Emerging hemostatic materials for non-compressible hemorrhage control

All-in-one extracellular matrix-based powders with instant self-assembly and multiple bioactivities integrate hemostasis and in-situ tissue functional repair

Non-compressible hemorrhage poses a severe threat to life globally, yet achieving effective hemostasis and facilitating tissue repair remain a significant challenge and desired requirement. Herein, the all-in-one extracellular matrix (ECM)-based powder, composed of modified small intestinal submucosa (SIS) and sodium alginate, was ingeniously designed to realize one-stop management for non-compressible hemorrhage. Specifically, upon contact bleeding site, the powder's extreme liquid absorption allows for the rapid removal of interfacial blood. Simultaneously, based on the instant self-assembly strategy of covalent/non-covalent interaction, the powder can transform to wet bio-adhesive hydrogel within 5 s, effectively sealing the wound. Using the inherent bioactivities, the ECM-based powder exhibits satisfactory biocompatibility, enhanced cell recruitment, angiogenesis and endothelial cell functions. Ulteriorly, excellent hemostasis performance have verified in rabbit liver non-compressible hemorrhage and heart/artery massive hemorrhage models, significantly reducing the blood loss. More importantly, after hemostasis, the impaired liver demonstrates functional restoration that the more vessels and bile ducts formation, facilitated by the biodegradation of ECM-derived powders in vivo and the multi-biological cues response. Collectively, leveraging the merits of powder and hydrogel, this novel powder fulfills the all-in-one need for both non-compressible hemorrhage control and subsequent tissue repair, signifying it a valuable material in first aid.

Ultrafast self-gelling, superabsorbent, and adhesive chitosan-based hemostatic powders for rapid hemostasis and wound healing

Hemostatic powders are widely used for managing bleeding from wounds with various irregular shapes. However, their limited liquid absorption capacity and difficulty in removal after application remain significant clinical challenges. Herein, we introduce a multifunctional hemostatic powder composed of dually crosslinked poly([2-(methacryloyloxy)ethyl]trimethylammonium chloride-co-acrylic acid) (pMATC-co-AA) and N-[(2-hydroxy-3-trimethylammonium)propyl] chitosan chloride (HTCC), which are integrated via electrostatic interactions and hydrogen bonding. This hemostatic powder exhibits superb liquid-absorbing capacity (94.5 times its own weight in water and 9.1 times in blood), sufficient adhesive properties (5.9 kPa on pig skin), and on-demand removability. It significantly reduces the number of viable Escherichia coli and Staphylococcus aureus by 4.61 and 4.04 orders of magnitude, respectively, thus providing an effective microbiological barrier for the wound. Furthermore, a series of in vivo and in vitro experiments confirm the powder's excellent hemostatic properties. The hydrogel formed on the wound after hemostasis can be removed by saline rinsing on demand, due to its superb liquid-absorbing capacity. Notably, the powder demonstrates good in vivo biocompatibility, with minimal risk of impeding wound healing, and it facilitates the healing process during the later stages. In sum, the hemostatic powder offers a promising solution for trauma bleeding control and acute wound treatment.

Bioactive Polyurethane Shape Memory Polymer Foam Dressings with Enhanced Blood and Cell Interactions for Improved Wound Healing

Polyurethane (PUr) shape memory polymer (SMP) foams have demonstrated excellent bleeding control in traumatic wounds. Unlike the current clinically available treatment options, PUr SMP foams can address noncompressible bleeds, are safe for prolonged use, and are highly tunable, offering broad functionalities like biodegradation and antimicrobial properties. Despite their hemostatic efficacy, PUrs are entirely synthetic, which limits their long-term healing capacity if left in a wound to degrade. This work employed methods for facile incorporation of bioactive collagen and gelatin into PUr foams postfabrication to enhance their clotting efficacy and drive cell interactions. The procoagulant nature of collagen and gelatin increased the clotting accomplished by the PUr SMP foams. Additionally, the bioactive PUr SMP foams promoted cell attachment, spreading, and proliferation on foam pores, which could facilitate tissue migration into the scaffold and promote wound repair. Overall, a bioactive PUr SMP foam dressing could significantly improve traumatic wound healing outcomes.

Centrifugal Spinning-Derived Biomimetic Aerogel for Rapid Hemostasis with Minimal Blood Loss

For emergency treatment, especially in situations where rapid and effective hemostasis is required beyond the natural clotting mechanisms, advanced materials designed to reduce bleeding time and minimize blood loss have become an urgent need. Herein, a root hair-inspired aerogel is developed, which is characterized by a 99.99% interconnected pore structure and a three-dimensional network constructed by blocked aqueous isocyanates cross-linked grooved cellulose acetate and wrinkled thermoplastic polyurethane fibers via centrifugal spinning. The aerogel exhibits enhanced water absorption and minimal blood adsorption through rapid coagulation cascade activation. In vivo studies using rat tail, hepatic, and renal injury models demonstrate a substantial reduction in blood loss (∼94%) and hemostasis time (∼78%) compared to commercial hemostats. The developed aerogel offers a promising solution for urgent hemorrhage control.

Advances in the application of hydrogel adhesives for wound closure and repair in abdominal digestive organs

The abdominal cavity houses the majority of the digestive system organs, which frequently suffer from diseases with limited responsiveness to pharmacological treatments, such as bleeding, perforation, cancer, and mechanical obstruction. Invasive procedures, including endoscopy and surgery, are typically employed to manage these conditions. Currently, sutures and staplers remain the gold standard for internal wound closure. However, these methods inevitably cause secondary tissue damage. Unlike superficial organs such as the skin, the abdominal cavity presents a relatively confined environment where postoperative complications tend to be more severe. To achieve wound closure and repair, hydrogel adhesives have garnered attention due to their minimal invasiveness, robust sealing, and ease of application. Nonetheless, the application of hydrogel adhesives within the abdominal cavity faces several challenges, including adhesion in moist environments, selective adhesion, and resistance to acids and digestive enzymes. To date, there has been no comprehensive review focused on the use of hydrogel adhesives for wound closure in abdominal digestive organs. This review introduces the design principles of hydrogel adhesives tailored for abdominal organs and provides a detailed overview of recent advances in their applications for esophageal endoscopic submucosal dissection, gastric perforation, hepatic bleeding, pancreatic leakage, and intestinal anastomotic leakage. Additionally, the current challenges and future directions of hydrogel adhesives are discussed. This review aims to provide valuable insights for the development of next-generation hydrogel adhesives for wound closure and repair in abdominal digestive organs.

Procoagulant, antibacterial and antioxidant high-strength porous hydrogel adhesives in situ formed via self-gelling hemostatic microsheets for emergency hemostasis and wound repair

Procoagulant, antibacterial and analgesic hemostatic hydrogel dressing with high wet tissue adhesion, ultra-high burst pressure, and easy preparation shows huge promising for rapid hemostasis in emergencies, yet it remains a challenge. Herein, we propose hemostatic microsheets based on quaternized chitosan-g-gallic acid (QCS-GA) and oxidized hyaluronic acid (OHA), which merge the benefits of sponges, hydrogels, and powders for rapid hemostasis and efficient wound healing. Specifically, they exhibit a large specific surface area and excellent hydrophilicity, rapidly absorbing blood and self-gelling through electrostatic interaction and Schiff base crosslinking. And this results in dense, porous hydrogel adhesives with superior mechanical properties, adhesion strength, and ultra-high burst pressure. Furthermore, the microsheets are biocompatible, biodegradable, and possess procoagulant, antibacterial, and antioxidant properties. In mouse and rat liver hemorrhage models, the optimized formulation (QCS-GA + OHA4) demonstrated superior hemostatic effects compared to Celox. In particular, QCS-GA + OHA4 microsheets could stop bleeding quickly from rat femoral artery transection and deliver lidocaine to provide analgesia during emergency treatment. Additionally, they promoted wound healing in mouse full-thickness skin defect wound. These easy-to-manufacture hemostatic microsheets are adaptable to irregular wounds, providing a novel solution for rapid hemostasis and wound healing.

