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Liu Y, Zhang Y, Yao W, Chen P, Cao Y, Shan M, Yu S, Zhang L, Bao B, Cheng FF. Recent Advances in Topical Hemostatic Materials. ACS APPLIED BIO MATERIALS 2024; 7:1362-1380. [PMID: 38373393 DOI: 10.1021/acsabm.3c01144] [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: 02/21/2024]
Abstract
Untimely or improper treatment of traumatic bleeding may cause secondary injuries and even death. The traditional hemostatic modes can no longer meet requirements of coping with complicated bleeding emergencies. With scientific and technological advancements, a variety of topical hemostatic materials have been investigated involving inorganic, biological, polysaccharide, and carbon-based hemostatic materials. These materials have their respective merits and defects. In this work, the application and mechanism of the major hemostatic materials, especially some hemostatic nanomaterials with excellent adhesion, good biocompatibility, low toxicity, and high adsorption capacity, are summarized. In the future, it is the prospect to develop multifunctional hemostatic materials with hemostasis and antibacterial and anti-inflammatory properties for promoting wound healing.
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Affiliation(s)
- Yang Liu
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
| | - Yi Zhang
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
| | - Weifeng Yao
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
| | - Peidong Chen
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
| | - Yudan Cao
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
| | - Mingqiu Shan
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
| | - Sheng Yu
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
| | - Li Zhang
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
| | - Beihua Bao
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
| | - Fang-Fang Cheng
- Jiangsu Collaborative Innovation Centre of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Centre of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province China
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The efficacy of oxidized regenerated cellulose (SurgiGuard®) in breast cancer patients who undergo total mastectomy with node surgery: A prospective randomized study in 94 patients. PLoS One 2022; 17:e0267694. [PMID: 35622779 PMCID: PMC9140258 DOI: 10.1371/journal.pone.0267694] [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: 11/27/2020] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Seromas frequently develop in patients who undergo total mastectomy with node surgery. We aimed to prospectively explore whether use of oxidized regenerated cellulose (ORC, SurgiGuard®) affects seroma formation after total mastectomy with node surgery (sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND)). Materials and methods Ninety four breast cancer patients were enrolled in the study who underwent total mastectomy with ALND or SLNB. The patients were randomized into two groups, one treated with ORC plus closed suction drainage and the other with closed suction drainage alone. Results Mean drainage volume was slightly lower in the ORC group on postoperative day 1 (123 ± 54 vs 143 ± 104 ml), but was slightly higher at all other time points; however, these differences were not significant. Mean total drainage volume in patients treated with ORC plus drainage did not differ from that of patients treated with drainage alone (1134 ± 507 ml vs 1033 ± 643 ml, P = 0.486). Conclusions Use of ORC (SurgiGuard®) did not significantly alter the risk of seroma formation.
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Wang JQ, Chen LY, Jiang BJ, Zhao YM. Oxidized Regenerated Cellulose Can Reduce Hidden Blood Loss after Total Hip Arthroplasty: A Retrospective Study. J INVEST SURG 2018; 32:716-722. [PMID: 29641267 DOI: 10.1080/08941939.2018.1458166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: There is a large amount of hidden blood loss (HBL) after total hip arthroplasty (THA), but the effective and safe methods to reduce HBL are still controversial. Methods: Sixty-nine consecutive patients who underwent THA in our hospital from January 2015 to December 2015 were analyzed retrospectively. The patients were divided into two groups, Group A (THA without oxidized regenerated cellulose) and Group B (THA with oxidized regenerated cellulose). Demographics, perioperative laboratory values, intraoperative data, blood loss, transfusion rate, transfusion reactions, and surgical complications were collected and analyzed. Results: A total of 37 (54%) patients used oxidized regenerated cellulose (ORC) in operation. The total blood loss (TBL), postoperative blood loss (PBL), hemoglobin (Hb) loss, and hidden blood loss (HBL) in group B were significantly lower than in group A. Conclusions: The use of ORC to fill the bone surface and soft tissue gap before incision closure can effectively reduce HBL and may be a potential treatment for blood prevention after THA.
