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Results for “Gelatin Sponge, Absorbable”

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PubMed1977

Spinal cord infarction following therapeutic renal artery embolization.

A patient with dialysis cachexia became paraparetic within hours of therapeutic renal artery embolization. At autopsy, emboli of absorbable gelatin sponge filled spinal arteries, accompanied by spinal cord infarcts. The renal arteries of patients with end-stage renal disease are smaller than normal becaue of intimal fibrosis associated with prolonged dialysis. Embolic material can reflux more readily in these patients than in patients with renal tumors.

Adult↗

PubMed1976

Antibacterial activity of oxidized regenerated cellulose.

It has been demonstrated that oxidized regenerated cellulose promptly and markedly reduces the bacterial census of ten different strains of common pathogens when exposed to them in vitro. This was not true of two other hemostatic agents tested, namely, absorbable gelatin sponge and topical thrombin. Wounds in guinea pigs in which oxidized regenerated cellulose was placed and infected with one of three pathogens had healing per primum in 39 of 40 instances. In similar control wounds and incisions in which absorbable gelatin sponge was placed, sepsis of the wound developed in 19 of 20 of the control group and in 39 of 40 guinea pigs in the absorbable gelatin sponge group.

Animals↗

PubMed1992

Sterile mediastinal gas mimicking abscess in aortic aneurysm repair.

Six weeks after aortic aneurysm repair, computed tomography (CT) showed mediastinal gas where absorbable gelatin sponge (Gelfoam) was used. A leukocyte scan labeled with indium 111, however, was normal and surgical exploration showed no infection. Sterile gas collections may be seen following absorbable gelatin sponge use many weeks after surgery and 111In-labeled leukocyte scanning may be a useful differential test.

Abscess↗

PubMed2006

Minor complications after mandibular third molar surgery: type, incidence, and possible prevention.

PURPOSE: The aim of this prospective study was to ascertain the incidence of minor complications after mandibular third molar surgery and to predict the risk of skin ecchymosis or mucosa petechiae related to the usage of an absorbable gelatin sponge. PATIENTS AND METHODS: One hundred and four patients subjected to surgical extraction of horizontally impacted lower third molars were selected and investigated by means of questionnaires and clinical examinations. The independent sample t test was used for numeric variables. The chi-square test was used for logistic variables to determine the association between variables, and thereafter stepwise logistical regression was used. RESULTS: The older group (> or = 30 years old), with deeply impacted teeth, and long operation times (> or = 10 minutes) were shown to have significantly higher swelling than the other groups (P < .05). The patients who had deeply impacted teeth or long operation times were shown to have significantly higher VAS scores compared to short operation times (P < .05). The use of an absorbable gelatin sponge in the extraction socket significantly decreased postoperative swelling, mucosal petechiae, and skin ecchymosis (P < .05). CONCLUSION: The clinical variables related to postoperative bleeding disorder, pain, and trismus were identified. The insertion of an absorbable gelatin sponge into the extraction socket was found to be a very useful method to prevent postoperative bleeding problems.

Adult↗

PubMed1999

A comparative evaluation of hemostatic agents in the management of soft tissue graft donor site bleeding.

BACKGROUND: Periodontal plastic surgery has increased the use of palatal wounds for donor tissue, with the most common complication being excessive bleeding from the palate after harvesting tissue. This study was conducted to evaluate the efficacy of 3 methods for achieving hemostasis on the palate after harvesting donor tissue for autogenous soft tissue grafts. METHODS: Thirty sites were evaluated at surgery for hemostasis and followed over 21 days for healing and adverse events. Three treatment groups were randomly selected and patients received either a test product or control comprising: 1) oxidized regenerated cellulose; 2) absorbable gelatin sponge; or 3) sterile gauze with external pressure as the control. All patients received a surgical stent for the palate. RESULTS: The results were analyzed for smokers and non-smokers, and the median time to hemostasis was significantly shorter when a hemostatic agent was applied to the palatal wounds compared to controls in both groups. Pain assessment showed no differences across treatment groups. However, by 21 days, only the oxidized regenerated cellulose group had complete healing based on blinded clinical evaluation with all sites rated as normal to rapid healing, compared to the absorbable gelatin sponge group where 40% of the sites were rated as slow healing. Adverse events, primarily bleeding episodes during the first 7 days after surgery, were found in 40% of the oxidized regenerated cellulose and gauze control groups, while no sites in the absorbable gelatin sponge group had an adverse event. The patients were followed for an average of 10 months and demonstrated a mean shrinkage of their recipient grafts of 24% in total surface area. CONCLUSIONS: This study concluded that the use of hemostatic agents for palatal wounds is confirmed as the treatment of choice when performing free soft tissue grafts.

