OBJECTIVE: The application progress of medical absorbable haemostatic material (MAHM) in hemostasis during orthoapedic surgery was reviewed, in order to provide reference for clinical hemostasis program. METHODS: The domestic and foreign literature on the application of MAHM for hemostasis in orthopedic surgery was extensively reviewed and summarized. RESULTS: According to biocompatibility, MAHM can be divided into oxidized cellulose/oxidized regenerated cellulose materials, chitosan and its derivatives materials, starch materials, collagen and gelatin materials, and fibrin glue materials, etc., which can effectively reduce blood loss when used in orthopedic surgery for hemostasis. Each hemostatic material has different coagulation mechanism and suitable population. Oxidized cellulose/oxidized regenerated cellulose, chitosan and its derivatives, starch hemostatic material mainly stops bleeding by stimulating blood vessel contraction and gathering blood cells, which is suitable for people with abnormal coagulation function. Collagen, gelatin and fibrin glue hemostatic materials mainly affect the physiological coagulation mechanism of the human body to stop bleeding, suitable for people with normal coagulation function. CONCLUSION Reasonable selection of MAHM can effectively reduce perioperative blood loss and reduce the risk of postoperative complications, but at present, single hemostatic material can not meet clinical needs, and a new composite hemostatic material with higher hemostatic efficiency needs to be developed.
Humans ; Hemostatics ; Orthopedic Procedures/methods* ; Hemostasis, Surgical/methods* ; Biocompatible Materials ; Cellulose, Oxidized ; Chitosan ; Fibrin Tissue Adhesive ; Gelatin ; Blood Loss, Surgical/prevention & control* ; Hemostasis/drug effects*

BACKGROUND: Topical hemostatic agents are used when ligation, electrocauterization, or other conventional hemostatic methods are impractical. Because a hemostatic agent is a foreign body, it can cause foreign body reactions, inflammation, and infections that can interfere with the wound healing process. Therefore, we should select hemostatic agents after considering their effects on wound healing. Here, we compared the effects of hemostatic agents on wound healing in a rectus abdominis muscle defect in rats. METHODS: Twelve Sprague Dawley rats were subjected to creation of a 6 × 6 mm defect in the rectus abdominis muscle and divided into four groups: control group; group A, Tachosil fibrin sealant patch; group B, Surgicel Fibrillar oxidized regenerated cellulose; and group C, Surgicel Snow oxidized regenerated cellulose. For the histologic analysis, biopsies were performed on the 3rd, 7th, and 27th days. RESULTS: The foreign body reaction was the weakest in group A and most significant in group C. The inflammatory cell infiltration was the weakest in group A and similar in groups B and C. Muscle regeneration differed among periods. The rats in group A were the most active initially, while those in group C showed prolonged activity. CONCLUSION: Tachosil and Surgicel administration increased inflammation via foreign body reactions, but the overall wound healing process was not significantly affected. The increased inflammation in the Surgicel groups was due to a low pH. We recommend using Tachosil, because it results in less intense foreign body reactions than Surgicel and faster wound healing due to the fibrin action.
Animals ; Biopsy ; Cellulose ; Cellulose, Oxidized ; Fibrin Tissue Adhesive ; Fibrin ; Fibrinogen ; Foreign Bodies ; Foreign-Body Reaction ; Hemostatics ; Hydrogen-Ion Concentration ; Inflammation ; Ligation ; Rats ; Rats, Sprague-Dawley ; Rectus Abdominis ; Regeneration ; Snow ; Thrombin ; Wound Healing ; Wounds and Injuries

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.
Animals ; *Blood Loss, Surgical/statistics & numerical data ; Cellulose, Oxidized/*therapeutic use ; Hemostasis, Surgical/*methods ; Hemostatics/*therapeutic use ; Liver/*surgery ; Random Allocation ; Spleen/*surgery ; Swine

PURPOSE: To evaluate the antiadhesive effects and safety of an oxidized regenerated cellulose (Interceed) after thyroidectomy. METHODS: Seventy-six thyroidectomized patients were prospectively randomized into two groups with regard to the use of Interceed. We evaluated each group for their adhesive symptoms using four subjective and four objective items at the 2nd week, 3rd and 6th month after thyroidectomy. All patients were examined for vocal cord motility by indirect laryngoscope at each period. RESULTS: Total adhesion scores at each postoperative follow-up period decreased with time, but were not significantly different in each group. The median score for swallowing discomfort for liquid was significantly lower in the Interceed group than in the control group 2 weeks after surgery. In addition, the severity of skin adhesion to the trachea was reduced in the Interceed group compared with the control group 6 months after surgery. During the study, there were no adverse effects or significant differences in postoperative complications between the groups. CONCLUSION: Interceed appeared to be safe and effective in improving neck discomfort at early postoperative periods and preventing skin adhesion to the trachea 6 months after thyroidectomy.
Adhesives ; Cellulose ; Cellulose, Oxidized ; Deglutition ; Follow-Up Studies ; Humans ; Laryngoscopes ; Neck ; Postoperative Complications ; Postoperative Period ; Prospective Studies ; Skin ; Thyroidectomy ; Trachea ; Vocal Cords