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Affiliation(s)
- Ji-Qi Wang
- Department of Orthopaedics, the Second Affiliated Hospital of Wenzhou Medical University, Xue Yuan Xi Road, Wenzhou, Zhejiang, China
| | - Lu-Ying Chen
- Department of Otolaryngology, the First Affiliated Hospital of Wenzhou Medical University, South White Elephant, Ouhai District, Wenzhou, Zhejiang, China
| | - Bing-Jie Jiang
- Department of Orthopaedics, the Second Affiliated Hospital of Wenzhou Medical University, Xue Yuan Xi Road, Wenzhou, Zhejiang, China
| | - You-Ming Zhao
- Department of Orthopaedics, the Second Affiliated Hospital of Wenzhou Medical University, Xue Yuan Xi Road, Wenzhou, Zhejiang, China
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Kim SH, Kim SH, Yoon HS, Kim HK, Kim KS. Efficacy of Oxidized Regenerated Cellulose, SurgiGuard®, in Porcine Surgery. Yonsei Med J 2017; 58:195-205. [PMID: 27873514 PMCID: PMC5122638 DOI: 10.3349/ymj.2017.58.1.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/10/2016] [Accepted: 07/18/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Adequate hemostasis is important for postoperative outcomes of abdominal surgery. This study evaluated the hemostatic effects and accompanying histopathological changes of a novel oxidized regenerated cellulose, SurgiGuard®, during abdominal surgery. MATERIALS AND METHODS Ten pigs underwent wedge resection of the spleen (1×1 cm) and liver (1.5×1.5 cm). The resected surface was covered with Surgicel® fabric or fibril type (Group A) or SurgiGuard® fabric or fibril type (Group B). Surgicel® and SurgiGuard® were randomized for attachment to the resected surface by fabric type (n=5) or fibril type (n=5). Blood loss was measured 5, 7, and 9 min after resection. Pigs were necropsied 6 weeks postoperatively to evaluate gross and histopathological changes. RESULTS There was no significant difference in total blood loss between groups [spleen fabric: Group A vs. Group B, 4.38 g (2.74-6.43) vs. 3.41 g (2.46-4.65), p=0.436; spleen fibril: Group A vs. Group B, 3.44 g (2.82-6.07) vs. 3.60 g (2.03-6.09), p=0.971; liver fabric: Group A vs. Group B, 4.51 g (2.67-10.61) vs. 6.93 g (3.09-9.95), p=0.796; liver fibril: Group A vs. Group B, 3.32 g (2.50-8.78) vs. 3.70 g (2.32-5.84), p=0.971]. Histopathological analysis revealed no significant difference in toxicities related to Surgicel® or SurgiGuard® [inflammation, fibrosis, foreign bodies, and hemorrhage (spleen: p=0.333, 0.127, 0.751, and 1.000; liver: p=0.155, 0.751, 1.000, and 1.000, respectively)]. CONCLUSION SurgiGuard® is as effective and non-toxic as Surgicel® in achieving hemostasis after porcine abdominal surgery.
