[Local haemostasis with an adhesive cyanoacrylate-coated membrane following tooth extraction in patients under anticoagulant or anti-platelet therapy]

OBJECTIVE

Assessment of a local hemostasis with a compressive, extemporaneous gutter glued to the alveolar crest after tooth avulsion in patients under anticoagulant and/or platelet aggregation inhibitors, and economical impact of this technique.

MATERIAL AND METHOD

Ninety-seven tooth extractions were performed in patients under AVK and/or anti-platelet drugs. The interventions were consecutive and concerned 251 teeth (138 different alveolar sites). The extraction alveolus was protected by an absorbable oxycellulose membrane coated with sterilized cyanoacrylate adhesive for medical use. This procedure was used with all patients, whatever the hemorrhagic risk (the only inclusion criterion was INR less than 4 for patients under AVK). All procedures were performed under local anesthesia.

RESULTS

There was one hemorrhagic complication (0.72%) due to mechanical gutter destruction by an antagonist tooth. The adhesive did not run, there was no tissue necrosis, and no wound infection requiring gutter removal.

DISCUSSION

This local hemostasis procedure is reliable. It may be an alternative to substitution of heparin, without or with hospitalization. This procedure, requiring modification of treatment, greatly decreases healthcare costs. Contra-indications include the presence of an antagonist tooth harmful for the gutter, and patients with impaired consciousness or tongue dyspraxia.

[Air tissue expansion, as an alternative to physiologic serum expansion: report of 30 cases]

There has been a renewed interest in cutaneous expansion as a plastic surgery procedure. Complications and failures remain considerable despite a more adequate and standardized technique. Based on a study of 30 cases of cutaneous expansion for burns sequelae, the authors emphasize the value of using air instead of physiological saline as filling medium, to reduce the negative repercussions on quality and quantity of cutaneous gain, related to the increasing weight of the prosthesis, even for large and possibly repeated expansion volumes.