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BMC Surgery Dec 2014Surgical bleeding can be associated with an increased risk of morbidity and mortality across all surgical areas. Thus, numerous products have been developed to achieve... (Review)
Review
BACKGROUND
Surgical bleeding can be associated with an increased risk of morbidity and mortality across all surgical areas. Thus, numerous products have been developed to achieve haemostasis. A flowable haemostatic matrix such as Floseal® can quickly and reliably stop bleeding across the full spectrum of bleeding scenarios. The aim of this study was to systematically review clinical and economic evidence regarding the use of Floseal® in surgical procedures.
METHODS
An extensive literature search was conducted in PubMed, EMBASE, and the Cochrane Library over the period spanning 2003-2013 to identify publications related to Floseal® use in all types of surgical procedures. Case reports and case series studies were excluded.
RESULTS
A total of 27 papers met the selection criteria and were analysed. In the studies, blood loss and the time to achieve haemostasis were the most reported outcomes used to assess the efficacy of Floseal®. The majority of published studies (64%) examined the use of Floseal® compared with conventional methods (such as electrocautery or suturing). The remaining 36% of the studies evaluated the use of Floseal® compared with other haemostatic agents, such as Surgicel®, Gelfoam®, and Hemostase®. FloSeal® has been demonstrated to be an efficacious method in surgical procedures to reduce the time to achieve haemostasis, the frequency of intra- and postoperative bleeding, and the length of hospital stay, among other primary outcomes, resulting in less consumption of health resources.
CONCLUSIONS
The majority of the selected studies confirmed that Floseal® showed improvements over other haemostatic agents in achieving haemostasis and reducing blood loss.
Topics: Blood Loss, Surgical; Cost Savings; Gelatin Sponge, Absorbable; Hemostasis, Surgical; Hemostatics; Humans
PubMed: 25528250
DOI: 10.1186/1471-2482-14-111 -
ACS Applied Materials & Interfaces May 2020Wound bleeding and infection are two of the major threats to patients' lives, but developing safe materials with high hemostasis efficiency and antibacterial activity...
Wound bleeding and infection are two of the major threats to patients' lives, but developing safe materials with high hemostasis efficiency and antibacterial activity remains a major challenge. Silver nanoparticles (AgNPs) are suitable as antibacterial agents in the hemostatic process, but the application is hampered because of easy accumulation of toxicity. Herein, thiol-modified chitosan (TMC) was prepared by modifying with mercaptosuccinic acid and then was used to immobilize AgNPs to obtain composite sponges (TMC/AgNPs) for stemming the bleeding and preventing infection. TMC/AgNPs sponges had complex interlaced tubular porous structure with high porosity (99.42%), indicating high absorption. TMC had high immobilization efficiency for AgNPs-the release rate of AgNPs was 14.35% after 14 days-but the TMC/AgNPs sponge still had excellent antibacterial activity against , , and . and experiments confirm that the TMC/AgNPs sponge had fast and efficient hemostatic performance in comparison with the PVF sponge, and its possible mechanism was the synergistic effect of high blood absorption capacity and the interaction between amino, sulfydryl, and blood cells. Furthermore, the TMC/AgNPs sponge can promote wound healing by preventing wound infection, while the PVF sponge cannot. More importantly, the sponges had good safety due to the immobilization of TMC for AgNPs.
Topics: Animals; Anti-Bacterial Agents; Blood Coagulation; Chitosan; Escherichia coli; Hemostatics; Male; Metal Nanoparticles; Mice; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Rabbits; Silver; Staphylococcus aureus; Surgical Sponges; Wound Healing
PubMed: 32298570
DOI: 10.1021/acsami.0c05430 -
Veterinary Radiology & Ultrasound : the... Sep 2023Retained surgical sponges or gauzes (RSS) are an uncommon complication of exploratory laparotomy surgery and pose a clinically significant risk to the patient. The...