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Affiliation(s)
- Sung Hyun Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sung Yoon
- Department of Quality Assurance, Samyang Biopharmaceuticals Corporation, Daejeon, Korea
| | - Hyun Kyoon Kim
- Department of Research and Development, Medical Device Program, Samyang Biopharmaceuticals Corporation, Daejeon, Korea
| | - Kyung Sik Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Kim SH, Yoon HS, In CH, Kim KS. Efficacy evaluation of SurgiGuard® in partially hepatectomized pigs. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2016; 20:102-9. [PMID: 27621746 PMCID: PMC5018953 DOI: 10.14701/kjhbps.2016.20.3.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/14/2016] [Accepted: 05/10/2016] [Indexed: 11/17/2022]
Abstract
Backgrounds/Aims This study evaluated the hemostatic effects of a novel oxidized regenerated cellulose, SurgiGuard®, during liver surgery, using a reproducible and clinically relevant animal model. Methods Fifteen mini-pigs underwent left partial hepatectomy. They were randomized to treatment of the resected surface with SurgiGuard® (Group C [test], n=5), Surgicel® (Group B [reference], n=5), or nothing (Group A [control], n=5). Blood loss was measured 5, 7 and 9 min after resection. Time to hemostasis was recorded. Mini-pigs were necropsied 4 or 6 weeks postoperatively to evaluate toxicity changes and material dissolution. Results The median resected liver weight was 2.13 g (2.02-2.20) in control group, 2.04 g (2.01-2.13) in reference group, and 2.01 g (1.99-2.12) in test group (p=0.024). Median total blood loss was 57.18 g (52.02-59.54) in control group, 32.52 g (27.66-35.10) in reference group, and 35.52 g (25.70-38.71) in test group (p=0.008). Blood loss at 0-5 minutes and 7-9 minutes was significantly different between groups (p=0.009 and p=0.006, respectively). At necropsy, no hematomas, granulomas, or adhesions were noted in any group. Histopathological analysis revealed no changes suggesting toxicity related to SurgiGuard®. Conclusions SurgiGuard® is as effective as Surgicel® in achieving hemostasis after porcine partial liver resection.
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Affiliation(s)
- Sung Hyun Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sung Yoon
- Department of Quality Assurance, Samyang Biopharmaceuticals Corporation, Daejeon, Korea
| | - Chang Hoon In
- Department of Biology and Clinical Pharmacology, Samyang Biopharmaceuticals Corporation, Daejeon, Korea
| | - Kyung Sik Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Coseri S, Doliška A, Kleinschek KS. Immobilization of Water-Soluble 6-Carboxylcellulose on Poly(ethylene terephthalate) Films Monitored by a Quartz Crystal Microbalance with Dissipation. Ind Eng Chem Res 2013. [DOI: 10.1021/ie400645j] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sergiu Coseri
- “Petru Poni” Institute of Macromolecular Chemistry of Romanian Academy, 41A Grigore Ghica Voda Alley, 700487 Iasi, Romania
| | - Aleš Doliška
- Laboratory for Characterization
and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Smetanova 17, SI-2000 Maribor,
Slovenia
| | - Karin Stana Kleinschek
- Laboratory for Characterization
and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Smetanova 17, SI-2000 Maribor,
Slovenia
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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.
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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.
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Chalupová M, Suchý P, Pražanová G, Bartošová L, Sopuch T, Havelka P. Local tissue reaction after the application of topical hemostatic agents in a rat partial nephrectomy model. J Biomed Mater Res A 2012; 100:1582-90. [PMID: 22447452 DOI: 10.1002/jbm.a.34098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 01/04/2012] [Accepted: 01/24/2012] [Indexed: 11/06/2022]
Abstract
Various hemostatics are used for renal surgical procedures. We investigated the hemostatic efficacy of cellulose derivatives on the model of partial nephrectomy in rats focusing on the local reaction of renal parenchyma. A total of 50 Wistar rats were divided into five groups of 10 animals each. Partial nephrectomy of the caudal pole without hilar vascular control was performed. Oxidized cellulose (OC), sodium salt of oxycellulose (OCN), carboxymethyl cellulose (CMC), dialdehyde cellulose (DAC), and gelatin-based hemostatic (C) were applied to the bleeding wounds. The time to hemostasis was monitored. Half of the animals were euthanized after 3 days, the second half 30 days from the experiment start date. The left kidney was excised and subjected to histopathological examination. The biochemical data was subjected to statistical analysis. The time to hemostasis in all groups was significantly less than in the C group (in OC p = 0.0057, OCN p = 0.0039, CMC and DAC p = 0.0001). In the C group, massive hemorrhages and necrosis did occur. In the OC and OCN groups, there were regenerative changes, a receding inflammatory reaction and hemorrhage. DAC caused an immune reaction and massive interstitial hemorrhages with biochemical signs of liver damage. Parenchyma in CMC revealed a reduction of necrosis and interstitial hemorrhages with regenerative processes. The most effective hemostatics were CMC and OC, achieving the best results both in the time to hemostasis, and for histopathological evaluation.
