Wound care
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
Passive agents – these rely on clotting factors of the patient. They need blood/bleeding in order to work – they absorb blood, activate platelets and induce coagulation. There are a variety of products: Cellulose (oxidised), e.g. Surgicel®. Note that it has a rim-enhancing appearance on CT that may mimic an abscess.Gelatin sponge, e.g. Gelfoam®, made from purified pork skin gelatin – the mechanism of action is not fully understood.Collagen (microfibrillar), e.g. Avitene®.Chitosan (shrimp shells), e.g. Celox rapid® – also causes vasospasm, attracts platelets, sticks to wound.Zeolite (from lava) Quikclot® – non-biodegradable, and thus has potential for foreign body reaction.Kaolin (a clay mineral) – ‘Combat gauze’, promotes clot formation.
How to perform revision lumbar decompression
Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro in Revision Spine Surgery, 2019
The lateral recess, from superior articular facet hypertrophy, may be the source of stenosis in the setting of previous inadequate decompression. The Kerrison rongeur can be used to undercut up to 50% of the medial aspect of the superior facet, ensuring decompression of the lateral recess and preservation of stability. Often, epidural venous bleeding can be encountered during decompression of the lateral recess. Hemostasis is achieved with topical human thrombin-gelatin hemostatic matrix (Surgiflo), bipolar electrocautery, or thrombin soaked gelatin sponges (Gelfoam). The laminectomy is carried out caudal to cranial until the caudal and cranial pedicle can be palpated with a dural or Woodson elevator. Any sharp spikes of bone along the decompression should be removed with a Kerrison rongeur to prevent inadvertent durotomy.
General Approach To Upper Gastrointestinal Bleeding
John P. Papp in Endoscopie Control of Gastrointestinal Hemorrhage, 2019
Selective celiac and superior mesenteric angiography may be used to localize a bleeding site in the upper tract, but rarely can identify the exact type of lesion. When endoscopy has failed and bleeding continues at least moderately active, there is a good chance of diagnostic success. In one report, visceral angiography documented a bleeding site in 22 of 23 cases.3 Such success requires a minimum bleeding rate of 0.5 to 1 m//min which is considerable, i.e., 720 to 1440 m//24 hr. Arteriography obviously has one major disadvantage, i.e., a marked reduction in diagnostic accuracy when bleeding slows. When a bleeding site is identified, the angiographer has the capability to treat the bleeding by infusion of vasoconstricting drugs, or injection of gelfoam or autologous clot in an attempt to embolize the bleeding vessel.
Preclinical characterization of the ADME properties of a surrogate anti-IL-36R monoclonal antibody antagonist in mouse serum and tissues
Published in mAbs, 2020
Kip P. Conner, Cinthia V. Pastuskovas, Marcus Soto, Veena A. Thomas, Mylo Wagner, Dan A. Rock
Surgical manipulation was similar to the 5/6 nephrectomy model described by Wang et al. with a few modifications.35 Aseptic surgical technique was used in all surgical procedures. Briefly, mice were anesthetized with 4–5% isoflurane (Abbott Laboratories, North Chicago, IL, USA). Two-thirds of renal mass was ablated by resection of 1/3 of the left kidney at the upper and lower poles. Gelfoam® (Pharmacia and Upjohn Co. Kalamazoo, MI, USA) was applied to renal tissue before the kidney was placed back into the abdomen. One week later the entire right kidney was removed, and the mice underwent an additional 1-week recovery period prior to being placed on study. An SC dose of buprenorphine (0.05 mg/kg) was given preoperatively and post-operatively twice a day for 48 h during each surgical session.
The efficacy of pelvic arterial embolisation for the treatment in massive vaginal haemorrhage in obstetric and gynaecological emergencies: a single-centre experience
Published in Journal of Obstetrics and Gynaecology, 2019
Several studies have described successful treatment of AVMs with embolisation alone (Yokomine et al. 2009; Vijayakumar et al. 2013). Transarterial embolisation protects the uterus should be preferred as a treatment option in cases of pregnancy expectancy. Preoperative embolisation can be used as a definitive treatment or to minimise intraoperative bleeding before surgery (Brown et al. 2008). Peitsidis et al. (2011) reported that 59% of their 100 cases were treated with UAE and 29% with total abdominal hysterectomy. Spontaneous resolution of AVM occurred in six (6%) patients, while recurrence was observed after treatment with UAE in 17 (17%). Those authors recommended the use of gelfoam, which resorbs within 10–14 days, over permanent particles as first-line embolic agents in women wishing to preserve fertility (Peitsidis et al. 2011). In fact, gelfoam sponge has been used as a safe and effective embolic agent for more than 30 years in UAE and other interventional procedures. It is also the most popular embolising agent for UAE in women with expectations of pregnancy (Delplanque et al. 2018). Although gelfoam particles are regarded as temporary embolising agents, embolisation has also been reported to induce permanent occlusion (Song et al. 2013). More recent studies have recommended polyvinyl alcohol particles or NBCA as agents of choice (Vijayakumar et al. 2013; Vilos et al. 2015).
Complicated bleeding challenge and intraoperative safety strategies in a case of hemophilia a with rhabdomyosarcoma
Published in Pediatric Hematology and Oncology, 2022
Phumin Chaweephisal, Hansamon Poparn, Kanhatai Chiengthong, Panya Seksarn, Piti Techavichit, Supanun Lauhasurayotin, Darintr Sosothikul
Local control of bleeding is as important as systemic control. It can be employed with hemostatic agents (e.g. Gelfoam, Surgicel, Fibrin glue, Electrocautery and others). Antifibrinolytic agents such as oral tranexamic acid or epsilon-aminocaproic acid (EACA) are also important for controlling primary and secondary hemostatic disorders. A medication that is not used is Desmopressin acetate (DDAVP). It may have a role with minor procedures in mild hemophilia A cases but it has little role in this type of situation. Aspirin and non-steroidal anti-inflammatory drug (NSAIDs) for pain control should also be avoided. Continuous infusion of Factor VIII for this type of complex surgery has also been shown to be safe and efficacious,7 and could have been considered; however, it has been our institution’s preference to use intermittent infusions instead. With utmost caution and careful preparation, major surgery can be performed safely.