Petersburg Polytechnic University, Polytechnicheskaya Street 29, 195251 Saint Petersburg, Russia; (A.S.S.); (E.N.D.); (I.P.D.); (V.E.Y.)
- Correspondence:
| | - Anton S. Shabunin
- Department of Medical Physics, Peter the Great St. Petersburg Polytechnic University, Polytechnicheskaya Street 29, 195251 Saint Petersburg, Russia; (A.S.S.); (E.N.D.); (I.P.D.); (V.E.Y.)
- H.Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery, Parkovaya Street 64-68, 196603 Pushkin, Saint-Petersburg, Russia
| | - Elena N. Dresvyanina
- Department of Medical Physics, Peter the Great St. Petersburg Polytechnic University, Polytechnicheskaya Street 29, 195251 Saint Petersburg, Russia; (A.S.S.); (E.N.D.); (I.P.D.); (V.E.Y.)
- Institute of Textile and Fashion, Saint Petersburg State University of Industrial Technologies and Design, Bolshaya Morskaya Street 18, 191186 Saint Petersburg, Russia;
| | - Irina P. Dobrovol’skaya
- Department of Medical Physics, Peter the Great St. Petersburg Polytechnic University, Polytechnicheskaya Street 29, 195251 Saint Petersburg, Russia; (A.S.S.); (E.N.D.); (I.P.D.); (V.E.Y.)
- Laboratory of Mechanics of Polymers and Composites, Institute of Macromolecular Compounds, Bolshoy pr. V.O. 31, 199004 Saint Petersburg, Russia
| | - Vladimir E. Yudin
- Department of Medical Physics, Peter the Great St. Petersburg Polytechnic University, Polytechnicheskaya Street 29, 195251 Saint Petersburg, Russia; (A.S.S.); (E.N.D.); (I.P.D.); (V.E.Y.)
- Laboratory of Mechanics of Polymers and Composites, Institute of Macromolecular Compounds, Bolshoy pr. V.O. 31, 199004 Saint Petersburg, Russia
| | - Moisey B. Paneyah
- Laboratory of Experimental Surgery of Scientific Research Center, Saint Petersburg State Pediatrical Medical University, Litovskaya Street 2, 194100 Saint Petersburg, Russia; (M.B.P.); (A.M.F.); (P.L.S.); (E.V.Z.)
| | - Andrey M. Fediuk
- Laboratory of Experimental Surgery of Scientific Research Center, Saint Petersburg State Pediatrical Medical University, Litovskaya Street 2, 194100 Saint Petersburg, Russia; (M.B.P.); (A.M.F.); (P.L.S.); (E.V.Z.)
| | - Petr L. Sushchinskii
- Laboratory of Experimental Surgery of Scientific Research Center, Saint Petersburg State Pediatrical Medical University, Litovskaya Street 2, 194100 Saint Petersburg, Russia; (M.B.P.); (A.M.F.); (P.L.S.); (E.V.Z.)
| | - Gerald P. Smirnov
- Institute of Textile and Fashion, Saint Petersburg State University of Industrial Technologies and Design, Bolshaya Morskaya Street 18, 191186 Saint Petersburg, Russia;
| | - Evgeniy V. Zinoviev
- Laboratory of Experimental Surgery of Scientific Research Center, Saint Petersburg State Pediatrical Medical University, Litovskaya Street 2, 194100 Saint Petersburg, Russia; (M.B.P.); (A.M.F.); (P.L.S.); (E.V.Z.)
- Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, Budapeshtskaya Street 3, 192242 Saint Petersburg, Russia
| | - Pierfrancesco Morganti
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, via L. De Crecchio 7, 80138 Naples, Italy;
| |
Collapse
|
11
|
Gao L, Ma S, Luo J, Bao G, Wu Y, Zhou F, Liang Y. Synthesizing Functional Biomacromolecular Wet Adhesives with Typical Gel–Sol Transition and Shear-Thinning Features. ACS Biomater Sci Eng 2019; 5:4293-4301. [DOI: 10.1021/acsbiomaterials.9b00939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Luyao Gao
- State Key Laboratory of Applied Organic Chemistry, Lanzhou University, Lanzhou 730000, P. R. China
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, 18 Middle Tianshui Road, Lanzhou 730000, P. R. China
| | - Shuanhong Ma
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, 18 Middle Tianshui Road, Lanzhou 730000, P. R. China
| | - Jiajun Luo
- Division of Surgery & Interventional Science, Institute of Orthopaedic & Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Stanmore HA7 4LP, United Kingdom
| | - Guangjie Bao
- College of Dentistry, Northwest Minzu University, 1 New Northwest Villiage, Lanzhou 730030, P. R. China
| | - Yang Wu
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, 18 Middle Tianshui Road, Lanzhou 730000, P. R. China
| | - Feng Zhou
- State Key Laboratory of Solid Lubrication, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, 18 Middle Tianshui Road, Lanzhou 730000, P. R. China
| | - Yongmin Liang
- State Key Laboratory of Applied Organic Chemistry, Lanzhou University, Lanzhou 730000, P. R. China
| |
Collapse
|
12
|
Topical Aluminum Chloride and Monsel's Solution Block Toluidine Blue Staining in Mohs Frozen Sections: Mechanism and Solution. Dermatol Surg 2019; 45:1019-1025. [PMID: 30640770 DOI: 10.1097/dss.0000000000001761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A diminished-staining artifact is observed in some Mohs frozen sections that are stained in toluidine blue (T-blue). Such an artifact, not yet described in the literature, may interfere with a Mohs surgeon's accurate reading. The authors hypothesize that topical hemostatic agents, aluminum chloride, and Monsel's solution are the causative factors. OBJECTIVE To evaluate the aforementioned topical hemostatic agents as a potential cause of the nonstaining artifact, to propose the mechanism associated with this phenomenon, and to develop a method to prevent or rectify the problem. MATERIALS AND METHODS Leftover Mohs frozen sections and specimens were treated with aluminum chloride or Monsel's solution and processed with routine Mohs histology. RESULTS Nonstaining artifact is reproduced in aluminum chloride or Monsel's solution-treated ex vivo skin specimens. The authors found that ethylenediaminetetraacetic acid (EDTA), a chelating agent, can reverse the staining blockage. Such a finding suggests that aluminum or ferric cations bind to tissue and subsequently inhibit T-blue from interacting with the tissue. Direct binding of ferric cations to the tissue section is demonstrated with Prussian blue iron staining. CONCLUSION By rinsing Mohs frozen sections in an EDTA solution before T-blue staining, the authors could prevent hemostatic agent-induced nonstaining. Applying an EDTA wash and restaining the slides can correct the same artifact.
Collapse
|
13
|
Carrion DM, Y Gregorio SA, Rivas JG, Bazán AA, Sebastián JD, Martínez-Piñeiro L. The role of hemostatic agents in preventing complications in laparoscopic partial nephrectomy. Cent European J Urol 2018; 70:362-367. [PMID: 29410886 PMCID: PMC5791400 DOI: 10.5173/ceju.2017.1432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction Nephron-sparing surgery is currently the treatment of choice for renal cell carcinoma stage T1a. During the past years, several hemostatic agents (HA) have been developed in order to reduce surgical complications. We present the results of our series and the impact of the use of HA in the prevention of surgical complications in laparoscopic partial nephrectomies (LPNs). Material and methods We retrospectively analyzed all LPN performed in our center from 2005 to 2012. A total of 77 patients were included for analysis. Patients were divided into two groups: Group A (no use of HA) and Group B (use of HA). HA used included gelatin matrix thrombin (FloSeal) and oxidized regenerated cellulose (Surgicel). Demographics, perioperative variables, and complications were analyzed with a special interest in postoperative bleeding and urinary leakage. Results Median age was 57.17 years old (±12.1), 72.7% were male, most common comorbidities were hypertension (33.8%) and diabetes mellitus (18.2%). All patients had one solitary tumor, and 87% had a tumor ≤4 cm. Renal cell carcinoma was found in 79.2% of cases, and 78.7% were stage pT1a. and were used in 36 cases (46.8%). No differences were found in demographics, perioperative variables, and complications between groups. No conversions to open surgery or perioperative mortality were reported. Conclusions We conclude that in our series the use of a hemostatic agent did not offer benefit in reducing the complication rate over sutures over a bolster.