PURPOSE: Tissue adhesion is a well-known postsurgical phenomenon, causing pain, functional obstruction, and difficult reoperative surgery. To overcome these problems, various synthetic and natural polymer membranes have been developed as postoperative tissue adhesion barriers. However, limitation in their use has hindered its actual application. We prepared a hyaluronate membrane (HM) to evaluate its efficacy and safety as an adhesion barrier compared to a commercialized product (Interceed, Ethicon). METHODS: To evaluate the antiadhesion effect, a cecum-abdominal wall abrasion model was adopted in a rabbit. The denuded cecum was covered by Interceed or HM or neither and apposed to the abdominal wall (each, n = 10). Four weeks after surgery, the level of adhesion was graded. Acute and chronic toxicity of the three groups were also evaluated. RESULTS: Blood samples drawn to evaluate acute toxicity at postoperative day 3 and 7 showed no significant difference among the three groups. The grade and area of adhesion were significantly lower in the HM compared to those of the control and Interceed at four weeks after surgery. Histologic evaluations, which was carried out to estimate tissue reactions at the site of application, as well as to assess chronic toxicity for the major organs, were not significantly different in the three groups. CONCLUSION: This study showed that the antiadhesion efficacy of HM was superior to commercialized antiadhesion membrane, Interceed. Low inflammatory response and nontoxicity were also demonstrated. From these results, we suggest that the HM is a good candidate as a tissue adhesion barrier.
Abdominal Wall ; Cecum ; Cellulose, Oxidized ; Hyaluronic Acid ; Membranes ; Polymers ; Tissue Adhesions

PURPOSE: The aim of this study was to investigate the current status of the use of antiadhesive agents (AAdAs) via a questionnaire and to discuss the availability of AAdAs. METHODS: The survey was sent to a list of members that was approved by the Korean Gastric Association. The survey included questions on AAdA use by surgeons, the type of AAdAs used, and the reasons for not using AAdAs. Surgeons were also asked to describe complications related to AAdAs, and the reliability of its use. RESULTS: The response rate was 21%. The rates of frequent use stratified by procedure were 26.9% (14/52) for open gastrectomy, 5.9% (3/51) for laparoscopic gastrectomy, and 31.5% (17/54) for surgery for postoperative bowel obstruction (P < 0.01). After including data from the occasional use group, the corresponding values were 51.9% (27/52), 19.6% (10/51), and 70.4% (38/54), respectively (P < 0.01). Sefrafilm and Guardix were most commonly used for open procedures. Guardix and Interceed were most commonly used for laparoscopic surgery. The primary reasons for nonuse of AAdAs were ineffectiveness and high cost. Ten percent (4/40) of surgeons observed complications associated with AAdAs. A minority (17.3%, 9/52) had positive attitudes toward AAdAs. The majority of respondents expressed neutral (73.1%, 38/52) or negative (9.6%, 5/52) attitudes toward AAdAs. CONCLUSION: The low use rates of AAdAs in gastric cancer surgery may be attributable to perceptions that AAdAs are ineffective, unreliable, and costly. We anticipate the emergence of promising antiadhesive strategies that reach far beyond the limitations of current products.
Cellulose, Oxidized ; Gastrectomy ; Laparoscopy ; Morinda ; Postoperative Complications ; Surveys and Questionnaires ; Republic of Korea ; Stomach Neoplasms ; Surveys and Questionnaires

