| Hemorrhage is perhaps the most difficult part of neurosurgical procedures. Surgeons must constantly battle pooling and oozing blood when performing dissection and manipulation in or near the spinal cord, brain, or nerve. Neurosurgeons employ several techniques and devices to gain control of unrelenting bleeding, such as the use of bipolar electrocautery, ligatures, endovascular therapies, and bone wax. However, when conventional means of controlling bleeding fail, neurosurgeons often turn to biological hemostasis devices, such as oxidized cellulose hemostats, absorbable gelatin sponges, or microfibrillar collagen hemostats.
Oxidized cellulose hemostats, such as SURGICEL Absorbable Hemostat, from Ethicon, Inc., a Johnson & Johnson company, have long been used for intraoperative hemostasis. When saturated with blood, oxidized cellulose sheets rapidly swell into a gelatinous mass, aiding hemostasis.
Ethicon’s SURGICEL Absorbable Hemostat is the only oxidized regenerated cellulose hemostat on the market. SURGICEL is fully absorbed within 7 to 14 days and delivers superior draping properties and bactericidal protection. SURGICEL does not stick or fall apart, and is endoscopically compatible.
Absorbable gelatin sponges, such as SURGIFOAM Absorbable Gelatin Sponge, from Ethicon, Inc. and GELFOAM Absorbable Sponge, from Pfizer, Inc., are often used in conjunction with thrombin, which generates fibrin from fibrinogen and promotes platelet aggregation. Gelatin sponges absorb within four to six weeks and are capable of holding within their mesh many times their weight in whole blood.
SURGIFOAM Absorbable Gelatin Sponge has a proven track record in providing excellent hemostasis in a variety of surgical procedures. For over 50 years, SURGIFOAM has proven to be safe and effective in over 100 million operations worldwide.
GELFOAM Absorbable Sponge is also derived from gelatin. Like SURGIFOAM, GELFOAM comes in compressed sheets that can be cut into pieces of an appropriate size. GELFOAM is pliable, and, when applied to bleeding areas of nasal, rectal, or vaginal mucosa, completely liquefies within two to five days.
Collagen is also known to cause aggregation of platelets. On contact with blood, microfibrillar collagen hemostats, such as Avitene® from Davol, Inc., and INSTAT® Collagen Absorbable Hemostat, from Ethicon, Inc., cause platelet aggregation, degranulation, and the release of coagulation factors that, along with plasma factors, enable the formation of fibrin.
Avitene® is the only collagen hemostat indicated for all surgical procedures, including neurosurgery and urology. Avitene is effective in controlling arterial bleeding in patients with platelet counts as low as 20,000 per cubic millimeter. It comes in the form of flour or sheets (non-woven web). Avitene also comes in a syringe. The 1 gram SyringeAvitene contains 1 gram of Avitene flour. It is designed to control bleeding in open surgeries and to access deep penetrating wounds. The 5mm SyringeAvitene contains an Avitene sheet and is used to control bleeding in hard-to-access areas, particularly in neurosurgery and ENT procedures. Avitene is also available preloaded in an endoscopic applicator. EndoAvitene Preloaded Applications is the only topical hemostat available in a preloaded endoscopic delivery system designed for use in all laparoscopic procedures. The EndoAvitene pass easily through standard trocars and cannula. The EndoAvitene is available in 5mm and 10mm diameters.
INSTAT Collagen Absorbable Hemostat, from Ethicon, is also available in pad as well as in powder form. INSTAT absorbs in eight to ten weeks, and provides excellent wet tensile strength to maintain integrity in the wound. INSTAT Collagen Absorbable Hemostat is made of a purified and lyophilized bovine dermal collagen. The material, when prepared as a sponge-like pad, is lightly cross-linked, sterile, non-pyrogenic, and absorbable.
In whatever form, whether oxidized cellulose, absorbable gelatin, or microfibrillar collagen, biological hemostats aid in platelet aggregation and help to stop bleeding in neurosurgical procedures, providing an excellent alternative to surgeons when conventional methods fail.
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