Collapse
Affiliation(s)
- Diego M Carrion
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | |
Collapse
|
14
|
Konstantinow A, Fischer TV, Ring J. Effectiveness of collagen/oxidised regenerated cellulose/silver-containing composite wound dressing for the treatment of medium-depth split-thickness skin graft donor site wounds in multi-morbid patients: a prospective, non-comparative, single-centre study. Int Wound J 2017; 14:791-800. [PMID: 27905181 PMCID: PMC7949593 DOI: 10.1111/iwj.12698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022] Open
Abstract
Split-thickness skin grafting (STSG) is a widely used method in reconstructive surgery, but donor site wounds (DSWs) are often slow healing and painful. This prospective study evaluated the performance of a composite wound dressing containing collagen/oxidised regenerated cellulose in the treatment of medium-depth (0·4 mm) DSWs in 25 multi-morbid patients with chronic leg ulcers requiring STSG. The range of patients' ages was 44-84 years (mean 71·6 years) with DSW sizes ranging between 12 and 162 cm2 (mean 78 cm2 ). Comorbidities included anticoagulation therapy (15 patients), anaemia (11 patients), diabetes (6 patients) and methicillin-resistant Staphylococcus aureus (MRSA) ulcer colonisation (6 patients). The first dressing change was performed after 10 days. Complete reepithelialisation was observed between the 10th and 34th day (mean 17·2, median 14 days). Postoperative medium to strong bleeding occurred in only five patients (four with anticoagulation). Wound pain levels one day after harvesting were only moderate (range 0-1·5, mean 0·5, median 0·5 on a six-item scale). No wound infection was observed during the first dressing. The composite dressing used allowed for the fast healing of medium-depth DSWs with minimal or no postoperative pain and bleeding in older multi-morbid patients under anticoagulation treatment.
Collapse
Affiliation(s)
- Alexander Konstantinow
- Department of Dermatology and Allergology BiedersteinTechnical University MunichMunichGermany
| | - Tatjana V Fischer
- Department of Dermatology and Allergology BiedersteinTechnical University MunichMunichGermany
| | - Johannes Ring
- Department of Dermatology and Allergology BiedersteinTechnical University MunichMunichGermany
| |
Collapse
|
15
|
Bandi M, Mallineni SK, Nuvvula S. Clinical applications of ferric sulfate in dentistry: A narrative review. J Conserv Dent 2017; 20:278-281. [PMID: 29259368 PMCID: PMC5721513 DOI: 10.4103/jcd.jcd_259_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Ferric sulfate (FS) has been commonly used as a local hemostatic agent for more than three decades in dentistry. Even though the hemostatic mechanism of FS is questioned, it seems that agglutination of blood proteins occurs due to the reaction of blood with ferric and sulfate ions in acidic pH. FS has gained widespread importance as a pulpotomy medicament in contemporary dentistry; nevertheless, it has several applications in different fields of dentistry which was paid little attention. Hence, the purpose of this paper is to review the various applications of FS in dentistry, along with restorative dentistry and endodontics.
Collapse
Affiliation(s)
- Madhuri Bandi
- Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Sreekanth Kumar Mallineni
- Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| | - Sivakumar Nuvvula
- Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
| |
Collapse
|
16
|
Edwards JV, Graves E, Bopp A, Prevost N, Santiago M, Condon B. Electrokinetic and hemostatic profiles of nonwoven cellulosic/synthetic fiber blends with unbleached cotton. J Funct Biomater 2014; 5:273-87. [PMID: 25459983 PMCID: PMC4285407 DOI: 10.3390/jfb5040273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/07/2014] [Accepted: 11/19/2014] [Indexed: 11/29/2022] Open
Abstract
Greige cotton contains waxes and pectin on the outer surface of the fiber that are removed when bleached, but these components present potential wound dressing functionality. Cotton nonwovens blended with hydrophobic and hydrophilic fibers including viscose, polyester, and polypropylene were assessed for clotting activity with thromboelastography (TEG) and thrombin production. Clotting was evaluated based on TEG measurements: R (time to initiation of clot formation), K (time from end of R to a 20 mm clot), α (rate of clot formation according to the angle tangent to the curve as K is reached), and MA (clot strength). TEG values correlate to material surface polarity as measured with electrokinetic parameters (ζplateau, Δζ and swell ratio). The material surface polarity (ζplateau) varied from −22 to −61 mV. K values and thrombin concentrations were found to be inversely proportional to ζplateau with an increase in material hydrophobicity. An increase in the swell ratios of the materials correlated with decreased K values suggesting that clotting rates following fibrin formation increase with increasing material surface area due to swelling. Clot strength (MA) also increased with material hydrophobicity. Structure/function implications from the observed clotting physiology induced by the materials are discussed.
