Article Commentary: Hemostats, Sealants, and Adhesives: A Practical Guide for the Surgeon

Abstract

Hemostats, sealants, and adhesives are useful adjuncts to modern surgical procedures. To maximize their benefit, a surgeon needs to understand the safety, efficacy, usability, and cost of these agents. To be truly added to a surgeon's own toolbox, the operator must also have knowledge of when and how to best use these materials. This commentary is designed to succinctly facilitate this understanding and knowledge. A nomenclature and classification system based on group, category, and class has been created to help with this process and is provided here. By using this system, materials consisting of similar design and for common indications can be compared. For example, in this system, the three functional groups are hemostats, sealants, and adhesives. The hemostats may be divided into four categories: mechanical, active, flowable, and fibrin sealant. These hemostat categories are further subdivided into generic classes based on the composition of the approved materials. Similarly, categories and classes are provided for sealants and adhesives. In this commentary, the salient points with respect to the characteristics of these agents are presented. A discussion of when these agents can be used in specific indications and how they may be applied to achieve the best results is also provided.

Engineering a highly elastic human protein–based sealant for surgical applications

“…In addition, piercing tissues to place sutures and staples can further damage the surrounding wound area and can increase the risk for infection (1,3,4). Sealant materials have attracted attention as alternatives to seal and reconnect tissues or incorporate implant devices into tissues because of their ease of application and versatility (3,(5)(6)(7). Surgical sealants combined with sutures have been reported to more effectively seal wounds than sutures alone and provide a reduced infection rate and patient blood loss (3,8,9).…”

Bleeding in Dental Surgery

“…There are two main categories of flowable biosurgicals: products containing porcine gelatin, which can be combined with thrombins (bovine, human-pooled plasma thrombin, or rhThrombin), and bovine collagen-based agents, packed with human-pooled plasma thrombin. The flowable agents are deemed the most effective of all the local hemostatic agents [30,53].…”

The Use of Topical Hemostatic Agents in Cardiothoracic Surgery

“…TOPICAL HEMOSTATIC AGENTS. Topical HAs are used in surgery to supplement endogenous blood clotting activity and can be broadly divided into active HAs, which contain agents involved in blood clotting, and nonactive HAs, which do not contain clotting agents (Fig 1; Supplemental Table 1 [manufacturers' locations are listed in Supplemental Table 1]) [9][10][11][12]. Some HAs have characteristics common to both categories and are known as flowable HAs [11].…”