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Clinical/pre-clinical research

Management of postoperative bleeding in surgically debrided wounds: topical hemostat versus electrocautery

02 September 2020
Practice
02 September 2020
Volume 4 · Issue 4

Abstract

Objective:

To compare the effectiveness of a temporary topical external hemostat (OMNI-STAT Granules, Omni-stat Medical Inc., US) versus the use of electrocautery for bleeding control in patients who have undergone surgical wound debridement. Time saved in the operating room (OR) was evaluated.

Method:

A prospective evaluation of use of a topical hemostat in an OR setting was compared with retrospective data collected using electrocautery to understand the time-saving benefits of using a topical hemostat versus electrocautery.

Results:

A total of 52 patients were treated with the topical hemostat, and 89 patients with electrocautery. The topical hemostat was shown to be as effective in achieving hemostasis post-surgical debridement as electrocautery, with the added benefits of significant time savings in the OR (reducing the mean total OR time by 19.1%). Additionally, preprocedure and surgical procedure times in patients treated with the topical hemostat were significantly reduced. The results showed that wounds treated with the topical hemostat demonstrated a more advanced stage of healing, which may be a result of the lack of tissue damage demonstrated with the topical hemostat compared with electrocautery.

Conclusion:

This study found that the temporary topical hemostat was equally as effective as cauterisation in achieving hemostasis. In addition, significant saving in OR time was demonstrated relative to electrocautery. The improved OR times may translate into increased cost-effectiveness, relative to electrocautery, by increasing the number of surgical cases per day and/or using resources more effectively to treat more patients. It may also enable bleeding control in the outpatient clinic or at the bedside, freeing up costly OR time and enabling more effective management of healthcare resources.

In the normal wound healing process, healing is aided by the removal of dead (necrotic) and damaged tissue through the process of autolytic debridement.1 However, in hard-to-heal wounds, this necrotic tissue may build up on the wound bed, acting as a physical barrier to wound progression, and prevent granulation tissue formation if it is not removed.2 Necrotic tissue also provides a nidus for bacterial growth, leading to biofilm formation and possible infection.3 Whether by natural means (autolysis) or by clinical intervention (for example, surgical), removal of necrotic tissue is a prerequisite for healing,3,4 thus removing a major physical obstacle to healing5 and ‘normalising’ the wound environment by providing a healthier wound bed to support wound repair.6,7

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chitosan-based hemostat
electrocautery
Omni-stat granules
operating room time
procedure time
topical hemostat