Efficacy of a Topical Gelatin-Thrombin Matrix Sealant in Reducing Postoperative Drainage Following Anterior Cervical Discectomy and Fusion

Abstract

Study Design:Retrospective fusion level(s)-, age-, and gender-matched analysis. Purpose: To determine whether the application of a topical gelatin-thrombin matrix sealant (Floseal) at the end of anterior cervical discectomy and fusion (ACDF) can reduce the amount of postoperative hemorrhage. Overview of Literature: The effect of the matrix sealant in decreasing postoperative hemorrhage following ACDF has not been reported. Methods: Matrix sealant was (n=116, study group) or was not applied (n=58, control group) at the end of ACDF. Patients were selected by 1:2 matching criteria of fusion level(s), age, and gender. Seven parameters described below were compared between the two groups. Results: The total drain amount for the first 24 hours (8±9 versus 27±22 mL), total drain amount until the 8-hour drainage decreased to ≤10 mL (8±10 versus 33±26 mL), and the total drain amount until 6 AM on the first postoperative day (7±8 versus 24±20 mL) were significantly lower in the study group than the control group (all p<0.001). The time for the 8-hour drainage to decrease to ≤10 mL was significantly lower in the study group (10±5 versus 26±14 hours, p<0.001). The 8-hour drainage decreased to ≤10 mL on the operation day in most patients (88%) in the study group versus mostly on the first (48%) or second (33%) postoperative day in the control group (p<0.001). The total drain amount until 6 AM on the first postoperative day was 0 mL in 43% of patients in the study group and in 7% in the control group (p<0.001). No patient in either group required hematoma evacuation.

Efficacy of a topical gelatin-thrombin hemostatic matrix, FLOSEAL®, in intracranial tumor resection

“…e effectiveness of FLOSEAL, which is a topical hemostatic agent containing a flowable gelatin bovine matrix and a human-derived thrombin component, has been shown in various types of operations [1][2][3][4]6,9,11,[13][14][15]16,20] . However, no reports have evaluated the effectiveness of FLOSEAL objectively in the neurosurgical field.…”

“…Our finding of a reduction in postoperative bleeding in the FLOSEAL group is consistent with the previous reports in orthopedics or adenotonsillectomy. [9,11,23] As a result of reduced postoperative bleeding, patients may have little risk for reoperation for postoperative hemorrhage or for having complications.…”

“…Compounded thrombin then facilitates forming a fibrin clot around the matrix that results in hemostasis. [15] e effectiveness of FLOSEAL has been previously reported in various types of operations, [1][2][3][4]6,9,11,[13][14][15]16,20] and the use of FLOSEAL may shorten the time to achieve hemostasis. [14] However, in neurosurgical operations, few previous reports have shown the utility of FLOSEAL, [1,6] and no reports have evaluated its effectiveness objectively.…”

Hemostats in Spine Surgery: Literature Review and Expert Panel Recommendations

“…Adjunctive use of flowable gelatin-thrombin hemostat (Floseal) has been shown to reduce both intraoperative blood loss (by 30%) and postoperative decrease in hemoglobin concentration in adolescents undergoing posterior spinal fusion for idiopathic scoliosis [ 69 ]. Application of Floseal at the end of anterior cervical discectomy and fusion has also been shown to significantly reduce occurrence of postoperative hemorrhage [ 70 ]. Analysis of 2 flowable hemostats found that surgery time, risk of blood transfusion, and amount of hemostat used is lower with Floseal patients in comparison to Surgiflo [ 71 ].…”

Efficacy, safety, and physicochemical properties of a flowable hemostatic agent made from absorbable gelatin sponge via vacuum pressure steam sterilization

“…Gelatin sponge has been proved to be safe because of the low antigenicity of gelatin-based hemostatic agents, and skin, horn, and hoof materials from pigs and cows are easily accepted by the human body. 5 However, these hemostatic methods, including gelatin sponge, may be ineffective and impractical in locations that are deep and difficult to access, and for irregularly shaped wounds, bleeding lesions near important and vulnerable tissues, and diffuse capillary and venous plexus bleeding, especially during spinal surgery, 6,7 neurosurgery, 8,9 cardiovascular surgery, 10,11 urology, 12 gynecology, 13,14 and other surgical specialties. Surgeons thus require suitable hemostatic agent for these situations.…”