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Control of the External Hemorrhage (A) by Aluminum Chloride (50%) (B) and Suturing Technique (C)
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Despite all the progress in surgical science, bleeding caused by traffic accidents is still one of the challenges surgeons face in saving patients' lives. Therefore, introducing an effective method to control external bleeding is an important research priority.
This study aimed to compare the hemostatic effect of aluminum chloride versus simple sut...
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Context 1
... with blood proteins, and this property makes alu- minum chloride a very efficient hemostatic agent. Then, it may be an effective hemostatic agent that adequately satisfies surgeons’ need to control bleeding even in pa- tients with abnormal body hemostatic system. Although the hemostatic effect of aluminum chloride has already been found, its effect in controlling external bleeding has not assessed and compared with suturing technique as a standard method. This study aimed to compare the hemostatic effect of aluminum chloride versus simple suturing technique in controlling external hemorrhage. This experimental study took place at Kashan University of Medical Sciences from August 2013 to December 2013. In this study, 60 male Wistar rats (weighting 180 - 230 g) were randomly allocated into 6 groups (simple random- ization) of 10 rats each. According to the pilot study, mean hemostatic time of the six groups were 43.3, 30.6, 19.6, 15.3, 9.1, 84.3 seconds, respectively and total variance was 16.9. Considering α = 0.05 and 1-β = 0.8, sample size was estimated at 10 in each group. One week before study, ani- mals were kept at 21 ± 1°C with a 12-hour light/dark cycle (lights on from 8:00 AM to 8:00 PM). They had free access to standard rat chaw and water ad libitum. Rats were anesthetized by intraperitoneal (ip) injection of a ketamine/xylazine mixture (ketamine 100 mg/kg and xylazine 10 mg/kg). The 10% ketamine and 2% xylazine (Alfasan, Holland) were purchased from local supplier (Shahid-Beheshti Hospital Pharmacy, Kashan, Iran). An incision of two cm in length and half a cm in depth was made on each rat’s shaved back skin by scalpels NO. 10. Aluminum chloride was purchased from Merck, (Darm- stadt, Germany). Aqueous solution of aluminum chlo- ride was prepared in five concentrations of 50%, 25%, 15%, 10% and 5% (w/v) in distilled water, each concentration to be used in one group of rats. Half a milliliter volume of solution was applied to the incision site by an insulin syringe. The times of hemostasis were measured using a chronometer. The hemostasis time was considered as the time required for complete drying of bleeding and no blood discharge from the incision site (Figure 1). The mean of the measured times in the ten rats in each group was considered as the hemostatic time for each alumi- num chloride concentration. Simple suturing using ny- lon 3-0 was used as the standard method of hemostasis in the control group. All simple sutures were performed by one surgeon. After controlling external bleeding, each rat was treated intraperitoneally with 50 mg keflin (1 g cefalotin/10 mL, Aspen Pharmacare Australia Pty Ltd, Aus- tralia). Seven days after the treatment, all rats were anesthe- tized using IP injections of a mixture of ketamine and xylazine (ketamine 100 mg/kg and xylazine 10 mg/kg). Then, the rats were placed in a prone posture on the op- erating table and the previous sites of treatment were resected. The resected tissues were immediately fixed in formalin and were sent for the pathology report. Based on the defined pathological grading (6-8), the pathology results were classified into 6 groups including: Zero: no change, 1: minor inflammatory infiltration without ede- ma, 2: mild to moderate inflammatory infiltration with mild edema, 3: mild to moderate inflammatory infiltra- tion and moderate edema, 4: moderate inflammation with neutrophils scattered and diffuse edema, 5: severe inflammation of the tissue and edematous changes, fi- brosis and hemorrhage. Animal handling and all experiments were performed in accordance with the international guidelines set out in the Guide for the Care and Use of Laboratory Animals (Institute of Laboratory Animal Resources, 1996) and ap- proved by the local research council at Kashan University of Medical