Bioactive hemostatic materials: a new strategy for promoting wound healing and tissue regeneration

Wound healing remains a critical global healthcare challenge, with an annual treatment cost exceeding $50 billion worldwide. Over the past decade, significant advances in wound care have focused on developing sophisticated biomaterials that promote tissue regeneration and prevent complications. Despite these developments, there remains a crucial need for multifunctional wound healing materials that can effectively address the complex, multiphase nature of wound repair while being cost effective and easily applicable in various clinical settings. This review systematically analyzes the latest developments in wound healing materials, examining their chemical composition, structural design, and therapeutic mechanisms. We comprehensively evaluate various bioactive components, including natural polymers, synthetic matrices, and hybrid composites, along with their different forms, such as hydrogels, powders, and smart dressings. Special attention is given to emerging strategies in material design that integrate multiple therapeutic functions, including sustained drug delivery, infection prevention, and tissue regeneration promotion. The insights provided in this review illuminate the path toward next-generation wound healing materials, highlighting opportunities for developing more effective therapeutic solutions that can significantly improve patient outcomes and reduce healthcare burden.

Recent progress in polysaccharide microsphere-based hemostatic material for intravascular and extravascular hemostasis: A review

Hemorrhage, a common consequence of diseases, surgical procedures, and traffic accidents, poses a significant threat to public health. Effective hemostasis is crucial for patient survival and prognosis, particular in case of internal bleeding. While polysaccharide microsphere-based hemostatic materials have gained clinical acceptance due to their effectiveness, good biocompatibility, and versatility in both intravascular and extravascular hemostasis, they are limited by their single function and insufficient hemostatic properties. Recently, booming developments have been witnessed in microsphere-based biomaterials to achieve a combination therapy for hemostasis. This review first examines the fundamentals of coagulation process, hemostatic mechanisms, and microsphere fabrication techniques. We then discuss the latest investigations in functionalized microsphere-based hemostatic materials for controlling intravascular and extravascular hemorrhage, focusing on design strategies, hemostatic properties, and clinical implementation. Finally, we also propose some limitations and challenges of these hemostatic materials, aiming to provide valuable insights for future research in novel polysaccharide microsphere-based biomaterial.

On-Demand Removal of Rapid Hemostatic Sponge for Non-Compressible Hemorrhage Through Disrupting Ionic Bonds

Self-expanding hemostatic sponge plays an important role in the control of non-compressible hemorrhage in deep wound. After hemostasis is accomplished, the sponge adheres to the wound via blood clots, posing a considerable challenge in wound debridement. A kind of protocatechualdehyde modified chitosan/sodium alginate composite hemostatic sponge with on-demand removal performance is designed in this study. After absorbing blood, the compression sponge rapidly expands and compresses the damaged blood vessels. The physical compression of the hemostatic sponge and the chemical adhesion of catechol is used to promote rapid hemostasis of the wound. The composite hemostatic sponge demonstrated outstanding hemostasis performance in both mouse liver and rat femoral artery bleeding model. Notably, after complete hemostasis of the rat femoral artery, the composite sponge is rapidly removed from the wound by rinsing it with a suitable concentration of Sodium carbonate (Na2CO3) solution. This composite hemostatic sponge featuring the on-demand removal capability demonstrates outstanding application potential for non-compressible hemorrhage in deep wounds and provides a novel way for constructing removable hemostatic sponges.

A silk nanofiber and hyaluronic acid composite hemostatic sponge for compressible hemostasis

Uncontrolled traumatic blood loss is a leading cause of hemorrhagic shock and death, highlighting the critical need for compressible and rapid hemostatic first-aid materials. In this study, silk nanofibers (MA-SNFs) were prepared through maleic acid (MA) hydrolysis decorated with enriched carboxyl groups. The MA-SNFs were then combined with hyaluronic acid (HA) through EDC/NHS crosslinking to form a porous sponge (i.e., MA-SNF/HA) through freeze-drying. The fabricated MA-SNF/HA sponges demonstrated excellent blood compatibility (hemolysis ratio < 5 %), outstanding hemocompatibility (blood clotting index (BCI) < 35 % within 60 s), and good cytocompatibility (cell viability >85 %). Among the different sponges prepared, M4-H6 (MA-SNFs: HA = 4:6) exhibited the best liquid reabsorption capacity after 80 % compression, outperforming M6-H4 and M5-H5 sponges. Furthermore, M4-H6 sponge absorbed liquid rapidly (~30 s) while matching the liquid absorption capacity of commercial gelatin sponge (GS), which require over 5 min for similar absorption (2232.84 ± 141.69 %). These findings suggest that M4-H6 sponge is highly suitable for compressible hemostasis applications and provide further insights into its potential hemostatic mechanism.

Rapid synthesis of degradable ester/thioether monomers and their incorporation into thermoset polyurethane foams for traumatic wound healing

Polyurethane (PUr) foam hemostatic dressings are highly effective at controlling bleeding in traumatic wounds, but their traditionally slow degradation rate requires dressing removal, which could result in wound rebleeding. Incorporating degradable linkages into the PUr network can provide a biodegradable dressing that could be left in place during healing, eliminating rebleeding upon removal and providing scaffolding for new tissue ingrowth with no remains of the applied dressing after healing. In this work, a library of degradable PUr foams was synthesized from degradable monomers based on hydrolytically labile esters and oxidatively labile thioethers using rapid click-chemistry reactions. In a twelve-week in vitro degradation study in 3% hydrogen peroxide and 0.1 M sodium hydroxide, incorporation of degradable monomers resulted in significantly increased PUr foam mass loss, offering biodegradable foam dressings that could better match the rate of traumatic wound healing. Changes to foam chemical, mechanical, thermal, and physical properties throughout degradation were also analyzed. Furthermore, the degradable PUr foams had increased platelet interactions, which could improve foam-induced clotting for a more effective hemostatic dressing. Overall, a biodegradable PUr foam hemostatic dressing could significantly improve healing outcomes in traumatic wounds. STATEMENT OF SIGNIFICANCE: A simple, solvent-free, rapid synthesis technique was developed to provide degradable polythiol monomers for use in polyurethane synthesis. The degradable monomers were incorporated into hemostatic polyurethane foams to provide materials with tunable degradation rates within clinically-relevant time frames. The resulting foams and their degradation byproducts were cytocompatible and hemocompatible, and foams made with the new degradable monomers had enhanced blood clotting, enabling their future use as hemostatic dressings.

Bicomponent nano- and microfiber aerogels for effective management of junctional hemorrhage

Managing junctional hemorrhage is challenging due to ineffective existing techniques, with the groin being the most common site, accounting for approximately 19.2% of potentially survivable field deaths. Here, we report a bicomponent nano- and microfiber aerogel (NMA) for injection into deep, narrow junctional wounds to effectively halt bleeding. The aerogel comprises intertwined poly(lactic acid) nanofibers and poly(ε-caprolactone) microfibers, with mechanical properties tunable through crosslinking. Optimized aerogels demonstrate improved resilience, toughness, and elasticity, enabling rapid re-expansion upon blood contact. They demonstrate superior blood absorption and clotting efficacy compared to commercial products (i.e., QuikClot® Combat Gauze and XStat®). Most importantly, in a lethal swine junctional wound model (Yorkshire swine, both male and female, n = 5), aerogel treatment achieved immediate hemostasis, a 100% survival rate, no rebleeding, hemodynamic stability, and stable coagulation, hematologic, and arterial blood gas testing.

Water absorption dynamics in medical foam: empirical validation of the Lucas-Washburn model

This study extends the Lucas-Washburn theory through non-equilibrium thermodynamic analysis to examine fluid absorption in medical foams used for hemorrhage control. As a universal model for capillary flow in porous media, the theory demonstrated strong agreement with experimental results, confirming its semi-quantitative accuracy. Minor deviations, likely due to material heterogeneity, were observed and explained, enhancing the theory's applicability to real-world conditions. Our findings underscore the universality of the Lucas-Washburn framework and provide valuable insights for optimizing the design of medical foams, ultimately contributing to more effective bleeding control solutions in clinical applications.

