Abstract
Object
The aim of this study was to investigate prospectively the efficacy and safety of Floseal hemostatic matrix.
Methods
A total of 214 patients (87 males, 127 females; mean age 56.2 years) undergoing cranial (71.4%), craniospinal (0.9%), and spinal (27.5%) procedures with the use of gelatin thrombin hemostatic matrix (Floseal) were included in this prospective study. The indications for its use, surgical techniques, time to bleeding control, and associated complications were recorded.
Results
Effective hemostasis, defined as cessation of bleeding, was achieved no later than 3 min after topical agent application in all patients except in 11 cases, in which the hemostatic application was repeated. Rebleeding was disclosed in four patients 1 day after initial surgery. In one case, an intracerebral abscess developed after a malignant glioma removal. No other patient developed allergic reactions or local or systemic complications associated with the hemostatic sealant.
Conclusion
In this study, matrix hemostatic sealant helped to control operative bleeding in cranial and spinal surgery, reducing damage to the surrounding healthy nervous tissue while shortening surgical timing. Other than safe, the immediate hemostatic effect is an advantage in the settings of refractory bleeding.
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Comment
This is an interesting paper summarizing the large surgical experience of the authors on the use of Floseal as a hemostatic agent in various cranial and spinal neurosurgical procedures. The conclusions are clear and convincingly discussed. This report is timely due because of the inherent importance of the topic and the relatively scant relevant literature. The cost of Floseal is an issue that the authors barely address, particularly relevant outside of the Western world in less developed countries. In this study, the decision to use the hemostatic matrix was made by the surgeon according to his/her preference and the intraoperative situation. Were the surgeons convinced that hemostasis could not be reached by traditional methods before applying the matrix? On the other hand, a percentage of about 6% of cranial and spinal procedures during which Floseal was applied seems to be reasonably adequate. I agree with the authors that Floseal represents a safe and efficacious method for controlling difficult intraoperative situations, but it must not be intended as the primary option for achieving hemostasis.
Domenico d'Avella
Padova, Italy
This article addresses an important issue. It investigates safety and efficacy in the use of Floseal, a hemostatic agent with widespread use despite the fact that it reached the market not too long ago. The authors have found an indication for its use in roughly 5% of all cases operated in the timeframe of the study. Indications and recommendations for the use of Floseal along with pearls to minimize any possible deleterious effects of the product are discussed. Widespread capillary or bone oozing is apparently the best indication for its use. Standard hemostasis procedures must always precede the use of any of these agents. Therefore, the argument of bipolar coagulation being time-consuming and therefore tedious is missing the point. Conformity to the cavity created especially in brain surgery is clearly an advantage. As a personal note, I have never found that regular hemostasis with bipolar, irrigation, and a little Gellfoam could not do the job for hemostasis in one or two level anterior cervical discectomies and fusion. For the younger generation and those starting their practices, the word should remain that nothing is more efficacious than regular hemostasis and that these adjuncts are of great value if not unduly used.
Manuel Cunha e Sa
Almada, Portugal
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Gazzeri, R., Galarza, M., Neroni, M. et al. Hemostatic matrix sealant in neurosurgery: a clinical and imaging study. Acta Neurochir 153, 148–155 (2011). https://doi.org/10.1007/s00701-010-0762-y
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DOI: https://doi.org/10.1007/s00701-010-0762-y