Collapse
Affiliation(s)
- J Vincent Edwards
- USDA-ARS, Southern Regional Research Center, 1100 Robert E. Lee Blvd., New Orleans, LA 70124, USA.
| | - Elena Graves
- USDA-ARS, Southern Regional Research Center, 1100 Robert E. Lee Blvd., New Orleans, LA 70124, USA.
| | - Alvin Bopp
- USDA-ARS, Southern Regional Research Center, 1100 Robert E. Lee Blvd., New Orleans, LA 70124, USA.
| | - Nicolette Prevost
- USDA-ARS, Southern Regional Research Center, 1100 Robert E. Lee Blvd., New Orleans, LA 70124, USA.
| | - Michael Santiago
- USDA-ARS, Southern Regional Research Center, 1100 Robert E. Lee Blvd., New Orleans, LA 70124, USA.
| | - Brian Condon
- USDA-ARS, Southern Regional Research Center, 1100 Robert E. Lee Blvd., New Orleans, LA 70124, USA.
| |
Collapse
|
17
|
Jang Y, Kim H, Roh BD, Kim E. Biologic response of local hemostatic agents used in endodontic microsurgery. Restor Dent Endod 2014; 39:79-88. [PMID: 24790919 PMCID: PMC3978108 DOI: 10.5395/rde.2014.39.2.79] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/24/2014] [Indexed: 11/11/2022] Open
Abstract
Appropriate use of local hemostatic agent is one of the important factors on the prognosis of endodontic microsurgery. However, most investigations to date focus on the hemostatic efficacy of the agents, whereas their biologic characteristics have not received enough attention. The purpose of this paper was to review the biologic response of local hemostatic agents, and to provide clinical guidelines on their use during endodontic microsurgery. Electronic database (PUBMED) was screened to search related studies from 1980 to 2013, and 8 clinical studies and 18 animal studies were identified. Among the materials used in these studies, most widely-investigated and used materials, epinephrine, ferric sulfate (FS) and calcium sulfate (CS), were thoroughly discussed. Influence of these materials on local tissue and systemic condition, such as inflammatory and foreign body reaction, local ischemia, dyspigmentation, delayed or enhanced bone and soft tissue healing, and potential cardiovascular complications were assessed. Additionally, biological property of their carrier materials, cotton pellet and absorbable collagen, were also discussed. Clinicians should be aware of the biologic properties of local hemostatic agents and their carrier materials, and should pay attention to the potential complications when using them in endodontic microsurgery.
Collapse
Affiliation(s)
- Youngjune Jang
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyeon Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Byoung-Duck Roh
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| | - Euiseong Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, Yonsei University College of Dentistry, Seoul, Korea
| |
Collapse
|
18
|
Newer hemostatic agents used in the practice of dermatologic surgery. Dermatol Res Pract 2013; 2013:279289. [PMID: 23997764 PMCID: PMC3749606 DOI: 10.1155/2013/279289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/07/2013] [Indexed: 11/18/2022] Open
Abstract
Minor postoperative bleeding is the most common complication of cutaneous surgery. Because of the commonality of this complication, hemostasis is an important concept to address when considering dermatologic procedures. Patients that have a bleeding diathesis, an inherited/acquired coagulopathy, or who are on anticoagulant/antiplatelet medications pose a greater risk for bleeding complications during the postoperative period. Knowledge of these conditions preoperatively is of the utmost importance, allowing for proper preparation and prevention. Also, it is important to be aware of the various hemostatic modalities available, including electrocoagulation, which is among the most effective and widely used techniques. Prompt recognition of hematoma formation and knowledge of postoperative wound care can prevent further complications such as wound dehiscence, infection, or skin-graft necrosis, minimizing poor outcomes.