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Affiliation(s)
- Marta Chalupová
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic.
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Broekema FI, van Oeveren W, Zuidema J, Visscher SH, Bos RRM. In vitro analysis of polyurethane foam as a topical hemostatic agent. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:1081-1086. [PMID: 21424213 PMCID: PMC3085060 DOI: 10.1007/s10856-011-4276-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 02/28/2011] [Indexed: 05/30/2023]
Abstract
Topical hemostatic agents can be used to treat problematic bleedings in patients who undergo surgery. Widely used are the collagen- and gelatin-based hemostats. This study aimed to develop a fully synthetic, biodegradable hemostatic agent to avoid exposure to animal antigens. In this in vitro study the suitability of different newly developed polyurethane-based foams as a hemostatic agent has been evaluated and compared to commonly used agents. An experimental in vitro test model was used in which human blood flowed through the test material. Different modified polyurethane foams were compared to collagen and gelatin. The best coagulation was achieved with collagen. The results of the polyurethane foam improved significantly by increasing the amount of polyethylene glycol. Therefore, the increase of the PEG concentration seems a promising approach. Additional in vivo studies will have to be implemented to assess the application of polyurethane foam as a topical hemostatic agent.
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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.
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Perniola G, Antonilli M, Gasparri ML. Let’s Think Twice Before Abandoning Fibrillar Oxidized Regenerated Cellulose. Ann Surg Oncol 2011; 18 Suppl 3:S292-3; author reply S294. [DOI: 10.1245/s10434-010-1520-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Indexed: 12/22/2022]
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Germanos S, Bolanis I, Saedon M, Baratsis S. Control of presacral venous bleeding during rectal surgery. Am J Surg 2010; 200:e33-5. [PMID: 20409516 DOI: 10.1016/j.amjsurg.2009.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 11/04/2009] [Accepted: 11/06/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Presacral venous hemorrhage is an uncommon but potentially life-threatening complication of rectal surgery. It is difficult to control presacral venous hemorrhage with conventional hemostatic measures and several alternative methods for hemostasis have been proposed. We described our experience of using the combination of a hemostatic matrix and an absorbable hemostat as an alternative method of hemostasis. METHODS From September 2007 to March 2009, 83 patients underwent rectal surgery for cancer, ulcerative colitis, or familial adenomatous polyposis. Three patients (3.6%) had severe presacral hemorrhage, which was controlled by the combined use of a hemostatic matrix (FloSeal; Baxter, USA) and an absorbable hemostat (Surgicel Fibrillar; Ethicon, USA). RESULTS Intraoperative blood transfusion was required in 1 patient. Postoperative blood loss was minimal and drain was removed on day 4 in all 3 patients. CONCLUSIONS The use of synthetic hemostatic agents is an effective and simple way to arrest presacral bleeding where conventional methods fail.
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Abstract
BACKGROUND A variety of local haemostatic agents is now available to stop troublesome bleeding. These agents are indicated for use during surgical interventions where conventional methods of haemostasis are not applicable because of the site of surgery or the degree of bleeding. METHOD A literature search using the PubMed and ISI Web of Knowledge databases identified relevant studies on topical haemostatic agents. Manufacturers' recommendations were also sought through commercial websites. RESULTS AND CONCLUSION A significant body of evidence now exists to support the use of topical haemostatic agents in a wide variety of clinical situations. The advantages and disadvantages of many of these agents are highlighted.
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Affiliation(s)
- H Seyednejad
- Division of Surgery and Interventional Science, University College London, UK
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