Sciences, Kashan, Iran. (grant number:9378, ethical code:1912) Data analysis was performed using SPSS software ver- sion 16 (SPSS, Inc., Chicago, IL, USA). Kolmogorov-Smirnov test was used to determine if the data are normally dis- tributed and this was not the case. To compare the mean hemostatic time in the aluminum chloride groups, the Kruskal-Wallis test was used. Moreover, the Mann-Whit- ney U test was used to compare the mean hemostasis times in the aluminum chloride groups and that of the control group (suturing technique). The mean hemostatic time in the groups aluminum chloride concentrations of 50% (Group 5), 25% (Group 4), 15% (Group 3), 10% (Group 2) and 5% (Group 1) were 8.20 ± 0.919, 14.10 ± 1.37, 21.20 ± 1.31, 30.80 ± 1.68 and 42.00 ± 4.19 seconds, respectively. Also, the mean hemostatic time in the control group (Group 6) was 84.00 ± 4.05 seconds (mean ± standard deviation). A significant difference was observed between the hemostatic time in different concentrations of aluminum chloride (Group 1 and 2, P value = 0.003), (Group 2 and 3, P value = 0.001), (Group 3 and 4, P value = 0.004), (Group 4 and 5, P value = 0.005). Moreover, a significant difference was observed between the hemostatic time in the groups with different concen- trations of aluminum chloride and the control group, so that the hemostatic time in all the experimental groups were significantly less than that of the control group (P value = 0.002) (Table 1). The pathology examination showed that all the wounds were in grade 1 on the third day after the experiment ex- cept the wounds in the groups in which 25% and 50% con- centrations of aluminum chloride were utilized (Table 2). No wound was in grades 0, 3, 4 and 5. Acidic property of aluminum chloride can be seen in Figure 1. This acidic property after reaction with blood proteins creates a bar- rier by coagulated proteins, and prevents the outflow ...
Context 2
... with blood proteins, and this property makes alu- minum chloride a very efficient hemostatic agent. Then, it may be an effective hemostatic agent that adequately satisfies surgeons’ need to control bleeding even in pa- tients with abnormal body hemostatic system. Although the hemostatic effect of aluminum chloride has already been found, its effect in controlling external bleeding has not assessed and compared with suturing technique as a standard method. This study aimed to compare the hemostatic effect of aluminum chloride versus simple suturing technique in controlling external hemorrhage. This experimental study took place at Kashan University of Medical Sciences from August 2013 to December 2013. In this study, 60 male Wistar rats (weighting 180 - 230 g) were randomly allocated into 6 groups (simple random- ization) of 10 rats each. According to the pilot study, mean hemostatic time of the six groups were 43.3, 30.6, 19.6, 15.3, 9.1, 84.3 seconds, respectively and total variance was 16.9. Considering α = 0.05 and 1-β = 0.8, sample size was estimated at 10 in each group. One week before study, ani- mals were kept at 21 ± 1°C with a 12-hour light/dark cycle (lights on from 8:00 AM to 8:00 PM). They had free access to standard rat chaw and water ad libitum. Rats were anesthetized by intraperitoneal (ip) injection of a ketamine/xylazine mixture (ketamine 100 mg/kg and xylazine 10 mg/kg). The 10% ketamine and 2% xylazine (Alfasan, Holland) were purchased from local supplier (Shahid-Beheshti Hospital Pharmacy, Kashan, Iran). An incision of two cm in length and half a cm in depth was made on each rat’s shaved back skin by scalpels NO. 10. Aluminum chloride was purchased from Merck, (Darm- stadt, Germany). Aqueous solution of aluminum chlo- ride was prepared in five concentrations of 50%, 25%, 15%, 10% and 5% (w/v) in distilled water, each concentration to be used in one group of rats. Half a milliliter volume of solution was applied to the incision site by an insulin syringe. The times of hemostasis were measured using a chronometer. The hemostasis time was considered as the time required for complete drying of bleeding and no blood discharge from the incision site (Figure 1). The mean of the measured times in the ten rats in each group was considered as the hemostatic time for each alumi- num chloride concentration. Simple suturing using ny- lon 3-0 was used as the standard method of hemostasis in the control group. All simple sutures were performed by one surgeon. After controlling external