Retained surgical sponges or gauzes (RSS) are an uncommon complication of exploratory laparotomy surgery and pose a clinically significant risk to the patient. The purpose of this two-part, prospective, descriptive study was to describe the previously uncharacterized ultrasonographic appearance of RSS in phantom and cadaveric models of the acute postoperative period (24-48 h). For the first part of the study, a gelatin phantom containing a woven gauze with a radiopaque marker (radiopaque gauze), a woven gauze with no marker (nonradiopaque gauze), and a laparotomy sponge with a radiopaque marker (radiopaque sponge) was evaluated with ultrasonography. For the second part of the study, a total of 23 gauzes and sponges (of the aforementioned three types) were placed within the peritoneal cavity of 20 cadavers in one of three randomized locations during an exploratory laparotomy laboratory. The cadavers were imaged with ultrasonography 17 h later and still images and video clips were reviewed. The retained surgical sponges and gauzes in the gelatin phantom displayed multiple hyperechoic layers and variable degrees of distal acoustic shadowing. In cadavers, 100% (23/23) of the retained surgical sponges and gauzes displayed a single hyperechoic layer of variable thickness and distal acoustic shadowing. In 95.6% (22/23) retained sponges and gauzes, there was a thin hypoechoic layer noted superficially to the hyperechoic layer. An improved understanding of the ultrasonographic appearance of retained sponges or gauzes in the acute postoperative period may assist in the identification of these objects.
Topics: Animals; Postoperative Complications; Prospective Studies; Gelatin; Surgical Sponges; Foreign Bodies; Cadaver
PubMed: 37485635
DOI: 10.1111/vru.13281 -
Arquivos Brasileiros de Cirurgia... 2021
Topics: Foreign Bodies; Humans; Surgical Sponges
PubMed: 34008712
DOI: 10.1590/0102-672020190004e1571 -
Annals of Vascular Surgery Jan 2022Deep-space surgical site infections carry significant morbidity and mortality. The evidence for gentamicin-containing collagen implants at reducing surgical site... (Observational Study)
Observational Study
BACKGROUND
Deep-space surgical site infections carry significant morbidity and mortality. The evidence for gentamicin-containing collagen implants at reducing surgical site infections in open infrainguinal arterial surgery is limited. This study examined whether gentamicin-containing collagen implants reduces 30-day surgical site infections and their severity following open infrainguinal arterial surgery.
METHODS
A retrospective observational cohort study that included all patients undergoing infrainguinal arterial bypass or endarterectomy between November 2015 and March 2019 at a single tertiary vascular unit. Patients with contaminated/infected surgical fields, surgical wounds treated with negative pressure therapy, or the usage of antimicrobial implants and dressings other than Collatamp G (Aralez Pharmaceuticals, Canada) were excluded. Patients with gentamicin-containing collagen implants placed abutting vasculature were compared against patients without gentamicin-containing collagen implants. Outcomes included the rate of surgical site infections and their severity within 30 days after the operation.
RESULTS
In 159 procedures (mean age 67.7 years, 74.8% male, 33.3% diabetic, 16.4% chronic renal failure, 25.2% anticoagulated postoperatively, 32.7% with prosthetic implants), 55 (34.6%) procedures received gentamicin-containing collagen implants. There were significantly more males (85.5% vs. 69.2%; P = 0.025), higher rates of obesity (41.8% vs. 26.0%; P = 0.041), and hyperlipidemia (65.5% vs. 49.0%; P = 0.048) in the gentamicin-containing collagen implant group. In total, 6 (3.8%) procedures developed deep-space surgical site infections (1 with gentamicin-containing collagen implant, 5 without) and 13 (8.2%) had severe surgical site infections that required re-intervention (1 with gentamicin-containing collagen implant, 12 without). On logistic regression analysis, the absence of gentamicin-containing collagen implants statistically significantly increased the odds of overall surgical site infections (OR = 2.50; 95% CI 1.01 - 6.19; P = 0.047). There was no statistically significant difference in the odds of deep-space surgical site infections or the severity and need for reintervention of surgical site infections.