Smart design in biopolymer-based hemostatic sponges: From hemostasis to multiple functions

Uncontrolled hemorrhage remains the leading cause of death in clinical and emergency care, posing a major threat to human life. To achieve effective bleeding control, many hemostatic materials have emerged. Among them, nature-derived biopolymers occupy an important position due to the excellent inherent biocompatibility, biodegradability and bioactivity. Additionally, sponges have been widely used in clinical and daily life because of their rapid blood absorption. Therefore, we provide the overview focusing on the latest advances and smart designs of biopolymer-based hemostatic sponge. Starting from the component, the applications of polysaccharide and polypeptide in hemostasis are systematically introduced, and the unique bioactivities such as antibacterial, antioxidant and immunomodulation are also concerned. From the perspective of sponge structure, different preparation processes can obtain unique physical properties and structures, which will affect the material properties such as hemostasis, antibacterial and tissue repair. Notably, as development frontier, the multi-functions of hemostatic materials is summarized, mainly including enhanced coagulation, antibacterial, avoiding tumor recurrence, promoting tissue repair, and hemorrhage monitoring. Finally, the challenges facing the development of biopolymer-based hemostatic sponges are emphasized, and future directions for in vivo biosafety, emerging materials, multiple application scenarios and translational research are proposed.

A randomized comparison of an adhesive gelatin sponge and a plain collagen sponge for hemostatic control during canine liver surgery

OBJECTIVE

To compare the effectiveness of a modified surface gelatin sponge to a plain collagen sponge for hemostasis of parenchymal hepatic bleeding.

STUDY DESIGN

Prospective, randomized trial of two hemostatic agents.

ANIMALS

A total of 45 dogs undergoing elective liver surgery were randomly allocated into two groups: 22 in the adhesive gelatin (AG) group and 23 in the plain collagen (PC) group. A total of 20 patients per group underwent liver biopsy to create a uniformly sized bleeding surface, with the remaining patients (AG = 2, PC = 3) undergoing liver lobectomy.

METHODS

Evaluation of hemostatic effectiveness and tissue adhesion of each sponge type was performed by the operating surgeon using structured scoring systems. Hemostatic parameters were primarily evaluated at the liver biopsy site to maintain homogeneity of bleeding surface size.

RESULTS

For the liver biopsy group (n = 40), 5 min after hemostatic sponge application, 10/20 dogs were bleeding in the PC group, compared to 2/20 in AG group (p = .0138). The PC bleeding was significantly higher than AG across the 3 to 6 min evaluation period (p < .001). When surgeons tested the adhesion of the sponge across the whole cohort (n = 45), AG scored 2 (of 3) against 1 for PC (p < .001). In group PC, 5/23 sponges dislodged during abdominal lavage and preparations for closure and had to be replaced due to recurrence of bleeding, compared with no AG sponges dislodging (p = .042). There were no further complications related to the use of either sponge.

CONCLUSION

In the dogs with hepatic parenchymal incision, use of an adhesive gelatin sponge improved intraoperative attachment and haemostatic effectiveness, compared to a collagen sponge.

CLINICAL SIGNIFICANCE

Based on our clinical experience in these cases, adhesive gelatin sponges could be considered an effective option when selecting a hemostatic agent for liver surgery in dogs.

In Situ Fabrication of Electrospun Magnetic Film under Laparoscopic Guidance for Preventing Postoperative Recurrence of Hepatocellular Carcinoma

Despite laparoscopic-guided minimally invasive hepatectomy emerging as the primary approach for resecting hepatocellular carcinoma (HCC), there is still a significant gap in suitable biomaterials that seamlessly integrate with these techniques to achieve effective hemostasis and suppress residual tumors at the surgical margin. Electrospun films are increasingly used for wound closure, yet the employment of prefabricated electrospun films for hemostasis during minimally invasive HCC resection is hindered by prolonged operation times, complexity in implementation, limited visibility during surgery, and inadequate postoperative prevention of HCC recurrence. In this study, montmorillonite-iron oxide sheets are integrated into the polyvinylpyrrolidone (PVP) polymer framework, enhancing the resulting electrospun PVP/montmorillonite-iron oxide (MI) film (abbreviated as PMI) with robustness, hemostatic capability, and magnetocaloric properties. In contrast to the in vitro prefabricated electrospun films, the electrospun PMI film is designed to be formed in situ on liver wounds under laparoscopic guidance during hepatectomy. This design affords superior wound adaptability, facilitating meticulous wound closure and expeditious hemostasis, thereby simplifying the operative process and ultimately alleviating the workload of healthcare professionals. Moreover, when exposed to an alternating magnetic field, the film can efficiently ablate residual tumors, significantly augmenting the treatment efficacy of HCC.

Stimulus-responsive smart bioactive glass composites for repair of complex tissue defects

Smart biomaterials with active environmental responsiveness have attracted widespread attention in recent years. Previous studies on bioactive glass (BG) have mainly focused on the property of bioactivity, while little attention has been paid to the property of smart response of BG. Herein, we propose the concept of Smart Bioactive Glass Composites (SBGC) which are capable of actively responding to the endogenous disease microenvironment or exogenous physical stimuli, thereby enabling active treatment of tissue defect sites and ultimately promoting tissue regeneration. In this review, the response characteristics of SBGC to different internal and external environments are described. Subsequently, the applications of SBGC in complex tissue defect repair of tumors, infections, and diabetes are reviewed. By deeply analyzing the recent progress of SBGC in different fields, this review will point out the direction for the research of next-generation BG.

Aliphatic-acid coating and nano chitosan nucleator synergistically regulate the performance of PMMA "bone-Locking" foam dressing used for emergency fixation of clavicle fracture

Clavicle emergency fixation can prevent fractured end from piercing heart and lung organs, which is crucial for wounded life. Clavicle with complex structure, great individual differences, and adjacent to important organs, which places high-requirements on performance of fixation materials. Developing advanced clavicle fixation material is a prominent hot-topic in the field of emergency-engineering. We prepared a Polymethyl-methacrylate (PMMA) "bone-Locking" foam dressing via novel polymer foaming process. Innovatively used aliphatic-acid and bio-polar macromolecule nanoparticles to adjust structure in non-traditional self-curing polymer melts to achieve high-performance. Stearic acid coating was prepared on the surface of foaming agent can delay nucleation period, increasing the initial Polymer-Bubble interface viscosity and effectively retard nuclei growth and escape. Nano-chitosan was compounded synchronously to induce in-situ nucleation and construct polar hydrogen bonds between chains, improve the crystallinity of PMMA matrix, reduce the relaxation ability of PMMA molecular chains and increase the interface viscosity again to inhibit nuclei growth and escape, realizing spontaneous coordination between viscosity and the bubble holes formation process. Obtained high-performance foam with uniform and regular bubble holes structure eventually. More, Dynamic Dual-Variable Field Bubble-Growth Dynamics was proposed, revealing the Bubble-Growth behavior synergistic driven by Viscosity and Temperature theoretically, providing reference for improving theory in polymer foaming field. Prepared foam dressing can be directly and softly coated on clavicle and spontaneously conform to the contour of clavicle with remarkable precision, then quickly (3.5 min) curing into a lightweight (0.57 g/cm3), high-strength (40.5 MPa), breathable (224.73 mm/s) "Armor", showing great application value in wound emergency engineering. The developed foaming method and theory provide technical and theoretical value for polymer foaming system. The foam dressing provides a promising new scheme for fixing various wound sites and ensuring the life safety of the wounded at the emergency scene.

Self-expanding cellulose sponge with enhanced hemostatic ability by tannic acid/metal ion composite coating for highly effective hemostasis of difficult-to-control bleeding wounds

Refractory bleeding presents a critical, life-threatening challenge, and the goal of medical professionals and researchers has always been to achieve safe and effective hemostasis for bleeding wounds. In this study, we utilized the benefits of a self-expanding cellulose sponge to control incompressible bleeding, which is achieved this by creating a tannic acid/metal ion coating on the surface and within the pores of the sponge to improve its hemostatic effectiveness. The effects of various types and concentrations of metal ions (calcium, magnesium, iron, and zinc) on hemostatic efficiency and biosafety is systematically investigated. The results from bacteriostasis and in vitro coagulation experiments identified 0.3 wt% Fe3+ as the optimal metal ion coating. Scanning electron microscope energy spectrum analysis confirmed the uniform distribution of Fe3+ within the cellulose sponge. Furthermore, the in vivo and in vitro results demonstrated that the prepared tannic acid/Fe3+ coated composite hemostatic sponge exhibits excellent coagulation ability and biocompatibility. Both the bleeding time and theblood loss in two bleeding models are significantly reduced, showing promising potential for treating extensive surface bleeding and deep penetrating wounds. Furthermore, the straightforward preparation method for this composite hemostatic sponge facilitates additional research towards market application.