BACKGROUND: Many topical hemostatics are widely applied for bleeding control. They can be classified into two categories according to their mechanism of action on the clotting cascade in a biologically active or passive manner. Passive hemostatics include cellulose and gelatin. We performed an experimental study to compare the effect of passive hemostatics in wound healing by applying them to a rectus abdominis muscle defect of white mice. METHODS: Surgicel is a sterile absorbable knitted fabric prepared by the controlled oxidation of regenerated cellulose. Spongostan is an absorbable hemostatic gelatin sponge. In 30 mice, a 1x1 cm defect was created on the rectus abdominis muscle and the materials were applied in three ways: control group, cellulose (Surgicel) group, gelatin (Spongostan) group. For the histologic analysis, biopsies were performed at 3 and 28 days. RESULTS: After 3 days, the cellulose group showed limited granulation formation with acute inflammatory reactions similar to the control group. At the 28th day, moderate amounts of granulation tissue formation was observed with milder inflammatory reactions than the control group. In the gelatin group, after 3 days, gelatin remnants were observed surrounded by severe inflammatory changes. After 28 days, the same quantity of gelatin remnants could be still observed. CONCLUSIONS: This study suggests that cellulose is associated with minimal morbidity in wound healing, while the use of gelatin shows severe adverse tissue reactions with delayed wound healing. Consequently, cellulose is better than gelatin when considering wound healing.
Animals ; Biopsy ; Cellulose ; Cellulose, Oxidized ; Fibrin Foam ; Gelatin ; Granulation Tissue ; Hemorrhage ; Hemostatics ; Humans ; Mice ; Muscles ; Porifera ; Rectus Abdominis ; Wound Healing

Airway Obstruction ; Arteries ; Cellulose, Oxidized ; Hemorrhage ; Hemostasis ; Humans ; Male ; Mandible ; Postoperative Hemorrhage

This paper reviews the mechanisms and properties of different absorbable hemostatic agents. The development tendency of absorbable hemostatic agent is forecasted. Its' qualities of being useful to surgeons are introduced and are embodied in surgeon's comprehending of the hemostatic characteristic of absorbable hemostatic agents as well as in their clinical use of such agents accurately. At the same time, the researchers in pursuit of the medical materials can work with reference to the data herein presented.
Absorption ; Animals ; Blood Loss, Surgical ; prevention & control ; Cellulose, Oxidized ; administration & dosage ; pharmacology ; Chitosan ; administration & dosage ; pharmacology ; Fibrin Tissue Adhesive ; administration & dosage ; pharmacology ; Gelatin Sponge, Absorbable ; administration & dosage ; pharmacology ; Hemostatics ; administration & dosage ; pharmacology ; Humans

BACKGROUND: To evaluate the efficacy of cellulose mesh with fibrin glue to decrease recurrence rate after bullectomy for a treatment of primary spontaneous pneumothorax. MATERIAL AND METHOD: 222 patients underwent a bullectomy for primary spontaneous pneumothorax in our institute between April. 1996, and June, 2000. Patients were divided into four groups by period and operation method. Group 1(n=25) underwent video-assited thorasic surgery(VATS) and mechanical pleurodesis between 1996 and 1997. Group 2(n=53) underwent axillary thoracotomy and mechanical pleurodesis between the same period. Group 3(n=110) undewent VATS and mechanical pleurodesis between 1998 and April, 2000. Group 4(n=34) underwent VATS and reinforcement with absorbable cellulose mesh and fibrin glue between 1998 and June, 2000. The data of recurrence rate, duration of air leakage, and duration of chest tube drainage evaluated by each group were compared and analysed using general linear model procedure. RESULT: There were 203 men and 19 women. Mean age was 23.2+9.6 years. Recurrent rate in group 1 was 25%, 3.8% in group 2 and 4.5% in group 3. Threre was no recurrence of pneumothorax in group 4. All recurrent cases after bullectomy were developed at the period of surgeon' s experience of bullectomy if it was less than 2 years. Chest tube indwelling period in group 4 was shorter compared to that of group 1,group 2(p<0.0006) and group 3(p<0.0001). There was no postoperative air- leakage in group 4. Recurrence rate was higher in minimal and moderate size pneumothorax than that in massive pneumothorax. In the 12 recurred cases, nine cases had blebs near the suture line. CONCLUSION: The covering of the suture area with an bsorbable cellulose mesh and the application of the fibrin glue on the mesh in wedge resection of blebs are effective and shorter tube indwelling period was resulted. There were no postoperative air leakage through chest tube after this additional procedure and no recurrence in short term follow-up period. Recurrence rate was higher in small size pneumothorax than that in large sizepneumothorax. Recurrence rate was also influenced by the experience of surgeon.
Blister ; Cellulose ; Cellulose, Oxidized* ; Chest Tubes ; Drainage ; Female ; Fibrin Tissue Adhesive* ; Fibrin* ; Follow-Up Studies ; Humans ; Linear Models ; Male ; Pleurodesis ; Pneumothorax* ; Recurrence ; Sutures* ; Thoracic Surgery, Video-Assisted ; Thoracotomy