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Transfusion in Trauma
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
TachoSil® (Baxter Corporation, Deerfield, IL, USA), is a fixed, ready-to-use combination of a collagen sponge coated with a dry layer of the human coagulation factors fibrinogen and thrombin, making it easy to employ. It is most suitable for oozing from the raw surfaces of solid organs or to seal air leaks from lung injuries. It is available in most countries in Europe and Australasia.
Radical Sphincter-Sparing Resection in Rectal Cancer
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
The pelvic cavity is washed out and inspected for bleeding. For troublesome presacral, pelvic sidewall or other bothersome bleeding, a haemostatic agent, such as Tachosil™, may be helpful. Rather than repeated futile attempts at diathermy or suturing, packing the pelvis will usually arrest bleeding if left in place for at least 10 to 15 minutes.
Vulvar cancer and post-vulvectomy complications
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Christos Iavazzo, Ioannis D. Gkegkes
Buda et al. proposed another preventive technique using the application of a sterile, absorbable hemostatic surgical patch (TachoSil®, Nycomed, Zurich, Switzerland), which is a fixed combination of a collagen matrix with coagulation factors (such as human fibrinogen and human thrombin), as a means of reducing postoperative complications after groin lymphadenectomy (Figure 13.2) (56). Such a technique seems to be effective in decreasing the rate of complications after lymphadenectomy. TachoSil® has already been utilized in reducing lymphatic leakage as a result of mediastinal lymph node dissection and preventing lymphocyst formation after inguinofemoral dissection (56,57). Its action is based on the effect of coagulation and fibrinolytic factors, produced by lymphatic endothelial cells, on the sealing of lymphatic capillaries. It is shown that patients using TachoSil® had significantly less lymphorrhea, lower rates of complications (such as cellulitis, wound infection, and lymphocysts), and earlier drainage removal (56).
Experimental Evaluation of a New Tissue Factor-Based Topical Hemostat (TT-173) for Treatment of Hepatic Bleeding
Published in Journal of Investigative Surgery, 2020
Alberto Centeno, Santiago Rojas, Belén Arias, Ignasi Miquel, Pilar Sánchez, Claudia Ureta, Esther Rincón, Ramón López, Jesús Murat
In the scenario of partial liver resection, TT-173 could present several advantages in comparison with other hemostatic products. There is no doubt that hemostatic patches such as Tachosil are very useful to improve bleeding control, but they are also expensive. Moreover, they immediately adhere to the parenchyma making any change in its position virtually impossible. Fibrin sealants present the same limitations and probably are less convenient than hemostatic patches for this specific surgery. From the safety point of view, both agents contain fibrinogen derived from human blood and in consequence are associated with a theoretical risk of pathogen transmission. This may be more relevant for those viruses especially resistant to inactivation procedures such as the human parvovirus B19. In the past, several cases of parvovirus infection due to the use of fibrin sealants have been reported [35,36]. However current manufacture procedures have minimized this risk [17]. In any case human blood is an expensive and limited resource and requires specialized procedures for its obtention and processing with enough safety guarantees.
An overview of surgical sealant devices: current approaches and future trends
Published in Expert Review of Medical Devices, 2018
Philipp Heher, James Ferguson, Heinz Redl, Paul Slezak
Active hemostatic sealant patches (or pads) have recently emerged as an alternative to the well-established liquid surgical sealants and provide a versatile sealant option across several surgical settings [9]. The first sponge- or fleece-like hemostatic matrices were based on gelatin [50] or oxidized cellulose [51] and introduced already in the 1940s. These topical hemostats provided a passive, low-cost and easy-to-use approach to hemorrhage control and have been commercialized as Gelfoam® (Pfizer Inc., New York, U.S.A.), a gelatin-based sponge, or Surgicel® (Ethicon, Somerville, U.S.A.), which is based on oxidized regenerated cellulose. However, the complexity of modern surgical procedures has driven the development of novel, advanced sealant patches that combine hemostasis with active sealing properties. These patches consist of a sheet- or foam-like backing and a functionalized self-binding surface, for example Tachosil® (Takeda Pharmaceutical, Osakashi, Japan; previously marketed as TachoComb®), a first-generation commercially available advanced sealant patch consisting of an equine collagen foam coated with human fibrinogen and thrombin on its active side [52]. The mechanism of action is activated after manual compression of the patch onto a leakage. This rapidly establishes a physical barrier and activates fibrin formation through solubilization after contact with body liquids, which results in adhesion to the site of application and hemostasis. Tachosil® gained FDA approval in 2010 and is indicated as an adjunct to hemostasis in cardiovascular and hepatic surgery. The need for more efficient (= more adhesive) sealant patches has recently driven the development of second-generation composite sealant patches [53–56]. Evarrest® (Ethicon, Somerville, U.S.A.), based on human fibrinogen and thrombin on a cellulose/polyglactin 910 patch, and Hemopatch® (Baxter Healthcare, Vienna, Austria), a NHS-PEG coated collagen patch, represent such novel, commercially available advanced sealant patches. Evarrest® and Hemopatch® have been granted FDA approval as adjuncts to hemostasis in various surgical fields [9,54,55,57]. VerisetTM (MedTronic, Minneapolis, U.S.A.), a cellulose-based patch with PEG-trilysine coating, is currently being evaluated in clinical trials [56,58]. A fully synthetic sealant patch, TissuePatchTM (TissueMed Ltd., Leeds, UK), has recently been approved in China as sealant device in thoracic surgery. TissuePatchTM is composed of a poly(lactide-co-glycolide) (PLGA) backing coated with the company’s TissueBondTM adhesive, a copolymer of vinyl pyrrolidone (PVP) and NHS-functionalized acrylic acid (PAA), and is currently being tested in several surgical fields [59–61]. An overview of commonly used first- and second-generation sealant patches and their composition is presented in Table 2.