TITLE:
A Qualitative Morphological Comparison of Two Haemostatic Agents in a Porcine Liver Trauma Model
AUTHORS:
Kenneth E. Coenye, Claire Bourgain, Claudia Keibl, Sylvia Nürnberger, Martijn van Griensven
KEYWORDS:
Haemostasis; Coagulation; Thrombin; Fibrin; Gelatine; Sealant; Clot; Surgery; Trauma; Wound Healing
JOURNAL NAME:
Surgical Science,
Vol.4 No.8,
July
23,
2013
ABSTRACT:
Background: Many
surgical haemostatic agents are available which aim to reduce morbidity and mortality
of bleeding, as well as associated costs. We used qualitative techniques to
compare the effectiveness of two topical gelatine-based haemostatic agents in a
porcine liver trauma model. Methods: We
compared the activity of Floseal? (with human or bovine thrombin), Surgiflo? and Surgiflo? plus 5000 IU bovine thrombin per 10 mL of product (n =
6 test sites/group). Different clinical scenarios were evaluated in two
anaesthetised piglets; normal physiological conditions (normotension and
normothermia), and a status of hypotension, hypothermia and haemodilution,
requiring inotropic support. Laparotomy was performed, and five identical stab wounds were made on each
liver lobe. Four of these wounds were randomly treated with one of the agents
under investigation, while one wound was kept as an untreated control. Haemostasis was observed during and
immediately following surgery. After euthanisation, wounds were examined
(blinded for treatment) macroscopically, microscopically and using scanning
electron microscopic evaluation. Results: Surgiflo? produced some degree of clotting in 1/3 applications in
both piglets. Co-treatment with thrombin resulted in a minor improvement in
performance in the animal with normal physiological conditions (some degree of
clotting in all wounds); no improvement was seen in the animal in a status of
hypotension, hypothermia and haemodilution. Floseal? induced
clotting in all wounds for both piglets. Microscopic and scanning electron
microscope examination of the stab wounds demonstrated that Floseal? created a stable, dense agglomerate of gelatine and fibrin, which firmly
adhered to the adjacent liver tissue. In wounds treated with Surgiflo? or Surgiflo? plus thrombin, the gelatine contained more air bubbles,
resulting in less fibrin inclusion in the clot and weaker adhesion of the clot
to the liver tissue. Conclusion: Floseal? created a dense
and stable blood clot, even in a piglet with hypotension, hypothermia and
haemodilution.