Mussel-inspired oxidized sodium alginate/cellulose composite sponge with excellent shape recovery and antibacterial properties for the efficient control of non-compressible hemorrhage

Enhancing the hemostatic efficacy and minimizing blood loss in the body has consistently been a primary objective for researchers. This study improved the hemostatic efficacy and tissue adhesion strength of the hemostatic material by augmenting the aldehyde groups in the side chains of sodium alginate. Additionally, it immobilized the aldehyde-modified sodium alginate onto the surface of the hemostatic material through complexation with iron ions, thereby enhancing its antibacterial properties. The mechanical performance results demonstrated that the composite hemostatic sponge can rapidly absorb water, swell to counteract arterial blood pressure, and seal the bleeding wound. The results of tissue and blood cell adhesion and in vivo hemostasis showed that the composite hemostatic sponge can enhance the rate of blood clot formation and the adhesion strength of tissue, thereby reducing the hemostasis time and blood loss. The bacterial and cell growth results demonstrated that the composite hemostatic sponge displays excellent biocompatibility and antibacterial properties. Based on the excellent water absorption, swelling properties, and softness of cellulose sponge, the composite hemostatic sponge offered a significant advantage for achieving rapid hemostasis in penetrating wounds or deep wounds with substantial bleeding.

Self-gelling, tunable adhesion, antibacterial and biocompatible quaternized cellulose/tannic acid/polyethylene glycol/montmorillonite composite powder for quick hemostasis

Hemostatic powders are widely used in incompressible or irregularly shaped bleeding wounds, but traditional hemostatic powders exhibit low adhesion, unsatisfactory hemostatic effect, limited infection control, and are not suitable for clinical or emergency situations. This study developed a novel self-gelling hemostatic powder (QTPM) consisting of quaternized cellulose (QC)/ tannic acid (TA)/ polyethylene glycol (PEG)/ montmorillonite (MMT). QTPM could absorb interfacial liquid hydrating to a stable hydrogel which form a switchable adhesion to tissues. Moreover, QTPM exhibits excellent antibacterial property by the synergistic effect of QC and TA. Furthermore, QTPM directly activate intrinsic and extrinsic coagulation hemostatic pathways to enhance hemostasis, and it concentrate coagulation factors. In vivo hemostasis study results show that QTPM significantly accelerated hemostasis and reduced blood loss compared with the blank group (>75 % reduction in hemostatic time, >85 % reduction in blood loss) in liver bleeding model (hemostasis time of 71.67 ± 7.09 s, blood loss of 19.23 ± 2.60 mg) and tail amputation model (hemostasis time of 91.03 ± 12.05 s, blood loss of 15.24 ± 1.77 mg). Therefore, the advantages of QTPM including rapid and effective hemostasis, easy usage, easy storability and adaptability make it a potential biomaterial for rapid hemostasis direction in the clinical setting.

A microenvironment-modulating dressing with proliferative degradants for the healing of diabetic wounds

Diabetic wounds are usually entangled in a disorganized and self-perpetuating microenvironment and accompanied by a prolonged delay in tissue repair. Sustained and coordinated microenvironment regulation and tissue regeneration are key to the healing process of diabetic wounds, yet they continue to pose a formidable challenge. Here we report a rational double-layered dressing design based on chitosan and a degradable conjugated polymer polydiacetylene, poly(deca-4,6-diynedioic acid) (PDDA), that can meet this intricate requirement. With an alternating ene-yne backbone, PDDA degrades when reacting with various types of reactive oxygen species (ROS), and more importantly, generates proliferative succinic acid as a major degradant. Inheriting from PDDA, the developed PDDA-chitosan double layer dressing (PCD) can eliminate ROS in the microenvironment of diabetic wounds, alleviate inflammation, and downregulate gene expression of innate immune receptors. PCD degradation also triggers simultaneous release of succinic acid in a sustainable manner, enabling long-term promotion on tissue regeneration. We have validated the biocompatibility and excellent performance of PCD in expediting the wound healing on both diabetic mouse and porcine models, which underscores the significant translational potential of this microenvironment-modulating, growth-promoting wound dressing in diabetic wounds care.

External Bleeding and Advanced Biomacromolecules for Hemostasis

Hemorrhage is a significant medical problem that has been an active area of research over the past few decades. The human body has a complex response to bleeding that leads to blood clot formation and hemostasis. Many biomaterials based on various biomacromolecules have been developed to either accelerate or improve the body's natural response to bleeding. This review examines the mechanisms of hemostasis, types of bleeding, and the in vitro or in vivo models and techniques used to study bleeding and hemostatic materials. It provides a detailed overview of the diverse hemostatic materials, including those that are highly absorbent, wet adhesives, and those that accelerate the biochemical cascade of blood clotting. These materials are currently marketed, under preclinical testing, or being researched. In exploring the latest advancements in hemostatic technologies, this paper highlights the potential of these materials to significantly improve bleeding control in clinical and emergency situations.

Efficacy and safety evaluation of a novel hemostatic gelatin matrix for intraoperative hemostasis: a prospective, randomized controlled trial

Borayflo Haemostatic matrix is a new absorbable hemostatic gelatin matrix which can be used for intraoperative assisted hemostasis. In a prospective, multicenter, non-inferiority, randomized controlled trial, a total of 354 subjects were recruited from the departments of hepatobiliary surgery, obstetrics and gynaecology and orthopaedics of 4 hospitals and randomly allocated to test group (Borayflo Haemostatic matrix) or control group (Surgiflo Haemostatic matrix) in a 1:1 ratio. In the modified intention-to-treat population, 163 (93.14%) of 175 subjects in the test group versus 167 (94.89%) of 176 subjects in the control group successfully achieved hemostasis within 5 min (P > 0.05). Non-inferiority for effective rates of hemostasis at 5 min to Surgiflo Haemostatic matrix was shown in the study (treatment difference: -1.74% [95%CI, -6.70-3.22%] for modified intention-to-treat population). In terms of efficacy and safety, the new hemostatic gelatin matrix (Borayflo Haemostatic matrix) is equivalent to Surgiflo Haemostatic matrix. There was no significant difference in the incidence of AEs or SAEs between the test and control groups(P > 0.05). In addition, Borayflo Haemostatic matrix is a domestically produced haemostatic gelatin product, an advantage that will reduce the cost of surgical haemostasis for Chinese patients.

Developing a multifunctional chitosan composite sponge for managing traumatic injuries

Developing porous hemostatic sponges that are both biosafe and multifunctional remains a complex challenge. Conventional hemostatic techniques often fall short in managing bleeding effectively, leading to severe critical cases such as suboptimal hemostasis, increased infection risk, and complications arising from profuse bleeding. To address these deficits, our study introduces a novel multifunctional nanocomposite sponge that synergistically incorporates chitosan (CS), cellulose (Cel), graphene oxide (GO), and silver (Ag) nanoparticles. The resulting CS/Cel/GO/Ag developed demonstrates a swelling rate exceeding 3000 %, an absorption rate of over 2100 %, and the lowest stress surpassing 20 kPa at an initial 80 % strain. In vitro analyses reveal that the CS/Cel/GO/Ag sponge has excellent cytocompatibility, non-hemolytic nature, and competence in blood cell adherence and bacterial inhibition. In vivo evaluations further demonstrate that compared to conventional hemostatic methods, the sponge substantially enhances hemostatic efficacy, as evidenced by the marked reductions in clotting times and diminished blood loss compared to conventional hemostatic methods. Specifically, the test results of the CS/Cel/GO/Ag sponge across three different models are as follows: for the rat tail amputation model, the clotting time was 99 s, while blood loss was 222 mg; for the rat liver injury model, the clotting time was 129 s. while blood loss was 812 mg; for the rat femoral artery laceration model, the clotting time was 96 s, while blood loss was 758 mg. The compelling attributes of the CS/Cel/GO/Ag sponges position them as a promising solution for the acute management of bleeding. Their excellent performance indicates they have potential role to play in trauma care.

