Gelatin Sponge with Thrombin

A recent addition to the absorbable haemostatic agents is the gelatin sponge or foam. This is prepared from ordinary commercial gelatin, which is made up in a solution to which a hardening agent is added. After bubbles of air are removed, the mixture is allowed to dry in cans. It can then be cut into any required size or shape. The material has been used for experimental purposes and has been provided in sealed glass jars previously subjected to sterilisation with dry heat. The sponge will take up many times its weight of water when it is submerged and the air bubbles expressed. It does not fragment easily, although it is not especially tough. Gelatin is a protein, which is non-antigenic, a factor to be acknowledged. Jenkins et a. in 1945, carried out an experiment on a series of 12 dogs to test the behaviour of gelatin in their tissues. Incisions were made 2 cm long and 1cm deep in the liver, the kidneys, and the spleen. The brisk haemorrhage resulting from the incisions was controlled by packing the moistened gelatin sponge into the incision and holding it in place for about two minutes with ordinary, moistened gauze. When the gauze was removed, the gelatin sponge was usually found adherent to the incision and the bleeding stopped. Sometimes, there was oozing from the ends of the incision, which was averted by placing another piece of gelatin sponge over the length of the incision. Gelatin sponge was also implanted in the omentum and in the rectus muscle near the abdominal incision. The animals were sacrificed at periods varying from two to 56 days after the implantation. Two of the animals died at two and three days, respectively. At autopsy the sponge was usually identified easily in the short-term implants as a red soggy mass. In the omentum there was an area of induration, in the centre of which the sponge could be found if the omentum was cut across at the point. After a week or ten days it was often difficult to identify the sponge in the abdominal wall, and in the omentum one could find only a slightly indurated area in which the sponge could be found. After two weeks it was difficult to identify the sponge grossly in the omentum. The sponge was usually identified easily in the early specimen of liver, kidneys, and spleen. Varying amounts of fibrinous adhesions were present about the implants in the liver, although they were not common in the kidney or the spleen. Microscopic sections were made of all the implants that could be identified either grossly or as a residual fibrous adhesion. The gelatine sponge appeared as a meshwork of homogenous haematoxylin-staining material. Where the sponge had been used for haemostasis, as in the liver, the kidney, and the spleen the interstices of the sponge were seen filled up with red blood cells. In some sections, there was evidence of invasion of the peripheral portion of the sponge by polymorphonuclear leukocytes and, in these cases too, there was evidence of absorption of the gelatin sponge. There were also some lymphocytes and plasma cells in the periphery. After a week, the predominant cells invading the gelatin sponge were macrophages. There was little tendency for the formation of foreign body giant cells. Fibroblast response was usually observed within a week, producing a definite encapsulation of the sponge. Subsequently, this encapsulation became fibrous. Sinclair and Douglas41 in 1944 found that the local implantation of gelatin into wounds led to accelerated fibroplasia and increased strength. The gelatin sponge was used in 15 clinical cases in various ways to determine its behaviour in human tissues. It has been used in the incisions in the liver to obtain specimens for liver biopsy, on the undersurface of the liver after cholecystectomy, on thyroid beds after thyroidectomy, on dermatome donor areas, in laparotomy wounds, and on the surface of granulating wounds. According to the authors, however, the observations were too limited to draw conclusions other than that bleeding was controlled and there were no complications that might be attributed to the gelatin sponge. Jampolis et al.42 and Jenkins et al.43 in 1947, conducted a series of 15 experiments on dogs and found it possible to control haemorrhage from relatively large wounds of the right or left vertical with a "Patch" of gelatin sponge, without any supplementary suture or the use of thrombin in the sponge.

Gelatin matrix thrombin tissue was used as an effective haemostatic agent by Bak et al..44 during laparoscopic partial nephrectomy in the period 2002 to 2003. The two-component sealant comprised of a thrombin component and gelatin matrix granula. It was applied after tumour resection and before reperfusion of kidney. Haemostasis was immediate after application ofthe agent for one to two minutes, to the moist resection zone. There were no cases of postoperative bleeding.

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