Surgery


to 39% faster than the standard version of the product11


– examples of cotton wool haemostats


include Fibrillar by Johnson & Johnson and Okcel F by Synthesia. Due to its fibrous makeup, the cotton wool form of oxidised cellulose can be easily adapted to the shape and amount required to stop unwanted bleeding, which has led to cardiovascular surgeons becoming big advocates of the products. 11


The cotton wool


version of oxidised cellulose also has multiple applications in the field of Neurosurgery. The product is “effective in controlling venous oozing during approaches to the skull base where safe, precise and rapid hemostasis is critical”, for example.12


The gelatin sponge haemostat Gelatin sponge haemostats are a type of gelatin foam that is made from animal skin, typically porcine,13


whipped and baked into a sponge


form; although made from animals, gelatin sponge is largely considered non-antigenic.15 Fundamentally, the gelatin sponge haemostat has undergone very little evolution since their introduction in 1945 when Gelfoam from Pfizer was introduced; some other commonly used products today are Spongostan by Johnson & Johnson and Cutanplast by Mascia Brunelli. Gelatin sponge haemostats are typically used as a dry sponge, can be moistened with injectable sodium chloride solution or commonly saturated with topical purified thrombin.15


A property of


gelatin sponge that makes it a great haemostat is its ability to absorb up to 50 times its own weight16


and expand up to 200% in vivo, creating


a mechanical filling in the wound site.15 Gelatin sponge comes in a range of formats with some suppliers having 10 different sizes and formats. The most typical gelatin sponge shape is a cuboid that varies in length and depth, with formats such as Standard (70x50x10mm), Special (70x50x1mm) and Film (200x70x0.5mm). Standard Gelatin sponge is recommended for a range of surgeries including during oozing bleeding from lesions in the liver from parenchymal surgery, deep bleeding in the mediastinum


as a complication to mediastinoscopy during thoracic surgery and haemorrhage following injury to the aorta and pulmonary arteries for cardiac surgery.16


Gelatin sponge in the Special format can be used when there is limited space but an area requires haemostasis, such as a laminectomy during spinal surgery.16


which is the superior product? Oxidised cellulose achieves haemostasis a lot quicker than gelatin sponge, with haemostasis being possible in 90 seconds6


in 5-10 minutes.17 The Film format of gelatin


sponge can be used when haemostasis is required, as well as providing a protective effect, such as on dural defects during neurosurgery, or leakage in a sutured vessel during vascular surgery.16 Due to the mouldable nature of the product, gelatin sponge is also available in a cube form, with uses in dental surgery from the dental cube format and also in dialysis from the dial cube format to stop bleeding of the fistula.16


Another


variant of gelatin sponge is a tube-style format used for a range of anal and rectal surgeries such as open hemorrhoidectomies.16


Which is superior oxidised cellulose or gelatin sponge? Although different, both gelatin sponge haemostats and oxidised cellulose haemostats have the same objective, haemostasis, but


, whereas gelatin sponge is achieved Oxidised cellulose’s better


performance can also be seen in the time to achieve resorbability, for the product to be removed from the body, taking 14 days8 gelatin sponge takes 3-4 weeks16


whereas . It could also


be suggested that oxidised cellulose may be a more effective product over larger areas too, with pieces up to 14x20cm being available8 for procedures that require large areas of haemostasis such as during major surgery, such as a hepatectomy.18 These advantages raise the question, is there


a requirement for gelatin sponge haemostats, when oxidised cellulose haemostats exist? The simple answer is yes, gelatin sponge has some advantages over oxidised cellulose. For instance, the format in which the product can be manufactured provides an advantage for healthcare professionals, such as tube style which makes it ideal for anal and rectal surgery16 Another benefit can be found in dental surgery where a study discovered the majority of patients preferred the gelatin sponge material against oxidised cellulose after it was used to pack the sockets after upper third molar removals.19 Another key benefit of gelatin sponge haemostats is they can be soaked with antibiotics16


, whereas oxidised cellulose should Figure 2 38 www.clinicalservicesjournal.com I December 2024


not be impregnated with anti-infective agents.20 One of the main advantages of a gelatin sponge over oxidised cellulose, however, is the price. A comparable piece of oxidised cellulose costs over 6 times the amount of a gelatin sponge unit, which could demonstrate a significant saving as long as it doesn’t cause any potential challenges or harm to the patient. With both


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