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      COMPARATIVE ANALYSIS OF SURGICAL HEMOSTATIC SPONGES IN LIVER INJURY: STUDY IN RATS Translated title: ANÁLISE COMPARATIVA DE ESPONJAS HEMOSTÁTICAS CIRÚRGICAS EM FERIMENTO DE FÍGADO: ESTUDO EM RATOS

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          ABSTRACT

          Background

          Obtaining effective hemostasis either in the traumatic or surgical lesions of parenchymal viscera, especially the liver, has always been a challenge.

          Aim:

          Comparative study between the use of different hemostatic sponges in hepatic wound and their capacity of integration to cells in a short period.

          Methods:

          Fifteen Wistar rats were divided into three groups. Through laparotomy a standardized wound in hepatic right lobe was made. The animals were treated with three sponges, being gelatin in group I, equine collagen in group II, and oxidized cellulose in group III. The hemostatic capacity was analysed. On the 7º day after surgery samples for histology analysis (H&E and picrosirius) were collected for inflammatory evaluation and collagen quantification (types I and III) with polarized microscopy.

          Results:

          All materials used had similar haemostatic effects, with no significant difference in hemostasis time. In the assessment of tissue repair and adhesions provoked, as well as analysis of the inflammatory process, the gelatin sponge presented greater inflammation and adhesions to the contiguous structures to the procedure in relation to the other groups.

          Conclusion:

          Animals which had their wounds treated with collagen and regenerated cellulose sponges presented better results in relationship to the ones treated with gelatin sponge.

          RESUMO

          Racional

          A obtenção de hemostasia eficaz nas lesões traumáticas ou cirúrgicas de vísceras parenquimatosas, em especial do fígado, sempre foi desafiante.

          Objetivo:

          Comparar o uso de hemostáticos absorvíveis em ferimento hepático quanto à capacidade hemostática e de integração aos tecidos em curto prazo.

          Métodos:

          Foram utilizados 15 ratos Wistar separados em três grupos. Foi realizada laparotomia e ferimento padronizado em lobo hepático direito. Os animais do grupo I foram tratados com esponja de gelatina sobre os ferimentos; os do grupo II com esponja de colágeno equino, e os do grupo III com celulose regenerada oxidada. Na ocasião foi estudada a capacidade hemostática. No 7º dia de pós-operatório nova laparotomia foi realizada e foram coletadas amostras para estudos histológicos (H&E e picrosirius) avaliando os processos por microscopia ótica e de polarização para quantificação de colágeno (tipos I e III).

          Resultados:

          Todos os materiais usados apresentaram efeitos hemostáticos semelhantes, não havendo diferença significativa no tempo de hemostasia. Na avaliação da reparação tecidual e aderências provocadas, assim como análise do processo inflamatório, os tratados com esponja de gelatina apresentaram maior inflamação e aderências às estruturas contíguas ao procedimento em relação aos outros grupos.

          Conclusão:

          Os animais tratados com a esponja de colágeno e celulose regenerada apresentaram resultados melhores que aqueles com esponja de gelatina.

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          Most cited references13

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          Tensile strength of wound closure with cyanoacrylate glue.

          2-Octyl cyanoacrylate tissue adhesive is increasingly being used for closure of traumatic lacerations. Data regarding the strength of incisions closed with 2-octyl cyanoacrylate are limited. We compared the strength of disruption of closure with glue with that of more conventional methods of wound closure. Segments of fresh porcine skin measuring 3.5 x 10 cm were approximated by one of four methods: 1) 2-octyl cyanoacrylate glue, 2) surgical staples, 3) 0.5 inch Steri-Strips, and 4) interrupted 4-0 poliglecaprone 25 sutures in a subcuticular fashion. Fifteen specimens were used to test each type of closure. The strength of closure was tested on an Instron 4502 tensionometer. The peak force required for disruption of the closure was recorded and the strength of the closure was compared. Staples provided the strongest closure. Skin glue proved superior to Steri-Strips but inferior to stapled closure. The difference between skin glue and suture closure was not statistically significant (P = 0.12). Patterns of failure differed between the groups. Skin glue failed because of disruption of the skin-glue interface. 2-Octyl cyanoacrylate glue provides a wound closure that is similar to closure with an interrupted subcuticular absorbable suture. This study validates the clinical use of skin glue for closure of surgical incisions. The technique should be used with caution in areas of the body that are subject to tension.
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            Fibrin glue terminates massive bleeding after complex hepatic injury.

            We determined the ability of a packaged fibrin glue (FG) product to terminate severe bleeding in a new porcine model of complex hepatic injury.
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              PEDIATRIC LIVER TRANSPLANTATION WITH EX-SITU LIVER TRANSECTION AND THE APPLICATION OF THE HUMAN FIBRINOGEN AND THROMBIN SPONGE IN THE WOUND AREA

              ABSTRACT Background: Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Aim: Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Methods: Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). Results: The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). Conclusion: There was a lower number of reoperations due to bleeding of the wound area of ​​the hepatic graft when the human fibrinogen and thrombin sponge were used.
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                Author and article information

                Journal
                Arq Bras Cir Dig
                Arq Bras Cir Dig
                abcd
                Arquivos Brasileiros de Cirurgia Digestiva : ABCD
                Colégio Brasileiro de Cirurgia Digestiva
                0102-6720
                2317-6326
                01 March 2018
                2018
                : 31
                : 1
                : e1342
                Affiliations
                [1 ]State University of Maringá, Maringá, PR, Brazil
                Author notes
                Correspondence: Carlos Edmundo Rodrigues Fontes E-mail: cerfontes@ 123456uem.br ; fontesc540@ 123456gmail.com

                Conflict of interest: none

                Article
                00303
                10.1590/0102-672020180001e1342
                5863994
                29513803
                2c025790-e424-4982-b669-8f9a68725436

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 05 December 2017
                : 08 February 2018
                Page count
                Figures: 12, Tables: 0, Equations: 0, References: 15, Pages: 1
                Categories
                Original Article

                hemostasis,wounds,injuries,liver.,ferimentos,lesões,fígado,hemostáticos.

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