Adult↗

PubMed1995

Effects of tumor necrosis factor alpha and vascular permeability factor on neovascularization of the rabbit ear flap.

OBJECTIVE: The survival of compromised skin flaps depends on neovascularization for their nutrition and metabolic waste removal. Our study investigated the effectiveness of angiogenic factors in accelerating peripheral neovascularization and in increasing skin flap viability. DESIGN: We elevated pedicled dorsal skin flaps on the ears of 23 New Zealand white rabbits, and the vascular pedicle was ligated to achieve partial flap necrosis. Fifteen flaps were treated with 0.1 micrograms/mL vascular permeability factor, and eight flaps were treated with 1.0 micrograms/mL tumor necrosis factor alpha. The ear flaps that were not treated with growth factor functioned in each rabbit as a normal saline control. MAIN OUTCOME MEASURES: The viability of skin flaps was observed visually and was measured by Cartesian planimetry using templates. Neovascularization was documented by microangiography and by histologic analysis of the flaps. RESULTS: Although the angiogenic factors accelerated neovascularization, increased flap survival was demonstrated only in those animals treated with vascular permeability factor that was supplied by an absorbable gelatin sponge. CONCLUSION: This experimental model, despite different levels of controls, contains multiple variables, including the use of an absorbable gelatin sponge, seroma formation, bioactivity of the angiogenic factors, optimal dosages and dosimetry, the need for a "blinded" format, and the validity of the histologic analysis. Additional investigation must be done and the experimental model itself must be improved before these apparently positive results may be accepted as clinically useful.

Animals↗

PubMed2004

Central renal stab wounds: treatment with augmented fibrin sealant in a porcine model.

PURPOSE: We determined whether fibrin sealant augmented by an absorbable bolster could salvage kidneys with major, centrally located stab wounds. MATERIALS AND METHODS: A grade 4 renal injury was created in 16 commercial swine via a 1.5 cm sagittal, centrally located, through-and-through right renal laceration. Animals were randomized to 1 of 4 treatment arms, including control groups that received conventional renal capsule suture repair with an absorbable gelatin sponge bolster (3 in group 1) or a microfibrillar collagen sheet (3 in group 2) and experimental groups that received sutureless treatment entailing fibrin sealant instillation into the knife tract augmented by an external gelatin sponge (5 in group 3) or an external microfibrillar collagen sheet (5 in group 4). Arterial occlusion was not performed. Blood loss and time to hemostasis were recorded. Abdominal computerized tomography was performed at 1 week and necropsy was done at 6 weeks. RESULTS: Renal reconstruction with fibrin sealant resulted in significantly lower blood loss (62 vs 155 ml, p <0.05) and time to hemostasis (3.5 vs 6.5 minutes, p <0.05) than in the conventional suture groups. There was no radiographic or gross evidence of significant postoperative bleeding, urinoma formation or abnormal tissue healing in the recovery period. Gelatin sponge and collagen sheet demonstrated similar hemostatic efficacy. CONCLUSIONS: In this porcine renal trauma model fibrin sealant augmented by absorbable gelatin sponge or a microfibrillar collagen sheet effectively promoted hemostasis and renal salvage. Because of its safety, ease of use and efficiency, fibrin sealant appears to be an appropriate adjunct for managing challenging renal injuries.

Animals↗

PubMed1984

A comparison between 2 absorbable hemostatic agents: gelatin sponge (Spongostan) and oxidized regenerated cellulose (Surgicel).

Oxidized, regenerated cellulose (Surgicel) and gelatin sponge (Spongostan) were packed in the sockets of upper third molars after surgical removal in 10 and 11 patients, respectively. The other side in each patient functioned as control. The study revealed that more pain was apparent on the sides, where the materials were packed, especially in the gelatin sponge group, although more patients preferred this material to oxidized, regenerated cellulose. The 2 materials did not differ with regard to swelling or bleeding. No complications were encountered. Use of these materials in post-extraction sockets did not seem to impair closure of the wound as estimated by epithelial cover of the sockets, although healing was slightly delayed in the gelatin group.

