The simplest and longest established method of haemostatic control in the field of endocrine surgery is the use of absorbable sutures and ties. Some surgeons advocate their use in the neck to the exclusion of all other haemostatic methods, although this view has become outmoded by newer technologies now available to the surgeon.
Suturing can be a valuable adjunct for haemostasis of the thyroid remnant after subtotal resection of the thyroid, for fixing the capsule of the gland to the pretracheal fascia. Similarly, absorbable sutures can be used for controlling troublesome bleeding from damaged anterior jugular veins. Absorbable sutures are recommended rather than silk, as adverse reactions have been reported with the latter.4
Another method of securing small vessels is with the Ligaclip (Ethicon Endo-surgery, Cincinatti, Ohio, USA), a titanium metal clip that is inexpensive, inert, and compatible with magnetic resonance imaging. These clips should be used in the correct size for the vessel being ligated, but in experimental studies can secure vessels to well above physiological levels of blood pressure.5-7 The potential for dislodgement has led the authors to use double rather than single clip applications.
Surgicel (Johnson & Johnson, Somerville, New Jersey, USA) is a resorbable oxidised cellulose material that can be placed into the thyroid wound before closure. It comes prepared as a sterile fabric meshwork that becomes fully absorbed with blood, swelling to a brown gelatinous mass that aids in clotting. Its mechanism of action is, however, unclear and may be physical rather than altering the clotting pathway.8
Surgicel has been found to be bactericidal in vitro because of its acidic pH and is also effective against antibiotic-resistant microorganisms.9 It has been suggested to cause adhesions under experimental conditions, which may make its use in the neck problematic, especially when second operations are possible.10,11 Its use does not, however, lead to increased risk of infection.12,13
ActCel (Coreva Health Sciences, California, USA) is a relatively new haemostatic agent made from a similar meshwork cellulose fabric as Surgicel. It is also indicated for haemostasis from open wounds and body cavities. In contact with blood, it expands to four times its original size, converting to a gel. It is completely dissoluted in 1 to 2 weeks and because its end products are water and glucose, wound healing is not affected.
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