Multifunctional injectable oxidized sodium alginate/carboxymethyl chitosan hydrogel for rapid hemostasis

Uncontrolled bleeding from incompressible or irregularly shaped wounds is a major factor in the death of people in the battlefield or surgery process. Ideal rapid hemostatic materials should have the performance of rapid hemostasis and at the same time can be applied to a variety of complex wound trauma types, in addition, excellent antimicrobial properties, adhesion, biocompatibility, degradation, and the non-toxicity of degradation products are also necessary, but there are fewer hemostatic materials that meet these requirements. Herein, we prepared an injectable hemostatic hydrogel based on the natural products sodium alginate (SA) and carboxymethyl chitosan (CMC). Oxidized sodium alginate (OSA) was prepared by the oxidation reaction of NaIO4 with SA, and OSA with aldehyde group was mixed with CMC with amino group to rapidly form an in situ injectable hemostatic hydrogel (OSA/CMC) by the Schiff base reaction. OSA/CMC hydrogel exhibited excellent antimicrobial and adhesion properties by the Schiff base reaction. In addition, OSA/CMC hydrogel directly activate the endogenous coagulation pathway through the synergistic effect of OSA, CMC to enhance the hemostatic effect. The results of in vivo hemostasis study showed that OSA/CMC hydrogel significantly accelerated hemostasis and reduced blood loss in liver hemorrhage model and tail amputation model. Therefore, OSA/CMC hydrogel is expected to be a potential material in the direction of rapid clinical hemostasis due to its good adhesion properties, antimicrobial properties, biocompatibility, blood compatibility, and efficient rapid hemostasis.

Janus Amphipathic Dressing With Liquid Self-Pumping and Blood-Clot Anti-Adhesion for Satisfactory Hemostasis

Ideal hemostatic materials for the emergency rescue of war and traffic accident sufferers are essential to significantly control hemorrhage, reduce patient discomfort, and improve the survival ratio. However, most hemostats absorb blood quickly in contact with the wound; and then, adhere to blood clots, resulting in breaking scabs and tearing the wound when the materials are removed. Herein, an effective Janus amphipathic hemostatic dressing (Fiber@Gel/Ca2+/KL) with a fiber layer (polylactic acid/carboxymethyl chitosan) and a hydrogel layer (polyvinyl alcohol, carboxymethyl chitosan, Ca2+, and kaolin) is reported. Such a composite dressing unidirectionally drains the excessive serum from its hydrophobic side (fiber layer) to its hydrophilic side (hydrogel layer), so-called self-pumping, thereby further concentrating coagulated factors (including red blood cells and platelets). Further, Ca2+ diffused from the hydrogel layer subsequently activates platelets and coagulation cascade. Besides, the Fiber@Gel/Ca2+/KL exhibits specific blood-clot anti-adhesion property on the fiber layer, making the dressing easily and safely peel off from the wound. It is believed that this novel hemostatic dressing with good hemostatic performance, easy clots removal, and excellent biocompatibility is expected to be used as a safe and efficient hemostatic dressing in clinical applications.

Facile fabrication of quaternized chitosan-incorporated biomolecular patches for non-compressive haemostasis and wound healing

Cell-free wound dressings (WDs) with desirable effectiveness and safety have received much attention in the field of regenerative medicine. However, the weak linkages between bioactive polymers and the spatial structure of WDs frequently result in interventional treatment failure. Herein, we create a series of quaternized chitosan (QCS)-incorporated composite hydrogels (referred to as GHCH-n) by UV cross-linking and then convert them into microneedle patches (MNPs). QCS, which is positively charged and amphiphilic, is essential for broad-spectrum antibacterial and haemostatic activities. QCS is proven to be slightly toxic, so it is immobilized into the methacrylate gelatine (GelMA) molecular cage to minimize adverse effects. A polydimethylsiloxane micro-mould is used to shape the MNPs. MNPs can pierce tissue, seal off bleeding sites, and cling to wounds securely. Thus, MNPs can cooperate with GHCH-n hydrogels to halt bleeding and accelerate wound healing. This study recommends GHCH-10 MNPs as an advanced biomaterial. Several preclinical research models have thoroughly validated the application effect of GHCH-10 MNPs. This research also proposes a novel strategy for integrating the nature of bioactive polymers and the structure of composite biomaterials. This strategy is not only applicable to the fabrication of next-generation WDs but also shows great potential in expanding interdisciplinary domains.

An Injectable Hydrogel with Ultrahigh Burst Pressure and Innate Antibacterial Activity for Emergency Hemostasis and Wound Repair

Uncontrolled bleeding and wound infections following severe trauma pose significant challenges for existing tissue adhesives, primarily due to their weak wet adhesion, slow adhesion formation, cytotoxicity concerns, and lack of antibacterial properties. Herein, an injectable hydrogel (denoted as ES gel) with rapid, robust adhesive sealing and inherent antibacterial activity based on ε-polylysine and a poly(ethylene glycol) derivative is developed. The engineered hydrogel exhibits rapid gelation behavior, high mechanical strength, strong adhesion to various tissues, and can sustain an ultrahigh burst pressure of 450 mmHg. It also presents excellent biocompatibility, biodegradability, antibacterial properties, and on-demand removability. Significantly improved hemostatic efficacy of ES gel compared to fibrin glue is demonstrated using various injury models in rats and rabbits. Remarkably, the adhesive hydrogel can effectively halt lethal non-compressible hemorrhages in visceral organs (liver, spleen, and heart) and femoral artery injury models in fully anticoagulated pigs. Furthermore, the hydrogel outperforms commercial products in sutureless wound closure and repair in the rat liver defect, skin incision, and infected full-thickness skin wound models. Overall, this study highlights the promising clinical applications of ES gel for managing uncontrolled hemorrhage, sutureless wound closure, and infected wound repair.

From hemostasis to proliferation: Accelerating the infected wound healing through a comprehensive repair strategy based on GA/OKGM hydrogel loaded with MXene@TiO2 nanosheets

The treatment of infected wounds poses a formidable challenge in clinical practice due to the detrimental effects of uncontrolled bacterial infection and excessive oxidative stress, resulting in prolonged inflammation and impaired wound healing. In this study, we presented a MXene@TiO2 (MT) nanosheets loaded composite hydrogel named as GA/OKGM/MT hydrogel, which was formed based on the Schiff base reaction between adipic dihydrazide modified gelatin (GA)and Oxidized Konjac Glucomannan (OKGM), as the wound dressing. During the hemostasis phase, the GA/OKGM/MT hydrogel demonstrated effective adherence to the skin, facilitating rapid hemostasis. In the subsequent inflammation phase, the GA/OKGM/MT hydrogel effectively eradicated bacteria through MXene@TiO2-induced photothermal therapy (PTT) and eliminated excessive reactive oxygen species (ROS), thereby facilitating the transition from the inflammation phase to the proliferation phase. During the proliferation phase, the combined application of GA/OKGM/MT hydrogel with electrical stimulation (ES) promoted fibroblast proliferation and migration, leading to accelerated collagen deposition and angiogenesis at the wound site. Overall, the comprehensive repair strategy based on the GA/OKGM/MT hydrogel demonstrated both safety and reliability. It expedited the progression through the hemostasis, inflammation, and proliferation phases of wound healing, showcasing significant potential for the treatment of infected wounds.

Superporous sponge prepared by secondary network compaction with enhanced permeability and mechanical properties for non-compressible hemostasis in pigs

Developing superporous hemostatic sponges with simultaneously enhanced permeability and mechanical properties remains challenging but highly desirable to achieve rapid hemostasis for non-compressible hemorrhage. Typical approaches to improve the permeability of hemostatic sponges by increasing porosity sacrifice mechanical properties and yield limited pore interconnectivity, thereby undermining the hemostatic efficacy and subsequent tissue regeneration. Herein, we propose a temperature-assisted secondary network compaction strategy following the phase separation-induced primary compaction to fabricate the superporous chitosan sponge with highly-interconnected porous structure, enhanced blood absorption rate and capacity, and fatigue resistance. The superporous chitosan sponge exhibits rapid shape recovery after absorbing blood and maintains sufficient pressure on wounds to build a robust physical barrier to greatly improve hemostatic efficiency. Furthermore, the superporous chitosan sponge outperforms commercial gauze, gelatin sponges, and chitosan powder by enhancing hemostatic efficiency, cell infiltration, vascular regeneration, and in-situ tissue regeneration in non-compressible organ injury models, respectively. We believe the proposed secondary network compaction strategy provides a simple yet effective method to fabricate superporous hemostatic sponges for diverse clinical applications.