Collapse
|
19
|
|
20
|
Broekema FI, van Oeveren W, Selten MHA, Meijer RJH, de Wolf JTM, Bos RRM. In vivo hemostatic efficacy of polyurethane foam compared to collagen and gelatin. Clin Oral Investig 2012; 17:1273-8. [PMID: 22855267 DOI: 10.1007/s00784-012-0809-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/19/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Topical hemostatic agents are used in all surgical disciplines. Most of these hemostats are based on animal-derived products like collagen and gelatin. They carry the potential risk of pathogen transmission. A newly developed biodegradable, fully synthetic hemostatic agent based on polyurethane foam (PU) with 55 % polyethylene glycol (PEG) would prevent these potential risks. MATERIALS AND METHODS The hemostatic efficacy of this new agent was compared to gelatin and collagen in humans who underwent extraction of an upper and lower molar (split-mouth model). After extraction of a molar in the maxilla and mandible, a PU foam and collagen or gelatin were inserted in the extraction socket for 2 min. Hereafter, the agents were removed and stored in ethylenediaminetetraacetic acid to stop coagulation. Then, the concentration of coagulation parameters thrombin-antithrombin III (TAT) complexes, fibrinogen, and thromboxane B2 (TxB2) in blood extracts from the agents was measured. The concentrations were also determined in baseline blood samples which were collected from the extraction socket. RESULTS The concentrations of TAT and TxB2 were significantly increased, and fibrinogen concentration was significantly reduced compared to baseline wound blood concentrations indicating enhanced hemostasis. No significant differences were seen in the concentrations of these coagulation parameters in the three different hemostatic agents. CONCLUSIONS These results show that PU combined with 55 % PEG is a promising alternative for the animal-derived hemostatic agents. CLINICAL RELEVANCE The synthetic hemostatic agent could replace the animal-derived products like collagen and gelatin and therewith prevent the potential risk of pathogen transmission.
Collapse
Affiliation(s)
- Ferdinand I Broekema
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
| | | | | | | | | | | |
Collapse
|
21
|
Spotnitz WD, Burks S. Hemostats, sealants, and adhesives III: a new update as well as cost and regulatory considerations for components of the surgical toolbox. Transfusion 2012; 52:2243-55. [DOI: 10.1111/j.1537-2995.2012.03707.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
22
|
Groenewold MD, Gribnau AJ, Ubbink DT. Topical haemostatic agents for skin wounds: a systematic review. BMC Surg 2011; 11:15. [PMID: 21745412 PMCID: PMC3143913 DOI: 10.1186/1471-2482-11-15] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 07/12/2011] [Indexed: 11/15/2022] Open
Abstract
Background Various agents and techniques have been introduced to limit intra-operative blood loss from skin lesions. No uniformity regarding the type of haemostasis exists and this is generally based on the surgeon's preference. To study the effectiveness of haemostatic agents, standardized wounds like donor site wounds after split skin grafting (SSG) appear particularly suitable. Thus, we performed a systematic review to assess the effectiveness of haemostatic agents in donor site wounds. Methods We searched all randomized clinical trials (RCTs) on haemostasis after SSG in Medline, Embase and the Cochrane Library until January 2011. Two reviewers independently assessed trial relevance and quality and performed data analysis. Primary endpoint was effectiveness regarding haemostasis. Secondary endpoints were wound healing, adverse effects, and costs. Results Nine relevant RCTs with a fair methodological quality were found, comparing epinephrine, thrombin, fibrin sealant, alginate dressings, saline, and mineral oil. Epinephrine achieved haemostasis significantly faster than thrombin (difference up to 2.5 minutes), saline or mineral oil (up to 6.5 minutes). Fibrin sealant also resulted in an up to 1 minute quicker haemostasis than thrombin and up to 3 minutes quicker than placebo, but was not directly challenged against epinephrine. Adverse effects appeared negligible. Due to lack of clinical homogeneity, meta-analysis was impossible. Conclusion According to best available evidence, epinephrine and fibrin sealant appear superior to achieve haemostasis when substantial topical blood loss is anticipated, particularly in case of (larger) SSGs and burn debridement.