bleeding, each rat was treated intraperitoneally with 50 mg keflin (1 g cefalotin/10 mL, Aspen Pharmacare Australia Pty Ltd, Aus- tralia). Seven days after the treatment, all rats were anesthe- tized using IP injections of a mixture of ketamine and xylazine (ketamine 100 mg/kg and xylazine 10 mg/kg). Then, the rats were placed in a prone posture on the op- erating table and the previous sites of treatment were resected. The resected tissues were immediately fixed in formalin and were sent for the pathology report. Based on the defined pathological grading (6-8), the pathology results were classified into 6 groups including: Zero: no change, 1: minor inflammatory infiltration without ede- ma, 2: mild to moderate inflammatory infiltration with mild edema, 3: mild to moderate inflammatory infiltra- tion and moderate edema, 4: moderate inflammation with neutrophils scattered and diffuse edema, 5: severe inflammation of the tissue and edematous changes, fi- brosis and hemorrhage. Animal handling and all experiments were performed in accordance with the international guidelines set out in the Guide for the Care and Use of Laboratory Animals (Institute of Laboratory Animal Resources, 1996) and ap- proved by the local research council at Kashan University of Medical Sciences, Kashan, Iran. (grant number:9378, ethical code:1912) Data analysis was performed using SPSS software ver- sion 16 (SPSS, Inc., Chicago, IL, USA). Kolmogorov-Smirnov test was used to determine if the data are normally dis- tributed and this was not the case. To compare the mean hemostatic time in the aluminum chloride groups, the Kruskal-Wallis test was used. Moreover, the Mann-Whit- ney U test was used to compare the mean hemostasis times in the aluminum chloride groups and that of the control group (suturing technique). The mean hemostatic time in the groups aluminum chloride concentrations of 50% (Group 5), 25% (Group 4), 15% (Group 3), 10% (Group 2) and 5% (Group 1) were 8.20 ± 0.919, 14.10 ± 1.37, 21.20 ± 1.31, 30.80 ± 1.68 and 42.00 ± 4.19 seconds, respectively. Also, the mean hemostatic time in the control group (Group 6) was 84.00 ± 4.05 seconds (mean ± standard deviation). A significant difference was observed between the hemostatic time in different concentrations of aluminum chloride (Group 1 and 2, P value = 0.003), (Group 2 and 3, P value = 0.001), (Group 3 and 4, P value = 0.004), (Group 4 and 5, P value = 0.005). Moreover, a significant difference was observed between the hemostatic time in the groups with different concen- trations of aluminum chloride and the control group, so that the hemostatic time in all the experimental groups were significantly less than that of the control group (P value = 0.002) (Table 1). The pathology examination showed that all the wounds were in grade 1 on the third day after the experiment ex- cept the wounds in the groups in which 25% and 50% con- centrations of aluminum chloride were utilized (Table 2). No wound was in grades 0, 3, 4 and 5. Acidic property of aluminum chloride can be seen in Figure 1. This acidic property after reaction with blood proteins creates a bar- rier by coagulated proteins, and prevents the outflow ...
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Citations
... epinephrine) and alpha-adrenergic (0.05% tetra hydrazine HCl, 0.05% oxymetazoline HCl, 0.025% phenyl epinephrine HCl). Astringents include chlorides of aluminium (10, 20, 25% AlCl₃) and iron (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and sulphates of aluminium [20-25% Al₂(SO₄)₃] and iron (15.5, 20, and 12.7 Fe(SO)₄). All the currently known astringents cause some local temporary tissue damage, and vasoconstrictors elicit negative systemic effects. ...
... These characteristics make it a suitable hemostatic agent due to the blood's high protein content. 60 Aluminum chloride acts by creating a barrier formed by the coagulated blood proteins that prevent blood flow from the arteries, thus preventing its possible systemic side effects. This mechanism may provide sufficient hemostasis, even in patients with bleeding disorders. ...
Objective:
Adequate hemostasis is a critical step in endodontic surgery. It facilitates the procedure and affects the success and prognosis of the operation. This systematic review and network meta-analysis (NMA) aimed to systematically assess the efficacy of hemostatic agents in endodontic surgery and to identify the most effective ones.