Enhancing Wound Recovery: A Self-Gelling Powder for Improved Hemostasis and Healing

A novel self-gelatinizing powder was designed to accelerate wound healing through enhanced hemostasis and tissue recovery. Significantly, this research addresses the critical need for innovative wound management solutions by presenting a novel approach. Carboxymethylcellulose calcium (CMC-Ca) was synthesized using an ion exchange method, and lysine (Lys) was integrated through physical mixing to augment the material's functional characteristics. The prepared powder underwent comprehensive evaluation for its self-gelling capacity, gelation time, adhesion, swelling rate, coagulation efficiency, hemostatic effectiveness, and wound healing promotion. Results indicate that the self-gelatinizing powder exhibited remarkable water absorption capabilities, absorbing liquid up to 30 times its weight and achieving rapid coagulation within 3 min. The inclusion of Lys notably enhanced the powder's gel-forming properties. The gelation time was determined to be within 4 s using a rotational rheometer, with the powder rapidly forming a stable gel on the skin surface. Furthermore, in a mouse skin injury model, near-complete skin recovery was observed within 14 days, underscoring the powder's impressive self-healing attributes and promising application prospects in wound management.

Clotting Blood into an Adhesive Gel by Hemostatic Powder Based on Cationic/Anionic Polysaccharides and Laponite

Hemostatic powder is widely employed for emergency bleeding control due to its ability to conform to irregularly shaped wounds, ease of use, and stable storage. However, current powders exhibit limited tissue adhesion and insufficient support for thrombus formation, making them easily washed away by blood. In this study, a hybrid powder (QAL) was produced by mixing quaternized chitosan (QCS) powder, catechol-modified alginate (Cat-SA) powder, and laponite (Lap) powder. Upon addition of QAL, the blood quickly transformed to a robust and adhesive blood gel. The adhesion strength of the blood gel was up to 31.33 ± 1.56 kPa. When compared with Celox, QAL showed superior performance in promoting hemostasis. Additionally, QAL exhibited effectiveness in eliminating bacteria while also demonstrating outstanding biocompatibility with cells and blood. These favorable properties, including strong coagulation, adhesion to wet tissue, antibacterial activity, biosafety, ease of use, and stable storage, make QAL a promising emergency hemostatic agent.

Dehydration-Toughing Dual-Solvent Gels with Viscoelastic Transition for Infectious Wound Treatment

The modulus of traditional biomedical hydrogels increases exponentially meditated by dehydration-stiffing mechanism, which leads to the failure of interface matching between hydrogels and soft tissue wounds. It is found in the study that the dual-solvent gels exhibit dehydration-toughening mechanism with the slowly increasing modulus that are always match the soft tissue wounds. Therefore, dual-solvent glycerol hydrogels (GCFen-gly DGHs) are prepared with hydrophobically modified catechol chitosan (hmCSC) and gelatin based on the supramolecular interactions. GCFen-gly DGHs exhibit excellent water retention capacity with a total solvent content exceeding 80%, permanent skin-like modulus within a range of 0.45 to 4.13 kPa, and stable photothermal antibacterial abilities against S, aureus, E. coli, as well as MRSA. Infectious full-thickness rat skin defect model and tissue section analysis indicate that GCFen-gly DGHs are able to accelerate infectious wound healing by alleviating the inflammatory response, promoting granulation tissue growth, re-epithelialization, collagen deposition, and vascular regeneration. As a result, GCFen-gly DGHs is expected to become the next-generation biological gel materials for infectious wound treatment.

Coagulating blood into adhesive gel by hybrid powder based on oppositely charged polysaccharide/tannic acid-modified mesoporous bioactive glass

Hemostatic powder is widely utilized in emergency situations to control bleeding due to its ability to work well on wounds with irregular shapes, ease of application, and long-term stability. However, traditional powder often suffers from limited tissue adhesion and insufficient support for blood clot formation, leaving it susceptible to displacement by the flow of blood. This study introduces a hemostatic powder composed of tannic modified mesoporous bioactive glass (TMBG), cationic quaternized chitosan (QCS), and anionic hyaluronic acid modified with catechol group (HADA). The resulting TMBG/QCS/HADA based hemostatic powder (TMQH) rapidly absorbs plasma, concentrating blood coagulation factors. Simultaneously, the water-soluble QCS and HADA interact to form a 3D network structure, which can be strengthened by crosslinking with TMBG. This network effectively captures clustered blood coagulation factors, leading to a strong and adhesive thrombus that resists disruption from blood flow. TMQH exhibits superior efficacy in promoting hemostasis compared to Celox™ both in rat arterial injuries and non-compressible liver puncture wounds. TMQH demonstrates excellent antibacterial activity, cytocompatibility, and blood compatibility. These outstanding superiorities in blood clotting capability, wet tissue adhesion, antibacterial activity, safety for living organisms, ease of application, and long-term stability, make TMQH highly suitable for emergency hemostasis.

Gluing blood into adhesive gel by oppositely charged polysaccharide dry powder inspired by fibrin fibers coagulation mediator

Hemostatic powders that adapt to irregularly shaped wounds, allowing for easy application and stable storage, have gained popularity for first-aid hemorrhage control. However, traditional powders often provide weak thrombus support and exhibit limited tissue adhesion, making them susceptible to dislodgment by the bloodstream. Inspired by fibrin fibers coagulation mediator, we have developed a bi-component hemostatic powder composed of positively charged quaternized chitosan (QCS) and negatively charged catechol-modified alginate (Cat-SA). Upon application to the wound, the bi-component powders (QCS/Cat-SA) rapidly absorb plasma and dissolve into chains. These chains interact with each other to form a network, which can effectively bind and entraps clustered red blood cells and platelets, ultimately leading to the creation of a durable and robust thrombus. Significantly, these interconnected polymers adhere to the injury site, offering protection against thrombus disruption caused by the bloodstream. Benefiting from these synthetic properties, QCS/Cat-SA demonstrates superior hemostatic performance compared to commercial hemostatic powders like Celox™ in both arterial injuries and non-compressible liver puncture wounds. Importantly, QCS/Cat-SA exhibits excellent antibacterial activity, cytocompatibility, and hemocompatibility. These advantages of QCS/Cat-SA, including strong blood clotting, wet tissue adherence, antibacterial activity, biosafety, ease of use, and stable storage, make it a promising hemostatic agent for emergency situations.

Expansion-clotting chitosan fabrics based on unidirectional fast-absorption fibers for rapid hemorrhage control

The rapid absorption of water from the blood to concentrate erythrocytes and platelets, thus triggering quick closure, is important for hemostasis. Herein, expansion-clotting chitosan fabrics are designed and fabricated by ring spinning of polylactic acid (PLA) filaments as the core layer and highly hydrophilic carboxyethyl chitosan (CECS) fibers as the sheath layer, and subsequent knitting of obtained PLA@CECS core spun yarns. Due to the unidirectional fast-absorption capacity of CECS fibers, the chitosan fabrics can achieve erythrocytes and platelets aggregate quickly by concentrating blood, thus promoting the formation of blood clots. Furthermore, the loop structure of coils formed in the knitted fabric can help them to expand by absorbing water to close their pores, providing effective sealing for bleeding. Besides, They have enough mechanical properties, anti-penetrating ability, and good tissue-adhesion ability in wet conditions, which can form a physical barrier to resist blood pressure during hemostasis and prevent them from falling off the wound, thus enhancing hemostasis synergistically. Therefore, the fabrics exhibit superior hemostatic performance in the rabbit liver, spleen, and femoral artery puncture injury model compared to the gauze group. This chitosan fabric is a promising hemostatic material for hemorrhage control.

Carbonized Cellulose Aerogel Derived from Waste Pomelo Peel for Rapid Hemostasis of Trauma-Induced Bleeding

Uncontrollable massive bleeding caused by trauma will cause the patient to lose a large amount of blood and drop body temperature quickly, resulting in hemorrhagic shock. This study aims to develop a hemostatic product for hemorrhage management. In this study, waste pomelo peel as raw material is chosen. It underwent processes of carbonization, purification, and freeze-drying. The obtained carbonized pomelo peel (CPP) is hydrophilic and exhibits a porous structure (nearly 80% porosity). The water/blood absorption ratio is significantly faster than the commercial Gelfoam and has a similar water/blood absorption capacity. In addition, the CPP showed a water-triggered shape-recoverable ability. Moreover, the CPP shows ideal cytocompatibility and blood compatibility in vitro and favorable tissue compatibility after long terms of subcutaneous implantation. Furthermore, CPP can absorb red blood cells and fibrin. It also can absorb platelets and activate platelets, and it is capable of achieving rapid hemostasis on the rat tail amputation and hepatectomized hemorrhage model. In addition, the CPP not only can quickly stop bleeding in the rat liver-perforation and rabbit heart uncontrolled hemorrhage models, but also promotes rat liver and rabbit heart tissue regeneration in situ. These results suggest the CPP has shown great potential for managing uncontrolled hemorrhage.