Adult↗

PubMed2005

Postbiopsy splenic bleeding in a dog model: comparison of cauterization, embolization, and plugging of the needle tract.

OBJECTIVE: The purpose of our study was to compare radiofrequency cauterization, embolization using an absorbable gelatin sponge, and a Histoacryl-Lipiodol mixture plugging as postbiopsy bleeding reduction methods after splenic core needle biopsy in a dog model. MATERIALS AND METHODS: Eleven mongrel dogs were randomly separated into nonheparinized (n = 5) and heparinized (n = 6) groups. Eight splenic biopsies per animal were performed using an 18-gauge automated core biopsy needle: two as controls, two ablated by radiofrequency, two embolized using an absorbable gelatin sponge, and two plugged using a Histoacryl-Lipiodol mixture. Procedure times and postbiopsy bleeding amounts were assessed. Statistically significant differences were determined by repeated measures analysis of variance; the Tukey-Kramer test for multiple comparisons was used for post hoc comparisons. Three-day follow-up CT scans were obtained to check for procedure-related complications or delayed bleeding. RESULTS: The postbiopsy bleeding reduction groups showed significantly less blood loss than the control group for both the nonheparinized (p < 0.0001) and heparinized groups (p < 0.0001). In the heparinized group, both radiofrequency cauterization (p < 0.01) and gelatin sponge embolization (p < 0.05) significantly reduced bleeding compared with Histoacryl-Lipiodol mixture plugging. Gelatin sponge embolization was the longest procedure (p < 0.001). On follow-up CT, no delayed bleeding was observed. However, multiple Histoacryl-Lipiodol emboli were observed in the splenic and portal veins in all the dogs we treated. CONCLUSION: Radiofrequency cauterization was found to be the most useful postbiopsy bleeding reduction method in terms of the amount of bleeding and the procedure time.

Analysis of Variance↗

PubMed1998

Pseudotumors after renal parenchymal sparing surgery.

PURPOSE: After renal parenchymal sparing surgery, residual defects may persist on imaging studies at the sites of resection. These "pseudotumors" may lead to confusion as to whether a lesion was removed or has recurred. We describe the imaging appearances and behavior of renal pseudotumors following renal parenchymal sparing surgery. MATERIALS AND METHODS: From 1988 to 1997, 32 patients underwent 46 renal parenchymal sparing surgeries for removal of renal cancers, including von Hippel-Lindau disease in 27, hereditary papillary renal cancer in 2 and sporadic disease in 3. A median of 14 tumors (range 1 to 114) were removed in each operation. Thrombin soaked absorbable gelatin sponge was placed in the tumor bed after resection to aid hemostasis. We reviewed all imaging studies performed after these operations to characterize these lesions and gain further understanding into the prevalence and etiology. RESULTS: Of the patients, 9 had a total 13 pseudotumors on initial postoperative imaging studies, including Hippel-Lindau disease in 7, hereditary papillary renal cancer in 1 and sporadic renal cancer in 1. Pseudotumors were observed after 10 of 46 operations (22%). All pseudotumors demonstrated round contours and enhancement after contrast media, simulating a tumor, yet, these lesions resolved in a mean of 13 months, leaving only small cortical scars. CONCLUSIONS: Renal pseudotumors are commonly seen after renal parenchymal sparing surgery and should not be confused with residual or recurrent disease. Enhancement is likely due to granulation tissue involving the lattice of absorbable gelatin sponge. These lesions usually resolve within a year but can take longer to do so.

Adult↗

PubMedDate not supplied

Absorbable laparoscopic cigarette sponge.

OBJECTIVES: Minor intraoperative bleeding during laparoscopy poses a significant challenge to the minimally invasive urologist. We report on our improvement of the previously reported laparoscopic cigarette sponge with absorbable materials. METHODS: The sponge was constructed from a strip of absorbable gelatin sponge wrapped in oxidized regenerated cellulose and secured with absorbable suture. This device can be inserted into the laparoscopic field through a standard 12-mm laparoscopic port and similarly removed. It can also remain intracorporeally if left behind following surgery. RESULTS: The sponge has proven to be very effective at controlling minor hemorrhage and aiding with dissection and retraction. CONCLUSION: This device has improved operative safety and provides a useful alternative when laparoscopic bleeding occurs.