CONCLUSIONS
This is the first study that examined the effect of gentamicin-containing collagen implants on the severity of surgical site infections in vascular surgery. Gentamicin-containing collagen implants may reduce the odds of overall surgical site infections. It did not reduce the odds of deep-space surgical site infections or the severity and reintervention rate of surgical site infections following infrainguinal arterial revascularization. Larger studies are required to achieve adequate power to assess for these outcomes.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Arterial Occlusive Diseases; Diabetes Complications; Female; Gentamicins; Humans; Ischemia; Lower Extremity; Male; Middle Aged; Obesity; Plastic Surgery Procedures; Retrospective Studies; Risk Factors; Surgical Sponges; Surgical Wound Infection; Vascular Surgical Procedures
PubMed: 34543713
DOI: 10.1016/j.avsg.2021.06.036 -
Plastic and Aesthetic NursingNurses and surgeons collaborate to conduct safe surgery. We follow time-consuming and labor-intensive protocols, such as the systematic counting and verifying of...
Nurses and surgeons collaborate to conduct safe surgery. We follow time-consuming and labor-intensive protocols, such as the systematic counting and verifying of surgical sponges. However, the counting process may be distracting from other patient-centered tasks. To understand the perception of plastic surgery professionals about the intraoperative sponge count, we designed an online questionnaire. One hundred plastic surgeons and residents from 32 different countries completed the survey. The results showed that most often (70%) the scrub person determines when sponges will be counted, and 34.3% of the time, a sponge count is incorrect at the first count and then corrected. The main reason for an incorrect sponge count appears to be a change in personnel (53%). Radiological imaging is required during an average of 8.7% of surgeries to rule out a retained sponge in the patient. Notably, missing sponges are most frequently found elsewhere in the operating room. Younger surgeons prefer to pause during the surgical procedure until the sponge count is completed and noted to be correct. This approach appears to be associated with fewer counting errors, a shorter counting time, and a significant reduction in distraction of the whole surgical team. Performing a cavity sweep before beginning wound closure and using large surgical sponges are also suggested as alternatives to counting sponges. A sponge count can become an impediment to patient care because it has limited reliability and causes distraction among the team. A surgical pause can be implemented until the sponge count is completed or until any discrepancy is resolved.
Topics: Humans; Female; Reproducibility of Results; Patient Care; Plastic Surgery Procedures; Bandages; Surgery, Plastic
PubMed: 36450091
DOI: 10.1097/PSN.0000000000000433 -
Journal of Multidisciplinary Healthcare 2021This study aimed to critically examine the circumstances contributing to, and the human costs arising from, the retention of surgical items through the lens of... (Review)
Review
OBJECTIVES
This study aimed to critically examine the circumstances contributing to, and the human costs arising from, the retention of surgical items through the lens of Australian case law.
DESIGN SETTING AND PARTICIPANTS
We reviewed Australian cases from 1981 to 2018 to establish a pattern of antecedents and identify long-term patient impacts (human costs) of retained surgical items. We used a modified four-step process to conduct a systematic review of legal doctrine, combined with a narrative synthesis approach to bring the information together for understanding. We searched LexisNexis, AustLII, Coroner Court websites, Australian Health Practitioner Regulation Agency Tribunal Decisions and Panel Hearings, Civil and Administrative Tribunal summaries, and other online sources for publicly available civil cases, medical disciplinary cases, coronial cases, and criminal cases across all Australian jurisdictions.
RESULTS
Ten cases met the inclusion criteria, including one coronial case, three civil appeal cases, and six civil first instance cases. Time from item retention to discovery ranged from 12 days to 20 years, with surgical sponges the most frequently retained item. Five case reports indicated possible deviations from standard protocols regarding counting procedures and record-keeping. In the four cases that reported on count status, the count was deemed correct at the end of surgery. Case reports also showed the human costs of retained surgical items, that is, the long-term impacts on patients associated with a retained surgical item. In eight of the nine civil cases, ongoing pain was the most frequently reported physical symptom; in three cases, patients suffered psychosocial symptoms requiring treatment.
CONCLUSION
While there was little uniformity in the items retained or how items came to be retained, we identified significant time delays between item retention and item discovery, coupled with long-lasting physical and psychosocial harms suffered by patients living with a retained surgical item. Current prevention strategies, including national standards-based professional practices, are not always effective in preventing retained surgical items. An internationally standardised taxonomy and reporting criteria, more consistent reporting, and open access to event and risk data could inform a more accurate global estimate of risk and incidence of this hospital-acquired complication.