PAA-PU Janus Hydrogels Stabilized by Janus Particles and its Interfacial Performance During Hemostatic Processing

Hydrogel is a very promising dressing for hemostasis and wound healing due to its good adhesion and long-term moist environment. However, secondary injury caused by tissue adhesion due to homogeneous hydrogel cannot be ignored. The obvious interface existing in Janus hydrogel will weaken its asymmetric function. Here, a hierarchical adhesive polyacrylic acid-polyurushiol water-oil Janus hydrogel (JPs@PAA-PU) without adhesive layer is fabricated by one-pot method in the stabilization of polystyrene@silica-siliver Janus particles (JPs). The morphological structure, mechanical properties, anisotropic chemical composition, and adhesion performance, in vivo, and in vitro hemostatic properties of Janus hydrogel are investigated. Result shows that the obtained Janus hydrogel possesses obvious compartmentalization in microstructure, functional groups, and chemical elements. Janus hydrogel is provided with asymmetric interfacial toughness with top 52.45 ± 2.29 Kpa and bottom 7.04 ± 0.88 Kpa on porcine liver. The adhesion properties of PAA side to tissue, red blood cells and platelets, promoting effect of PU side on coagulation cascade reaction and its physical battier endow Janus hydrogel with shorter hemostatic time and less blood loss than control group. It also exhibits excellent antibacterial effects against Escherichia coli and Staphylococcus aureus (>90%). Janus hydrogel possesses biosafety, providing safety guarantee for clinical applications in the future.

Nanocellulose-Based Hybrid Scaffolds for Skin and Bone Tissue Engineering: A 10-Year Overview

Cellulose, the most abundant polymer on Earth, has been widely utilized in its nanoform due to its excellent properties, finding applications across various scientific fields. As the demand for nanocellulose continues to rise and its ease of use becomes apparent, there has been a significant increase in research publications centered on this biomaterial. Nanocellulose, in its different forms, has shown tremendous promise as a tissue engineered scaffold for regeneration and repair. Particularly, nanocellulose-based composites and scaffolds have emerged as highly demanding materials for both soft and hard tissue engineering. Medical practitioners have traditionally relied on collagen and its analogue, gelatin, for treating tissue damage. However, the limited mechanical strength of these biopolymers restricts their direct use in various applications. This issue can be overcome by making hybrids of these biopolymers with nanocellulose. This review presents a comprehensive analysis of the recent and most relevant publications focusing on hybrid composites of collagen and gelatin with a specific emphasis on their combination with nanocellulose. While bone and skin tissue engineering represents two areas where a majority of researchers are concentrating their efforts, this review highlights the use of nanocellulose-based hybrids in these contexts.

Preparation and assessment of agar/TEMPO-oxidized bacterial cellulose cryogels for hemostatic applications

In this work, we have demonstrated agar and oxidized bacterial cellulose cryogels as a potential hemostatic dressing material. TEMPO-oxidized bacterial cellulose (OBC) was incorporated into the agar matrix, improving its mechanical and hemostatic properties. The oxidation of bacterial cellulose (BC) was evidenced by chemical characterization studies, confirming the presence of carboxyl groups. The in vitro blood clotting test conducted on agar/OBC composite cryogels demonstrated complete blood clotting within 90 seconds, indicating their excellent hemostatic efficacy. The cryogels exhibited superabsorbent properties with a swelling degree of 4200%, enabling them to absorb large amounts of blood. Moreover, the compressive strength of the composite cryogels was appreciably improved compared to pure agar, resulting in a more stable physical structure. The platelet adhesion test proved the significant ability of the composite cryogels to adhere to and aggregate platelets. Hemocompatibility and cytocompatibility tests have verified the safety of these cryogels for hemostatic applications. Finally, the material exhibited remarkable in vivo hemostatic performance, achieving clotting times of 64 seconds and 35 seconds when tested in the rat tail amputation model and the liver puncture model, respectively. The experiment results were compared with those of commercial hemostat, Axiostat, and Surgispon, affirming the potential of agar/OBC composite cryogel as a hemostatic dressing material.

A Laparoscopically Compatible Rapid-Adhesion Bioadhesive for Asymmetric Adhesion, Non-Pressing Hemostasis, and Seamless Seal

Bioadhesive hydrogels offer unprecedented opportunities in hemostatic agents and tissue sealing; however, the application of existing bioadhesive hydrogels through narrow spaces to achieve strong adhesion in fluid-rich physiological environments is challenged either by undesired indiscriminate adhesion or weak wet tissue adhesion. Here, a laparoscopically compatible asymmetric adhesive hydrogel (aAH) composed of sprayable adhesive hydrogel powders and injectable anti-adhesive glue is proposed for hemostasis and to seal the bloody tissues in a non-pressing way, allowing for preventing postoperative adhesion. The powders can seed on the irregular bloody wound to rapidly absorb interfacial fluid, crosslink, and form an adhesive hydrogel to hemostatic seal (blood clotting time and tissue sealing in 10 s, ≈200 mm Hg of burst pressure in sealed porcine tissues). The aAH can be simply formed by crosslinking the upper powder with injectable glue to prevent postoperative adhesion (adhesive strength as low as 1 kPa). The aAH outperforms commercial hemostatic agents and sealants in the sealing of bleeding organs in live rats, demonstrating superior anti-adhesive efficiency. Further, the hemostatic seamless sealing by aAH succeeds in shortening the time of warm ischemia, decreasing the blood loss, and reducing the possibility of rebleeding in the porcine laparoscopic partial nephrectomy model.

Injectable Self-Expanding/Self-Propelling Hydrogel Adhesive with Procoagulant Activity and Rapid Gelation for Lethal Massive Hemorrhage Management

Developing hydrogels that can quickly reach deep bleeding sites, adhere to wounds, and expand to stop lethal and/or noncompressible bleeding in civil and battlefield environments remains a challenge. Herein, an injectable, antibacterial, self-expanding, and self-propelling hydrogel bioadhesive with procoagulant activity and rapid gelation is reported. This hydrogel combines spontaneous gas foaming and rapid Schiff base crosslinking for lethal massive hemorrhage. Hydrogels have rapid gelation and expansion rate, high self-expanding ratio, excellent antibacterial activity, antioxidant efficiency, and tissue adhesion capacity. In addition, hydrogels have good cytocompatibility, procoagulant ability, and higher blood cell/platelet adhesion activity than commercial combat gauze and gelatin sponge. The optimized hydrogel (OD-C/QGQL-A30) exhibits better hemostatic ability than combat gauze and gelatin sponge in rat liver and femoral artery bleeding models, rabbit volumetric liver loss massive bleeding models with/without anticoagulant, and rabbit liver and kidney incision bleeding models with bleeding site not visible. Especially, OD-C/QGQL-A30 rapidly stops the bleedings from pelvic area of rabbit, and swine subclavian artery vein transection. Furthermore, OD-C/QGQL-A30 has biodegradability and biocompatibility, and accelerates Methicillin-resistant S. aureus (MRSA)-infected skin wound healing. This injectable, antibacterial, self-expanding, and self-propelling hydrogel opens up a new avenue to develop hemostats for lethal massive bleeding, abdominal organ bleeding, and bleeding from coagulation lesions.