Gelatin↗

PubMed1999

Systemic absorption of insulin from a Gelfoam ocular device.

In previous reports (Lee et al., 1997b; Lee and Yalkowsky, 1999), it has been shown that insulin, delivered by an acidified Gelfoam (absorbable gelatin sponge, USP) based ocular device, can be efficiently absorbed into the systemic circulation without the aid of an absorption enhancer. The role of acid in the enhancer-free absorption of insulin is investigated in this report. Gelfoam ocular devices containing 0.2 mg of sodium insulin prepared with either water or 10% acetic acid were evaluated in rabbits. The results suggest that a change in the Gelfoam upon treatment with acid is responsible for the efficient systemic absorption of insulin from these enhancer-free devices.

Absorption↗

PubMed2001

Effects of exposing the opened endolymphatic sac to large doses of steroids to treat intractable Meniere's disease.

To enhance the effect of treatment for intractable Meniere's disease, we exposed the opened endolymphatic sac to high concentrations of steroids. This technique--endolymphatic sac drainage and steroid instillation surgery--involves the application of a mass of prednisolone followed by absorbable gelatin sponges soaked in a high concentration of dexamethasone into a sac lumen opened and expanded with a bundle of absorbable gelatin film. These sponges are also placed around the sac and coated with biochemical adhesive so that the medicine is slowly delivered into the sac over a prolonged period of time by means of a natural sustained-release vehicle. The short-term results (6 to 14 months) in 12 patients with Meniere's disease, including those in stage IV, treated by the above techniques showed that definitive spells were completely controlled in all cases. Hearing was improved, and annoyance due to tinnitus was decreased in all cases except one.

Adult↗

PubMed2005

Clinical benefits and risk analysis of topical hemostats: a review.

A variety of local hemostats including absorbable gelatin sponge, collagen hemostat, and oxidized cellulose are commercially available. Local hemostats are applied when cautery, ligature, or other conventional hemostatic method is impractical. Proper handling is essential to control bleeding and only the required amount should be used, even though the hemostat is expected to dissolve promptly. A dry local hemostat absorbs body fluid of several times its own weight and expands postoperatively. Therefore, when an absorbable hemostatic agent is retained on or near bony or neural spaces, the minimum amount should be left after hemostasis is achieved. Documentation is important with regard to the hemostat used, including the name of the agent, site, and amount. This information is used as a reference in the interpretation of postoperative diagnostic images, since retained hemostat may sometimes mimic an abscess or recurrent tumor. The antigenicity of collagen is known to be low because of homology. When the safety of collagen was evaluated, the incidence of positive reactions was reported as 3.0%, and collagen may cause allergic reactions. Minimum inflammation without strong foreign body reactions or blockade of healing is desirable after the use of local hemostats. Strong foreign body reactions, chronic inflammation, and infections can cause granuloma formation after local hemostat use. By using local hemostats, it is possible to improve the condition of the patient, reduce complications, and lower direct and indirect costs.

Cellulose, Oxidized↗

PubMed1983

Comparative tissue reactivity to topical hemostatic agents in the periureteral area.

Application of the topical hemostatic agents microfibrillar collagen hemostat (Avitene), oxidized cellulose (Surgicel), and absorbable gelatin sponge (Gelfoam) to the periureteral regions in dogs did not incite an adverse inflammatory or fibrotic reaction when used in standard, recommended fashion. No instances of ureteral obstruction resulted from such application. The addition of a small amount of sterile urine in the same area with the topical agent did not influence the degree of reaction. We concluded that these useful hemostatic agents, when used properly, are absorbed with only slight or no residual tissue reaction. The adverse tissue reaction occasionally reported probably can be ascribed to either improper use of the hemostatic agent, other concomitant noxious influences such as infection, or admixture with abnormal collections of body fluids.

Administration, Topical↗

PubMed2001

Treatment of grade 4 renal stab wounds with absorbable fibrin adhesive bandage in a porcine model.