Methods:
PubMed, Scopus, Embase, Cochrane Library, Web of Science, ProQuest, and EBSCO host databases were searched up to December 2020. We included randomized controlled trials (RCTs) evaluating the efficacy of different hemostatic measures in endodontic surgery, and their risk of bias was assessed using Cochrane’s randomized trial tool (RoB 2.0). Frequentist network meta-analysis was conducted, with Odds Ratios and 95% confidence intervals (OR, 95% CI) as effect estimates using the "netmeta" package in R. The quality of evidence was assessed using the CINeMA approach.
Results:
Six RCTs involving 353 patients (mean age 48.12 y) were included. NMA revealed that aluminum chloride achieved higher hemostatic efficacy than epinephrine (OR = 2.55, 95% CI [1.41, 4.64]), while there was non-significant difference when compared with PTFE strips + epinephrine (OR = 1.00, 95% CI [0.35, 2.90]), electrocauterization
(OR = 2.67, 95% CI [0.84, 8.46]), or ferric sulfate (OR = 8.65, 95% CI [0.31, 240.92]). Of all hemostatic agents, aluminum chloride ranked
first in control bleeding during endodontic surgery (P-score = 0.84), followed by PTFE strips + epinephrine (P-score = 0.80), electrocauterization (P-score = 0.34), epinephrine (P-score = 0.34), ferric sulfate (P-score = 0.18). The quality of evidence was very low.
Conclusions:
Based on the limited data, aluminum chloride provides better hemostasis than epinephrine, while there was no significant difference between the remaining hemostatic agents used in endodontic surgery, which could help clinicians choose the hemostatic agent that achieves adequate hemostasis. Given insufficient evidence, future RCTs addressing this evidence
gap are required.
... 5 Aluminum chloride hexahydrate solution at varying concentrations demonstrated a significant reduction in hemostasis time compared to the control group. 7 However, there is limited research directly comparing the time to hemostasis among these three chemical cautery solutions. ...
... The chemical cautery solutions investigated in this study have all been validated as an effective means of achieving hemostasis. [5][6][7][8][9] However, there are risks and benefits to each of these cautery solutions that should assist in clinical decisions. ...
BACKGROUND: Acrochordon (skin tag) removal by snip excision is a routine dermatologic procedure. Bleeding is a common sequelae of snip excision that requires hemostatic control. Chemical cautery is a common means of achieving hemostasis in this procedure. OBJECTIVE: The aim of this study was to evaluate three different chemical cautery solutions for their time to hemostasis, pain upon application, and associated pigmentary changes. METHODS: Twelve patients with six or more skin tags on the bilateral neck and/or axilla were enrolled. Two skin tags were cauterized with ferric subsulfate solution, two with silver nitrate, and two with aluminum chloride hexahydrate solution. Time to hemostasis and pain with application of each cautery solution to the skin tag was recorded. At a two-week follow-up appointment, patient satisfaction was assessed with a survey, and pigmentary changes were documented with digital photography. RESULTS: There was no significant variability in the time to hemostasis among the three chemical cautery solutions (p=0.57). Pain response was significantly different among the three solutions (p=0.003). Compared to silver nitrate (median=6.00, interquartile range [IQR]: 4.50-6.50), aluminum chloride hexahydrate (median=1.00, IQR: 0.50 to 6.00; Sidak p=0.02) and ferric subsulfate (median=1.50, IQR: 0.00-3.50; Sidak p=0.01) had a significantly lower pain response. Among participants, three (25%) experienced a pigmentary change with ferric subsulfate, two (17%) with aluminum chloride, and six (50%) with silver nitrate (overall p= 0.14). CONCLUSION: These results indicate that the three standard chemical cautery solutions for skin tag snip excision have significant differences in pain upon application and pigmentary changes. This might be a relevant consideration when selecting a chemical cautery solution.
... It is formulated as AlCl 3 and has acidic character. It can be formulated in concentrations of 20-40% in water, alcohol, ether or glycerol as a protein coagulant (13). The 25% buffered aluminum chloride solution is marketed under the brand name Frenna AC Solution (Dharma Research, Inc., US). ...
... Since there is a significant amount of protein in the blood, its protein coagulant property makes this agent a potent hemostatic agent (13). When blood is exposed to AlCl 3 a chemical reaction occurs between blood proteins and hydrochloric acid (HCl) that is believed to be formed by hydrolysis of AlCl 3 (13,14). ...
