1.0 Gelatin-based products – INSTASPON

 

2.0 Collagen-based products

 

3.0 Cellulose-based products

 

4.0 Chitosan BASED hemostat

 

5.0 FIBRIN SEALANT

 

 

 

 

 

1.0 GELATIN-BASED PRODUCTS – INSTASPON

 

ABSORBABLE  GELATIN SPONGE

DIRECTIONS : cut in various Sizes and applies to bleeding surfaces

INSTASPON ABSORBABLE GELATIN SPONGE  is commonly employed agents for the control of minor bleeding which is a porous. Absorbable gelatin sponge is prepared from purified pork skin gelatin. It is manufactured in the form of films,

ADVANTAGES :

  • Gelatin Sponges i.e INSTASPON powder that is mixed to form a paste.

  • INSTASPON has very little tissue reaction and liquefies in the oral cavity within a week, fully absorbing within 4-6 weeks.

  • It is very useful in managing post-operative bleeding after dental extractions and periodontal surgeries and addition of thrombin improves its efficacy.

  • Gelatin based hemostat have been reported to induce a better quality clot than collagen based hemostats

CONTRAINDICATIONS:

  • INSTASPON Should not be use in closour to skin incisions

  • INSTASPON should not be placed in intravascular compartments

FLOSEAL (FLOWABLE HEMOSTATIC AGENT):

Floseal agent is a proprietary combination of two independent hemostatic agents and consists of bovine derived gelatin granules which are coated in human derived thrombin that works in combination to form a stable clot at the bleeding site. This agent is resorbed by the body within 6- 8 weeks, that is with the time frame required for normal wound healing

 

 

2.0 COLLAGEN-BASED PRODUCTS

Microfibillar collagen

It is derived from purified bovine dermal collagen which is a fibrous in nature, water insoluble partial hydrochloric salt. They get absorbed in 10-14 days.

Advantages:

  • Products can be stored at room temperature.

  • They are immediately available for use, and should not be resterilized.

  • It attracts platelets and stimulates aggregation of platelets to form the fibrous mass resulting in the formation of a physiologic platelet plug, degranulation, and release of clotting factors, leading to initiation of the coagulation cascade. Adverse effects: Allergic reaction, adhesion formation, inflammation, foreign body reaction, and potentiation of wound infections which may lead to abscess formation.

Contraindications:

  • In known cases of allergies or sensitivities to materials of bovine origin.

  • Should be avoided in any area where it may exert pressure on adjacent vital structures because of fluid absorption and expansion

 

Absorbable collagen

Helistat is collagen derived from purified and freeze-dried bovine flexor tendon which is available as soft, white, pliable, no friable, coherent, sponge like structure.

 Advantage:

  • this product is highly absorbent and able to hold many times their own weight of fluid.

  • When helistat comes in contact with blood, collagen causes aggregation of platelets, which bind in large numbers to the collagen fibrils. These aggregated platelets degranulation, releasing factors such as thromboxane A2.

  • This sponge also provides a three-dimensional (3D) matrix for strengthening the blood clot.

  • These collagen materials are completely resorbed within 14-56 days. Indications: Wound protection and for control of oozing or bleeding from clean oral wounds.

Contraindication:

  • Not to be used in infected or contaminated wounds.

  • Contraindicated in patients with known allergies or sensitivities to materials of bovine origin.

Disadvantages

  • It may serve as a nidus for abscess formation and may favor bacterial growth.

 

3.0 CELLULOSE-BASED PRODUCTS

Oxidized CELLULOSE-BASED PRODUCTS (SURGICEL ):

Oxidized regenerated cellulose is derived from plant based alpha cellulose and is available in an absorbable white, knitted, fabric which may be single or multiple

Advantage:

  • sheets that is either available in high or low density.

  • It achieves hemostasis by mechanical pressure.

  • It is relatively bacteriostatic when compared with other hemostatic agents. Absorption of Surgicel will occur in approximately 4-8 weeks.

Disadvantages:

  • It has low pH and this acidic nature may cause inflammation and necrosis of the adjacent tissue. Thrombin is ineffective with this agent due to its acidic nature.

  • Encapsulation of fluid and foreign body reaction can occur if the product is left in the wound.

Contraindication:

  •  In bony defects (fractures) as it may interfere with bone regeneration.

 

ACTCEL AND GELITACEL:

It is a new topical hemostatic agent made from treated and sterilized cellulose, available as meshwork like Surgicel hemostatic agent. It is used to control bleeding in periodontal and orthognathic surgeries. One study has demonstrated that Actcel adheres to calcium ions, thus making calcium more available for the coagulation cascade. It has a role in the modifying intrinsic pathway. Gelitacel is relatively fast-working, oxidized resorbable cellulose hemostatic gauze of natural origin made from highest alphagrade selected cotton. It resorbs as quick as in 96 hours, therefore giving it decreased risk for encapsulation.

 

4) CHITOSAN BASED HEMOSTAT

  • CHITOSAN SPONGE made up of chitosan, a polysaccharide that carries abundant cations, NH+3, which rapidly attract erythrocytes in blood flow, initiate coagulation and form strong blood clots at the wound site.

  • CHITOSAN SPONGE  is a dressing indicated for topical wound management and for the external topical temporary control of moderate to severe bleeding.

  • The dressing is indicated for the following wounds: abrasions, lacerations, skin surface puncture sites for vascular procedures (arteries and veins).

5) SEALANTS

SEALANTS:

Sealants mechanism of action is by forming a barrier that is impervious to the flow of most liquids. Various types of sealants to achieve surgical hemostasis are: Fibrin sealants, PEG polymers, albumin with glutaraldehyde and the new cyanoacrylate sealant.

FIBRIN SEALANT: Fibrin sealant is a naturally derived or synthetic combination hemostatic agent which is also tissue adhesive. It has an impact on angiogenesis and wound healing. Fibrin sealants consist of fibrinogen, fibrin stabilizing factor, and thrombin. When applied to the surgical site it forms a fibrin clot. These products are applied using a syringe like applicator or sprayed over a larger area using a gas-driven device.

Uses:

  • In bone grafting procedures particularly sinus lift surgery.

  • They can be used in patients with coagulopathies who have insufficient fibrinogen to form a blood clot and can also be used on patients who are receiving heparin.

  • Fibrin sealants control local as well as diffuse bleeding from the site; however,

DISADVANTAGE:

  • they are not useful in control of vigorous bleeding.

 

Contraindication:

  • It is contraindicated in patients who are sensitive to bovine proteins. An excessively thick sealant layer may prevent revascularization at the surgical site, causing tissue necrosis