Evolution of hemostatic agents in surgical practice

Abstract

Objective:Topical hemostatic agents are used in a wide variety of surgical settings, and the evolution of this class of surgical tools is an interesting topic. We reviewed and outlined the historical progress of topical hemostats into present day surgery and urology, and highlight opportunities for future research.Materials and Methods:A MEDLINE search of all available literature concerning several classes of topical hemostatic agents was performed. Fibrins sealants, Gelatin sponge hemostatics, cyanoacrylate adhesives, oxidized regenerated cellulose, and microfibrillar collagen were included. References were chosen from a broad range of surgical literature.Results:Topical hemostatic agents have historically taken advantage of a wide variety of mechanisms for hemostasis. Fibrin sealants have a rich history and large potential for further applications. Gelatin sponge hemostatics have been widely used since their introduction, but have changed little. Cyanoacrylate adhesives have a unique mechanism and opportunity for novel applications of existing products. Oxidized cellulose was original in the use of plant-based components. Microfibrillar collagen hemostats have evolved to a wide variety of formats.Conclusions:A review of the evolution of topical hemostatic agents highlights opportunities for potential novel research. Fibrin sealants may have the most opportunity for advancement, and understanding the history of these products is useful. With the drive in urology for minimally invasive surgical techniques, adaptation of topical hemostatic agents to this surgical approach would be valuable and offers an opportunity for novel contributions.

Acute respiratory failure from Surgifoam expansion after anterior cervical surgery

“…A property of gelatin sponge hemostatic agents is their ability to absorb upwards of 40 times their weight in whole blood or fluids as well as their capacity to expand up to 200% in vivo. 20 When electrocoagulation is not indicated, such as in narrow cervicothoracic epidural spaces, venous bleeding can be successfully managed using Surgifoam. On the other hand, bleeding from soft tissues, as well as muscle, should be treated with electrocautery instead of placing a large amount of Surgifoam which, other than producing mass effect with its overexpansion, may occlude Hemovac drain holes.…”

Printed microelectrode arrays on soft materials: from PDMS to hydrogels

“…93 Second, it has been used as a scaffold for tissue engineering and shown to be a promising material for repairing traumatic injuries to the brain as it improves the brain-tissue reconstruction. 94 Third, it exhibits antibacterial and hemostatic effects, 95,96 which is beneficial for recovery after mechanically inserting the electrodes to the desired tissue location. 97,98 Thus, it can be expected that adding functionality to gelatin-based devices will have an impact on future implant technology.…”

A randomized controlled trial on effects of different hemostatic sponges in posterior spinal fusion surgeries

“…Therefore, it is imperative to take safe and effective measures to reduce blood loss and rates of transfusions after spinal fusion surgeries. In recent years, the use of hemostatic materials, such as gelatin sponge and other collagen sponges, has led to significant reductions in both intraoperative blood loss and postoperative transfusions [2]. However, there are many differences between gelatin sponges, which have been in use for several decades, and collagen sponges which have been featured with new properties.…”