... Since there is a significant amount of protein in the blood, its protein coagulant property makes this agent a potent hemostatic agent (13). When blood is exposed to AlCl 3 a chemical reaction occurs between blood proteins and hydrochloric acid (HCl) that is believed to be formed by hydrolysis of AlCl 3 (13,14). This causes coagulation of the tissues, vasoconstriction, thrombus and occlusion of small blood vessels, tissue damage and thus activation of the extrinsic coagulation pathway, protein precipitation and coagulation (14,15). ...
Purpose:
Hemostatic agents are used to control hemorrhage and the gingival crevicular fluid for dental applications. In this study; the antimutagenic and antioxidant activities of aluminum chloride (AlCl3), a topical hemostatic agent used especially in the fields of dermatology and dentistry, were determined. To our knowledge, this is the first study that investigates these properties.
Materials and methods:
The antioxidant activity was determined by DPPH free radical scavenging and β-carotene-linoleic acid bleaching assays. The antimutagenic activity was evaluated with the Ames Salmonella/ microsome mutagenicity test using Salmonella typhimurium TA98 and TA100 strains.
Results:
The total antioxidant activity of AlCl3, determined by β-carotene bleaching assay was found to be 25.59 ± 2.55% and the DPPH scavenging activity of AlCl3 was determined as 17.49 ± 3.07%. AlCl3 showed not any mutagenicity at the tested concentrations by the AMES test used S. typhimurium TA98 and TA100. This drug demonstrated antimutagenic effects at the test concentrations and the strongest antimutagenic activity was observed on 1.25 mg·mL-1/plate concentration of AlCl3.
Conclusion:
AlCl3 showed potent antimutagenic and antioxidant activities and these properties are significant for dentistry and dermatology.
... The mechanism of action of AlCl 3 to stop bleeding is astringent by precipitation of proteins. The acidic property of aluminum chloride causes a reaction with blood proteins, which in turn creates a barrier by coagulated proteins and thereby prevents the outflow of blood from vessels [29]. ...
The purpose of this study was to investigate whether hemostatic agents (HA) show an effect on the retention strength (RS) of zirconia crowns luted to dentin abutments after cleaning with an air/water spray. Human molars (N = 60/n = 12) were prepared and zirconia crowns were milled. Prior to luting (Scotchbond Universal/RelyX Ultimate), molars were pretreated using HA: i. 25% AlCl₃ (VSC), ii. 20% Fe₂(SO₄)₃ (VS), iii. 15.5% Fe₂(SO₄)₃ (AS), iv. 12.7% iron ion solution (ASX) and v. no pretreatment (control). Mastication simulation and pull-out tests were performed. Failure types were defined: cohesive 1-tooth root; cohesive 2-tooth crown; adhesive 1-cement on tooth; adhesive 2-cement on tooth and crown; mixed-adhesive/cohesive. Data were analyzed using 1-way ANOVA, post-hoc Scheffé, Pearson's chi-square-test and Ciba⁻Geigy table (p = 0.05). No RS differences between the tested groups were observed (p = 0.200). ASX fractured more cohesive 2 than the control group. VSC showed more cohesive 2 than adhesive 1 fractures. VS showed more adhesive 2 than mixed fractures. AS showed more cohesive 2 than adhesive 1 and more adhesive 2 than mixed fractures. ASX showed predominantly cohesive 2 fractures. RS was not affected when HA were cleaned off by 30 s of air/water spray prior to luting. HA still seem to weaken the dentin abutment, making it prone to cohesive fractures.
... at the same time prevents aluminum chloride from entering the blocked vessels and thereby does not allow any systemic effects to happen. 46 Others describe that aluminum chloride acts by precipitating proteins and inhibiting transcapillary movement of plasma proteins. 13 Ultradent Products USA in turn describes the mechanism of their 25% AlCl 3 gel ViscoStat Clear in the following manner: tissues surrounding capillaries swell and thereby squeeze the capillaries causing the bleeding and sulcular fluid seepage to stop. ...
