Comparative Analysis of Surgical Hemostatic Sponges in Liver Injury: Study in Rats

Abstract

BackgroundObtaining effective hemostasis either in the traumatic or surgical lesions of parenchymal viscera, especially the liver, has always been a challenge. Aim: Comparative study between the use of different hemostatic sponges in hepatic wound and their capacity of integration to cells in a short period. Methods: Fifteen Wistar rats were divided into three groups. Through laparotomy a standardized wound in hepatic right lobe was made. The animals were treated with three sponges, being gelatin in group I, equine collagen in group II, and oxidized cellulose in group III. The hemostatic capacity was analysed. On the 7º day after surgery samples for histology analysis (H&E and picrosirius) were collected for inflammatory evaluation and collagen quantification (types I and III) with polarized microscopy. Results: All materials used had similar haemostatic effects, with no significant difference in hemostasis time. In the assessment of tissue repair and adhesions provoked, as well as analysis of the inflammatory process, the gelatin sponge presented greater inflammation and adhesions to the contiguous structures to the procedure in relation to the other groups. Conclusion: Animals which had their wounds treated with collagen and regenerated cellulose sponges presented better results in relationship to the ones treated with gelatin sponge.

An Overview of the Use of Equine Collagen as Emerging Material for Biomedical Applications

“…Effective hemostatic systems for traumatic or surgical lesions of soft tissues such as viscera, liver [ 143 , 146 , 147 , 171 ], heart [ 106 , 145 , 151 , 155 ], lymphatic system [ 150 ], kidney [ 144 , 148 ], post-cesarean uterus [ 149 ], blood vessels [ 139 , 142 ], have always been of great importance. During surgical interventions on parenchymatous organs, hemorrhages are hard to control.…”

“…Apart from different surgical measures to stop such bleedings (compression, ligation, suturing, clipping argon beam coagulation, electrocautery), a very common strategy consists in the use of topical agents with high hemostasis power (collagen-based sealants, cellulose fleece, cotton gauze, synthetic glues, fibrin sealants) [ 145 ]. Among these, promising results were given by collagen-based pads that demonstrated to be able to promote coagulation within few minutes after the application (3–5 min) [ 143 , 171 ] by naturally favoring platelets recall by chemotaxis besides their adhesion and aggregation. The contact of platelets with collagen start a reaction cascade which leads to platelets aggregation to form a clot that effectively reduces bleeding [ 82 ].…”

“…The contact of platelets with collagen start a reaction cascade which leads to platelets aggregation to form a clot that effectively reduces bleeding [ 82 ]. It is worth noting that the cascade of events can be induced by native collagen rather than its denatured form [ 82 , 171 ], reasons why all hemostatic commercial products (TissueFleece ® , Biocollagen ® , Tachotop ® , Antema ® , CollGARA ® , Kollagen ® , Parasorb ® ) take care in maintaining the nativeness and thus the natural binding sites of collagen during the manufacturing process.…”

“…The intrinsic adhesiveness of collagen demonstrates its efficacy in the treatment of wounds not only by promoting good hemostasis but also by favoring repairing processes [ 171 ]. This “secondary” property of collagen is important to decrease the probability to have surgical site infections.…”

<p>A review of the application of cellulose hemostatic agent on trauma injuries</p>

“…The regenerated cellulose sponge stimulated the production of type I collagen more than that of gelatin and collagen did. 16 Karahaliloglu et al (2017) evaluated the effectiveness of a fabricated nano/microbilayer hemostatic dressing for blood conservation in the diabetic rat. They set a nano/ microbilayer hemostatic dressing that contains effective properties.…”