Use of a Gelatin-Thrombin Hemostatic Matrix for Secondary Bleeding After Pediatric Tonsillectomy

Abstract

Results suggest that GTHM is generally simple, safe, and effective for use in the treatment of posttonsillectomy secondary bleeding types not associated with a direct vein or artery source but oozing from multiple sites and/or overcauterized tonsillar bed that cannot be stopped by traditional hemostatic methods.

Securing Hemostasis in Pediatric Low-Grade Posterior Cerebral Fossa Tumors: The Value of Thrombin-Gelatin Hemostatic Matrix

“…Binnetoglu et al [17] evaluated the use of TGHM in the case of secondary bleeding after tonsillectomy, particularly for patients with multiple sites of bleeding and/or an overcauterized tonsillar bed, confirming the effectiveness of this product as a means of achieving competent hemostasis. Jo and Mathiasen [18] and Mathiasen et al [19] prospectively assessed the use of this hemostatic matrix in children who underwent adenoidectomy and adenotonsillectomy, respectively.…”

Topical biomaterials to prevent post-tonsillectomy hemorrhage

“…Gelatin-thrombin hemostatic matrix (GTHM) agent is a gelatin-based biomaterial consisting of bovine-derived gelatin matrices and human-derived thrombin. It has been used to treat and manage secondary PTH [61]. Gelatin-based materials provide a combination of two independent hemostatic agents, gelatin and thrombin, in order to achieve hemostasis [62, 63].…”

“…Not cost efficient. Too expansive for some surgical units [58]Y TachoSil [48]Y Evarrest® [54]N TachoCombGelatin-based HemostatGelatin-Thrombin Hemostatic Matrix (GTHM)Y [67]NY [61], [67]N [68]Case study by reviewing 42 pediatric patients and retrospective data analysis [61], randomized, controlled trial in adults [68, 69] and children [67, 70] and a review [71]Floseal™ Hemostatic MatrixPost-op [61, 71]simple, safe, and efficacious and cost-effective [61, 70]Y [72]Absorbable cellulose-based Hemostatoxidized cellulose polymer hemostatic agentY [73]Y (when combine with suturation) [74]N (when combine with suturation) [74]Surgicel plus saturation on total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years [74]Surgicel®, Cellistypt®, Pahacel®, Oxycel®, Gelita®, GuraTamp®Intra-opaids in clot formation by activation of the extrinsic and intrinsic coagulation pathways,Introduced a risk of aspiration and suffocation [75]; Possible inflammation [76]. Y Surgicel® [77]N for othersBismuth subgallate-basedBSG- adrenaline paste, BSG- phenylephrine hydrochloride mixtureY [78]Y (BSG mixed with phenylephrine hydrochloride) [79]Y BSG with adrenaline for primary PTH [80], N for secondary PTH [81]N [81]Clinical study on patients underwent tonsillectomy [78, 81]Spectrum Chemical (powder), mixing 26 g of BSG powder to 20 ml of normal saline with 0.7 ml of 1:1000 adrenalinePost-opdecreases operating time by significantly reducing the hemostasis time and the number of ligatures [78, 81]; accelerates the cascade of blood clotting [79]; accelerate the intrinsic clotting pathway through the activation of factor XII (Hageman factor) [82].…”

“…The other side effects of gelatin-based hemostatic agents include 1) A nidus for infection and abscess formation, as they have been reported to potentiate bacterial growth, 2) foreign body reactions and “encapsulation” of fluid, and 3) toxic shock syndrome, which was reported in association with the use of absorbable gelatin-based hemostats in nasal surgery [155]. Though there were no adverse effects of GTHM reported in secondary PTH [61], it should be proved consistently beneficial effect on pain and hemorrhage to be used for PTH.…”