PURPOSE: In a porcine model we evaluated the efficacy of the absorbable fibrin adhesive bandage and other novel fibrin products for treating major renal stab wounds. MATERIALS AND METHODS: In commercial swine we produced an almost lethal, grade 4 renal stab wound via a 3.5 cm. sagittal, centrally located, through-and-through laceration. Each pig then received treatment in random fashion, including conventional oversewing of capsular defects with absorbable gelatin sponge and horizontal mattress sutures in 6, external absorbable fibrin adhesive bandage that was pressure held for 60 seconds in 6, external and internal absorbable fibrin adhesive bandage that was applied externally, inserted into the renal defect and pressure held for 60 seconds in 6, liquid fibrin sealant that was placed in the laceration and held for 60 seconds in 8, fibrin foam that was applied in the same manner as liquid fibrin in 5 and closing of the peritoneum over the lacerated kidney without further treatment in 6. Blood loss and time to hemostasis were recorded. Animals were sacrificed at 6 weeks to evaluate the injured renal unit. RESULTS: Compared with conventional therapy the absorbable fibrin adhesive bandage applied externally alone or externally and internally resulted in significantly less bleeding and significantly less time to hemostasis (p <0.001). Liquid fibrin and fibrin foam did not reliably achieve hemostasis. Postoperatively computerized tomography and histological sectioning suggested that the absorbable fibrin adhesive bandage results in a stable, durable clot and healing is at least as successful as with conventional treatment. CONCLUSIONS: The absorbable fibrin adhesive bandage appears to be a safe, rapid means of renal salvage after injury.

Animals↗

PubMed2005

Haemostasis using a ready-to-use collagen sponge coated with activated thrombin and fibrinogen.

Adequate haemostasis is an important part of any surgical procedure, but particularly so in the case of visceral organ surgery where apparently insignificant ooze can ultimately result in significant haemorrhage and coagulopathy. To achieve haemorrhage control, the surgeon may use conventional techniques (eg, suture ligation, diathermy, and swab compression), but failing this has the option of using physical coagulation tools (eg, the argon beam coagulator) and haemostasis adjuncts (eg, fibrin glues and collagen sheets). Advances in manufacturing have led to development of several other haemostatic products including absorbable gelatin sponges, cyanoacrylates, and polymer-based adhesives. One such product consists of a fixed, ready-to-use equine collagen sponge coated with human thrombin and fibrinogen. It may be applied directly to the bleeding surface, without the need for preparation or reconstitution. This chapter reviews the published evidence and compares its use to other classes of haemostasis adjuncts across a range of surgical specialties, namely hepatic, splenic, thoracic, vascular, and minimally invasive surgery. It also aims to highlight the apparent advantages and limitations of the fibrinogen and thrombin-coated collagen sponge compared to other commercially available haemostasis adjuncts, and identify potential applications for the product.

Animals↗

PubMed2003

Intravenous sedation vs general anesthesia for pediatric otolaryngology procedures.

OBJECTIVE: To compare efficacy, safety, and hospital charges for common pediatric otolaryngology procedures with the use of intravenous sedation (IVS) vs general anesthesia (GA). DESIGN: Retrospective chart study. SETTING: Hospital-based pediatric otolaryngology practice. PATIENTS: Patients younger than 18 years who underwent tympanostomy tube removal and/or patch myringoplasty with absorbable gelatin sponge, nasal ciliary biopsy, fine-needle aspiration, or other minor procedures between September 1, 1998, and August 31, 2001. INTERVENTIONS: Procedures performed in 2 settings: outpatient clinic with IVS or operating room with GA. MAIN OUTCOME MEASURES: Procedure completion rate, tympanic membrane perforation rate after ear procedures, complications, and hospital charges. RESULTS: Of 103 procedures, 54 were performed with IVS and 49 with GA. Within the GA group, 32 of 49 patients had additional operations performed and were excluded from analysis of safety and hospital charges. Procedure completion rate was 100% in both groups. The most common procedure was tympanostomy tube removal with patch myringoplasty (IVS, 52 ears; GA, 42 ears). The rate of persistent tympanic membrane perforation was similar between these groups (IVS, 7 [16%] of 45 ears; GA, 5 [15%] of 33; P =.96). All complications were minor and occurred at similar rates (IVS, 10 [19%] of 54 ears; GA, 3 [18%] of 17; P =.94). These events included hypoxia, airway obstruction, and bradycardia, all of which resolved spontaneously or responded to noninvasive interventions such as oxygen or repositioning. Average hospital charges were significantly higher for the GA group (IVS, $356.22; GA, $1516.55; P<.001). CONCLUSION: Various procedures can be performed safely, effectively, and with decreased hospital charges with the use of IVS administered by a pediatric sedation service.

Adolescent↗