Efficacy of Three Alternative Hemostatic Agents
(Chitosan, Gelatin, and Cellulose) for Soft Tissue
Dissection during Lumbar Spine Surgery: A Comparative
Study in an Animal Model
Twinprai N, MD¹, Sae-Jung S, MD, PhD¹
Affiliation : ¹ Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Intraoperative bleeding can lead to morbidity and complications. Hemostatic materials have been developed, but
the relative efficacy of different agents has not been assessed.
Objective: To evaluate the hemostatic properties of four common hemostatic materials including chitosan clot pad, absorbable gelatin sponge, cellulose membrane, and gauze on para-spinal muscle bleeding using a rat lumbar spine soft tissue dissection model.
Materials and Methods: Forty 8-week-old Sprague-Dawley rats were used. Under adequate anesthesia, the para-spinal muscle of each rat was posteriorly dissected until the L5 and L6 spinous processes were found. Then the rats were randomly allocated to receive one of the four hemostatic materials. The allocated materials were placed over the raw surface of the dissected muscle and were changed every one minute until there was no further bleeding. Bleeding volume in each of the materials was recorded.
Results: The mean hemorrhage volumes (±SD) for the chitosan pad, gelatin sponge, cellulose membrane, and gauze were 0.06±0.03, 0.06±0.02, 0.07±0.03, and 0.18±0.17 ml, respectively. The overall bleeding volumes for the chitosan pad, gelatin sponge, cellulose membrane were significantly lower than the gauze; however, among those three, there were no significant differences in overall bleeding volume.
Conclusion: Chitosan pads, gelatin sponges, and cellulose membranes have better soft tissue hemostatic properties than gauze, and are all equally effective. Each of the three can be used as a hemostatic material without serious adverse effects during posterior lumbar para-spinal surgery.
Keywords : Chitosan, Cellulose, Gelatin, Rat, Para-spinal muscle
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