A sodium alginate - silk fibroin biosponge loaded with thrombin: Effective hemostasis and wound healing

In trauma first aid, rapid hemostasis is a priority, extricating patients from hemorrhagic shock and infection risks. This paper explores novel hemostatic materials, using ion-crosslinking and freeze-drying techniques. Iterative experiments determined optimal conditions for the temperature-variable mixing-freeze-drying chemical reaction of sodium alginate (SA)/silk fibroin (SF). We used SA, SA/SF, SA/SF-TB and commercial hemostatic sponge control samples to perform hemostasis experiments on rat liver injury and femoral artery injury models, and to perform wound healing experiments on rat back full-layer skin. The results showed that the hemostatic time and blood loss of SA/SF-TB group rats (liver hemorrhage model: 397.17 ± 34.80 mg, 77.83 ± 7.41 s; Femoral artery bleeding model: 940.33 ± 41.93 mg, 96.83 ± 4.07 s) was significantly better than other experimental groups, and similar to the commercial group. The wound healing experiment showed that the new granulation tissue thickness of SA/SF-TB group was thicker (380.39 ± 28.56 μm) at day 14. In addition, the material properties and biocompatibility of sponges were characterized by cell experiments and in vivo embedding experiments. All the results showed that the SA/SF-TB hemostatic sponge prepared in this study could not only seal the wound quickly and stop bleeding, but also promote the growth of epidermal cells and fibroblasts and accelerate wound healing. This new material solves the shortcomings of traditional materials such as low stability, limited shelf life, high unit price, and has good biocompatibility, easy preparation, rapid hemostasis and other excellent properties. Therefore, this innovative hemostatic material has great prospects and potential in clinical applications.

Recent Advances in Topical Hemostatic Materials

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.

A Visible Light Cross-Linked Underwater Hydrogel Adhesive with Biodegradation and Hemostatic Ability

Hydrogel adhesives with integrated functionalities are still required to match their ever-expanding practical applications in the field of tissue repair and regeneration. A simple and effective safety strategy is reported, involving an in situ injectable polymer precursor and visible light-induced cross-linking. This strategy enables the preparation of a hydrogel adhesive in a physiological environment, offering wet adhesion to tissue surfaces, molecular flexibility, biodegradability, biocompatibility, efficient hemostatic performance, and the ability to facilitate liver injury repair. The proposed one-step preparation process of this polymer precursor involves the mixing of gelatin methacryloyl (GelMA), poly(thioctic acid) [P(TA)], poly(acrylic acid)/amorphous calcium phosphate (PAAc/ACP, PA) and FDA-approved photoinitiator solution, and a subsequent visible light irradiation after in situ injection into target tissues that resulted in a chemically-physically cross-linked hybrid hydrogel adhesive. Such a combined strategy shows promise for medical scenarios, such as uncontrollable post-traumatic bleeding.

Recent research advances on polysaccharide-, peptide-, and protein-based hemostatic materials: A review

Hemorrhage is a potentially life-threatening emergency that can occur at any time or place. Whether traumatic, congenital, surgical, disease-related, or drug-induced, bleeding can lead to severe complications or death. Therefore, the development of efficient hemostatic materials is critical. However, the results and prognosis demonstrated by clinical means of hemostasis do not reach expectations. With the development of technology, novel hemostatic materials have been developed from polysaccharides (chitosan, hyaluronic acid, alginate, cellulose, cyclodextrins, starch, dextran, and carrageenan), peptides (self-assembling peptides), and proteins (silk fibroin, collagen, gelatin, keratin, and thrombin). These new materials exhibit high hemostatic efficacy due to the enhancement or interaction of various hemostatic mechanisms. The main forms include adhesives, sealants, bandages, hemostatic powders, and hemostatic sponges. This article introduces the clotting process and principles of hemostatic methods and reviews the research on polysaccharide-, peptide-, and protein-based hemostatic materials in the last five years. The design ideas and hemostatic principles of polysaccharide-, peptide-, and protein-based hemostatic materials are mainly introduced. Finally, we summarize material designs, advantages, disadvantages, and challenges regarding hemostatic materials.

Recent advances in the application of clay-containing hydrogels for hemostasis and wound healing

INTRODUCTION

Immediate control of bleeding and anti-infection play important roles in wound management. Multiple organ dysfunction syndrome and death may occur if persistent bleeding, hemodynamic instability, and hypoxemia are not addressed. The combination of clay and hydrogel provides a new outlet for wound hemostasis. In this review, the current research progress of hydrogel/clay composite hemostatic agents was reviewed.

AREAS COVERED

This paper summarizes the characteristics of several kinds of clay including kaolinite, montmorillonite, laponite, sepiolite, and palygorskite. The advantages and disadvantages of its application in hemostasis were also summarized. Future directions for the application of hydrogel/clay composite hemostatic agents are presented.

EXPERT OPINION

Clay can activate the endogenous hemostatic pathway by increasing blood cell concentration and promoting plasma absorption to accelerate the hemostasis. Clay is antimicrobial due to the slow release of metal ions and has a rich surface charge with a high affinity for proteins and cells to promote tissue repair. Hydrogels have some properties such as good biocompatibility, strong adhesion, high stretchability, and good self-healing. Despite promising advances, hydrogel/clay composite hemostasis remains a limitation. Therefore, more evidence is needed to further elucidate the risk factors and therapeutic effects of hydrogel/clay in hemostasis and wound healing.

Nanoapatite-Loaded κ-Carrageenan/Poly(vinyl alcohol)-Based Injectable Cryogel for Hemostasis and Wound Healing

Immediate control of excessive bleeding and prevention of infections are of utmost importance in the management of wounds. Cryogels have emerged as promising materials for the rapid release of medication and achieving hemostasis. However, their quick release properties pose the challenge of exposing patients to high concentrations of drugs. In this study, hybrid nanocomposites were developed to address this issue by combining poly(vinyl alcohol) and κ-carrageenan with whitlockite nanoapatite (WNA) particles and ciprofloxacin, aiming to achieve rapid hemostasis and sustained antibacterial effects. A physically cross-linked cryogel was obtained by subjecting a blend of poly(vinyl alcohol) and κ-carrageenan to successive freezing-thawing cycles, followed by the addition of WNA. Furthermore, ciprofloxacin was introduced into the cryogel matrix for subsequent evaluation of its wound healing properties. The resulting gel system exhibited a 3D microporous structure and demonstrated excellent swelling, low cytotoxicity, and outstanding mechanical properties. These characteristics were evaluated through analytical and rheological experiments. The nanocomposite cryogel with 4% whitlockite showed extended drug release of 71.21 ± 3.5% over 21 days and antibacterial activity with a considerable growth inhibition zone (4.19 ± 3.55 cm). Experiments on a rat model demonstrated a rapid hemostasis property of cryogels within an average of 83 ± 4 s and accelerated the process of wound healing with 96.34% contraction compared to the standard, which exhibited only ∼78% after 14 days. The histopathological analysis revealed that the process of epidermal re-epithelialization took around 14 days following the skin incision. The cryogel loaded with WNAs and ciprofloxacin holds great potential for strategic utilization in wound management applications as an effective material for hemostasis and anti-infection purposes.

Preparation of healing-promoting and fibrosis-inhibiting asymmetric poly(ethylene glycol-b-L-phenylalanine)/cRGD-modified hyaluronate sponges and their applications in hemorrhage and nasal mucosa repair

Acute or chromic bleeding, such as epistaxis, requires hemostatic materials to assist hemostasis. Even in complex cases, hemostatic materials must have other functions, including the promotion of healing and prevention of adhesion. Herein, a series of fibrosis-suppressive functional cRGD-modified crosslinking hyaluronic acid sponges were prepared. The in vitro hemostatic efficiency and mechanism were determined using blood clotting time, blood coagulation index, lactate dehydrogenase (LDH) and thromboxane B2 (TX-B2) ELISA, and proteomics. Among the prepared sponges, both poly(ethylene-b-L-Phe) (PEBP)-and cRGD contained SPN4 and exhibited the highest platelet concentration and activation efficiency as well as the most effective coagulative effect. In addition, no significant cytotoxicity was observed for the sponges in rat airway epithelial cells. The in vivo hemostatic and adhesion-preventive effects of the sponges were evaluated using rat models of liver injury and sidewall defect-cecum abrasion. PEBP-containing sponges effectively prevented postoperative adhesion and cRGD-modified sponges exhibited excellent hemostatic effects. Finally, the comprehensive repair effects of the sponges were evaluated using a rabbit maxillary sinus mucosal injury model, based on CT, MRI examination, and pathological staining. SPN4 exhibited the best comprehensive reparative effects, including the promotion of mucosal repair and infection inhibition. Thus, SPN4 is a promising multifunctional hemostatic material.