Gelatin sponge (Gelfoam®): Spongostan-leaflet
- No intrinsic coagulating effect.
- Absorbs 45 times its weight in blood which causes it to expand and tamponade bleeding.
- Expands to the same size prior to its compression
- Absorbable.
- May be combined with thrombin as patties or as powder (e.g. FLOSEAL®, SurgiFlo®)
- Floseal: Gelatin + thrombin
- May affect healing of skin edges do not use them there
- Can expand by 20% of volume (max swell volume is at 10 mins)
- Excess floseal is not incorporated at the haematoma site and should be washed off
- It should not be used to pack the lumen of venous sinuses as this may lead to dural venous sinus thrombosis.
Oxidized cellulose (Oxycel®) and oxidized regenerated cellulose (Surgicel®)
- Cellulose from cotton
- Surgicel
- Decomposing wood pulp, then regenerating the cellulose by manufacturing continuous cellulose fibers
- Polyanhydroglucuronic acid, which is spun into threads and then woven into gauze
- Mechanism of action
- Oxidized cellulose is saturated with blood at the bleeding site and swells into a gelatinous mass that aids in clot formation
- Expands by 3-4x its original size
- Acidic material (pH 3)
- Acidic nature stimulates inflammation → Can retard wound healing/bone growth
- Oxycel® interferes with epithelialization more than Surgicel®
- Acidic nature causes red cell lysis occurs
- Reacts with blood to form a reddish brown “pseudoclot”
- Bactericidal to over 20 different organisms
- Low pH can inactivate topical thrombin; thus, oxidized regenerated cellulose and topical thrombin should not be used together.
- Normally reabsorbed within 7-14 days
- When used in small amounts, it is absorbed from the sites of implantation with minimal tissue reaction
- Gelitacel-CA powder
- 100% oxidized cellulose + Calcium powder
Microfibrillar collagen (Avitene®)
- Promotes adhesion and aggregation of platelets.
- Loses effectiveness in severe thrombocytopenia (< 10,000/ml).
- May be used on bone bleeding.
- Remove excess material to reduce risk of infection
Thrombin (Thrombostat®/floseal)
- Does not depend on any intermediate physiological agent.
- Caution: although thrombin may cause significant oedema when placed on brain where the pia has been disrupted, practical experience indicates this is uncommon
- Thrombin come from human plasma: can spread CJD
- Usage
- This thrombin solution alone may be used to irrigate the operative field. Slow venous oozing after glioma resection is responsive to this haemostatic manoeuvre.
- Not seen any untoward side effects from using the irrigation of thrombin solution even within the ventricular spaces.
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