PubMed: 34511923
DOI: 10.2147/JMDH.S316166 -
Ear, Nose, & Throat Journal Feb 2020
Topics: Diagnosis, Differential; Foreign Bodies; Humans; Kazakhstan; Male; Medical Illustration; Middle Aged; Postoperative Complications; Recurrent Laryngeal Nerve; Surgical Sponges
PubMed: 30955368
DOI: 10.1177/0145561319840512 -
Otology & Neurotology : Official... Jun 2023This study investigates the physical properties upon immersion of two gelatin sponges commonly used in otologic surgery.
OBJECTIVE
This study investigates the physical properties upon immersion of two gelatin sponges commonly used in otologic surgery.
BACKGROUND
Absorbable gelatin sponges are often used in middle ear surgery to achieve hemostasis and, perhaps more importantly, to provide a "scaffolding" to support ossicular chain and/or tympanic membrane reconstructions. Their rate of dissolution may therefore affect the success of tympanic membrane closure.
METHODS
An in vitro study was conducted to quantify the material changes of two absorbable gelatin sponges, a standard-density sponge and one with fewer collagen cross-linkages (low-density sponge). Volume loss (%) in 0.9% saline, 0.3% ciprofloxacin, and/or 0.1% dexamethasone as single-agent otic drops in a combination formulation was measured at 15-minute intervals for the first hour and at days 1, 3, and 5 postimmersion. Secondary end points included compressibility, porosity under microscopy, and infrared spectroscopy analysis.
RESULTS
The low-density sponge immersed in any of the three otic solutions showed a statistically significant greater volume loss at all time points when compared with the standard-density sponge (27.2% ± 5.4% vs. 15.4% ± 6.0% at 15 minutes and 44.8% ± 5.1% vs. 34.6% ± 2.9% at 5 days, p < 0.001). Interestingly, both sponges immersed in normal saline had lost almost half of their original volume after 15 minutes when compared with samples immersed in an otic solution (48.3% ± 4.6% vs. 21.3% ± 8.3%, respectively, p < 0.001).
CONCLUSION
The standard-density sponge immersed in an otic solution of ciprofloxacin, dexamethasone, or a combination formulation best maintained its structural integrity. Ancillary in vivo studies are required to assess the hemostatic properties, surgical outcomes, and middle ear synechiae of the above study conditions.
LEVEL OF EVIDENCE
Foundational evidence.
Topics: Humans; Gelatin Sponge, Absorbable; Ear, Middle; Hemostatics; Gelatin; Dexamethasone
PubMed: 36962059
DOI: 10.1097/MAO.0000000000003857 -
Colloids and Surfaces. B, Biointerfaces Sep 2018Kaolin is an effective and safe hemostatic agent for hemostasis. However, its ontic powder is difficult to use in actual practice. To develop a wieldy and powerful...
Kaolin is an effective and safe hemostatic agent for hemostasis. However, its ontic powder is difficult to use in actual practice. To develop a wieldy and powerful hemostat, composite strategy is usually a good choice. Herein, we developed a graphene-kaolin composite sponge (GKCS), synthesized with graphene oxide sheets, linker molecules and kaolin powders through a facile hydrothermal reaction. SEM observations support that GKCS has a porous structure, and EDS mapping further confirms that kaolin powders are embedded in graphene sheets. Once GKCS is exposed to bleeding, plasma is quickly absorbed inside the sponge, meanwhile blood cells are gathered at the interface. The gathered blood cells are in favor of accelerating clotting due to multi stimulations, including concentration, surface charge and activation of hemostatic factors, originating from both kaolin powders and graphene sponge. As a result, GKCS could stop bleeding in approximately 73 s in rabbit artery injury test. Besides, cytotoxicity and hemolysis assessments highlight that GKCS has a good biocompatibility. These remarkable properties suggest that GKCS is a potential riskless hemostatic agent for trauma treatment.
Topics: Animals; Antidiarrheals; Carotid Artery Injuries; Cells, Cultured; Graphite; Hemostasis; Kaolin; Particle Size; Rabbits; Rats; Surface Properties; Surgical Sponges
PubMed: 29763772
DOI: 10.1016/j.colsurfb.2018.05.016