Collapse
Affiliation(s)
- Marieke D Groenewold
- Department of Quality Assurance & Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
| | | | | |
Collapse
|
23
|
Hutchinson RW, Broughton D, Barbolt TA, Poandl T, Muench T, Rockar R, Johnson M, Hart J. Hemostatic effectiveness of Fibrin pad after partial nephrectomy in swine. J Surg Res 2010; 167:e291-8. [PMID: 20451926 DOI: 10.1016/j.jss.2010.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 01/05/2010] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Current management of severe surgical or traumatic bleeding is often achieved by manual tamponade or occlusion using devices such as tourniquets or ligatures. There are some clinical scenarios where these options are either marginally effective or impractical. The present study evaluates a new combination device (Fibrin pad) consisting of biologically active components (human thrombin and fibrinogen) delivered to the targeted site by an absorbable synthetic matrix (oxidized regenerated cellulose and polyglactin 910) in a swine severe bleeding model. In this model, severe bleeding can be managed by concurrent use of several currently available treatments, or a more convenient option that offers performance and safety advantages. MATERIALS AND METHODS Partial nephrectomies were performed on swine and treated with either Fibrin pad (FP) or conventional therapy (CTR)-temporary occlusion of renal artery, electrocautery, SURGIFLO, EVITHROM, SURGICEL NU-KNIT, and PDS II suture). After intraoperative hemostasis was confirmed, the animals were closed and recovered, then survived for 2, 14, or 56 d. RESULTS Hemostasis was achieved at surgery and maintained in all FP and CTR treated animals. FP was as effective as CTR at establishing durable hemostasis. Treatment with FP did not require temporary occlusion of the renal artery and decreased the total treatment time by half. No animals in either group had complications related to postoperative bleeding at any time during the study. There was no evidence of pulmonary thrombi or evidence of thrombotic complications. No biologically significant adverse local tissue response was present in association with the Fibrin pad at any study interval, and no biologically relevant or consistent changes in blood parameters were identified. CONCLUSIONS Fibrin pad was as effective as CTR for the primary management of severe bleeding without occlusion of the renal artery and a shorter surgical time. No evidence of a systemic or local adverse response was identified due to exposure to the Fibrin pad.
Collapse
Affiliation(s)
- Richard W Hutchinson
- Ethicon, Inc., a Johnson and Johnson Company, Somerville, New Jersey 08876-0151, USA.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Hemostatic mechanisms are an integral part of the human physiology. Traditionally divided into intrinsic and extrinsic arms, the coagulation cascade converges, through the interactions of many different factors, at a common element-thrombin. As a consequence, a number of different agents have been developed to supplement this common, critical step to aid surgical hemostasis. Intraoperative interventions most commonly include sutures and heat-generating cautery devices; however, these methods are sometimes insufficient or inappropriate for a specific procedure or anatomic location, leading to the development of other adjunctive therapies, including topical hemostats. Topical hemostatic agents generally act as active, passive, and combinations therapies, depending on their individual composition and mode of action. We provide a brief review of the normal coagulation cascade, including critical points, followed by a discussion of surgical strategies and adjuctive therapies used to achieve surgical hemostasis and concluding with a discussion of topical thrombins.
Collapse
Affiliation(s)
- Bradley A Boucher
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
| | | |
Collapse
|
25
|
Abstract
Abnormal placentation poses a diagnostic and treatment challenge for all providers caring for pregnant women. As one of the leading causes of postpartum hemorrhage, abnormal placentation involves the attachment of placental villi directly to the myometrium with potentially deeper invasion into the uterine wall or surrounding organs. Surgical procedures that disrupt the integrity of uterus, including cesarean section, dilatation and curettage, and myomectomy, have been implicated as key risk factors for placenta accreta. The diagnosis is typically made by gray-scale ultrasound and confirmed with magnetic resonance imaging, which may better delineate the extent of placental invasion. It is critical to make the diagnosis before delivery because preoperative planning can significantly decrease blood loss and avoid substantial morbidity associated with placenta accreta. Aggressive management of hemorrhage through the use of uterotonics, fluid resuscitation, blood products, planned hysterectomy, and surgical hemostatic agents can be life-saving for these patients. Conservative management, including the use of uterine and placental preservation and subsequent methotrexate therapy or pelvic artery embolization, may be considered when a focal accreta is suspected; however, surgical management remains the current standard of care.
Collapse
Affiliation(s)
- Samuel T Bauer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
| | | |
Collapse
|