Use of PerClot® in head and neck surgery: a Scottish centre experience

Abstract

Objective PerClot® is a biocompatible, polysaccharide haemostatic system recommended for surgical procedures. It is an absorbable modified polymer that is non-pyrogenic and is derived from purified plant starch. Our goal was to evaluate the safety, efficacy and usefulness of PerClot® in head and neck surgery (H&N) in our department. Methods All patients who received PerClot® after their neck operation over 1-year period (2019–2020) were prospectively investigated. The information collected included demographics, admission and discharge dates, type of operation, operative details, postoperative complications and their management. The data were collected and analysed using Excel. Results A total of 57 patients (males = 26, females = 31) with mean age of 51 (range 19–83) were identified. None of the patients developed primary or secondary haemorrhage. Ten patients suffered from post-operative wound complications (18%). Wound infection was noticed in 9/57 (16%) of patients. 1/57 patients had seroma. Conclusions PerClot® is safe, effective in reducing the postoperative bleeding and would appear to be useful in head and neck surgery with minimal adverse effects.

Clotting Blood into an Adhesive Gel by Hemostatic Powder Based on Cationic/Anionic Polysaccharides and Laponite

“…Presently, a wide range of organic and inorganic substances have been the focus of thorough investigation, leading to the creation of coagulation-promoting powders. ,− Inorganic hemostatic powders, such as mesoporous silica, bioactive glass, kaolinite nanoclay, and calcium carbonate microspheres, have been demonstrated to be successful in managing bleeding by virtue of their vesicular structure and incorporation of inorganic metal oxides. ,− Organic hemostatic materials, including chitosan, starch, cellulose, gelation, and hyaluronic acid, have been thoroughly researched for their ability to effectively control hemorrhage . Some of these materials, such as chitosan-based Celox and starch-based PerClot, have even entered the commercial market. , In general, traditional hemostatic powders achieve hemostasis through three main mechanisms: (i) absorbing plasma to concentrate erythrocytes and thrombocytes, (ii) interacting and bonding with coagulation factors to initiate the coagulation cascade, and (iii) supporting the aggregation of blood components to form a physical seal on bleeding wounds. , However, there is no interaction between the hemostatic particles, resulting in a weak mechanical strength of the supported thrombus. Additionally, this traditional powder has poor tissue adhesion.…”

“…17 Some of these materials, such as chitosan-based Celox and starch-based PerClot, have even entered the commercial market. 18,19 In general, traditional hemostatic powders achieve hemostasis through three main mechanisms: (i) absorbing plasma to concentrate erythrocytes and thrombocytes, (ii) interacting and bonding with coagulation factors to initiate the coagulation cascade, and (iii) supporting the aggregation of blood components to form a physical seal on bleeding wounds. 1,20 However, there is no interaction between the hemostatic particles, resulting in a weak mechanical strength of the supported thrombus.…”

Alone Against Bleeding. Active or Mechanical Hemostatic in Severe Hemorrhage?

“…Some active agents, including brinogen and thrombin, actively participate at the end of the coagulation cascade to form brin clots (6) (7) (8). Others, such as porcine gelatin (9), oxidized cellulose (10), and plant-derived polysaccharide spheres (11) (12), are known as mechanical hemostats. They activate and aggregate platelets and form a matrix at the site of bleeding, allowing clotting to occur (8).…”