The purpose of this topic review is to give a general overview of gingival retraction agents used during prosthodontic treatment, and the possible difficulties connected to them that may be faced by the dentist. Hemostatic agents are important for successful gingival retraction and in achieving hemostasis. However, these agents may show numerous negative effects on the prosthodontic treatment and oral tissues of which the practicing dentist must be aware, and which will be elucidated in this review. PubMed and Google Scholar databases were searched for publications up to and including 2017. The following key words were used in different combinations: "hemostatic agent," "astringent," "astringency," "epinephrine," "ferric sulfate," "aluminum chloride," "hemorrhage control," "soft tissue," "hard dental tissue," "self-etch adhesive," "total-etch adhesive," "bond strength," "impression," "gypsum," "plaster cast," and "dental cast." In the last three decades the hemostatic agents used by practicing dentists have changed from epinephrine towards astringents, with AlCl3 and Fe2(SO4)3 now the most popular. All of the currently known hemostatic agents cause some local, temporary gingival tissue damage, but only epinephrine is known to elicit negative systemic effects. Studies concerning the influence of hemostatic agents on impression materials show highly contradictory results regarding the possible polymerization-inhibiting properties of hemostatic agents, probably due to the lack of standardization of methodology. Hemostatic agents seem to alter the dentinal surface properties making it more resistant to acid etching. Therefore the relatively low acidity of self-etch adhesives when compared to total-etch systems may not be strong enough to sufficiently etch a more resistant dentinal surface, and consequently may result in lower adhesive bond strengths.
... A cellular necrosis independent of cholinergic receptors dysfunction resulting from incubation with aluminum-flavonoid mixture has been described [17]. This process was accompanied by nAdHcytochrome c reductase, cytochrome c oxidase of mitochondrial respiratory chain; decrease in transmembrane mitochondrial potential and in ATP concentration, as well as increase in ADP to ATP ratio. ...
Combined effect of aluminum chloride and quercetin solutions on the enzymatic activity and contraction dynamics of muscle fiber bundles of the Rana temporaria m. tibialis anterior was investigated. It was shown that these complexes inhibit muscle contraction. Linear reduction of Ca2+,Mg2+-ATPase activity induced by all of the used concentrations of AlCl3 – quercetin was demonstrated. It was found that complex of quercetin with AlCl3 has a greater inhibitory effect on muscle contraction dynamic and causes greater reduction during all periods of stimulation in comparison to the separate effect of the investigated compounds. All the studied concentrations of AlCl3 and quercetin solutions (AlCl3: 10-4-10-2 M; quercetin: 10-6-10-5 M) caused concentration depended contraction strengths and lengths reduction. The decrease in strength and length of muscle contractions was of constant and mostly linear nature within observed timeframe as well as within each periods of contraction. The changes were least pronounced within pretetanic period, but were profound within terminal period of muscle activity. The changes in dynamic contraction properties and Ca2+,Mg2+- ATPase activity of sarcoplasmic reticulum under effect of the investigated compounds was minimal in the beginning of the muscle’s response to stimulus, prior to muscle strength reaching stable contraction level. © 2015, Natsional’na Akademiya Nauk Ukrainy. All rights reserved.
... The recombinant factor VII is newly proposed to be used as a procoagulant agent to control liver bleeding. Several studies have investigated the efficacy and safety of recombinant factor VII in controlling liver bleeding (60,62,63,69,70). Although no important side effect is documented in using of the recombinant factor VII (65,66,71), none of the studies showed a significant difference in blood loss or needing to blood products between patients who received recombinant factor VII and the patients who did not receive it. ...
Context: Despite advancements in the science of surgery, minimizing bleeding from parenchymal tissue of the liver continues to be one of the challenges surgeons are facing to protect patients’ lives. However, the number of surgeries needing incisions in the liver tissue, e.g. metastatectomy, is constantly increasing.
Evidence Acquisition: A MEDLINE and conventional search of the past 50 years of the medical literature was performed to identify relevant articles on hemostasis in the liver parenchymal tissue.
Results: The studies that have been published on hemostasis in the liver parenchymal tissue can be classified into 3 categories: 1. surgical procedures; 2. methods affecting body hemodynamic; 3. pharmacological methods. The purpose of these studies are to identify the best therapeutic approaches that not only minimize the bleeding, but also save the maximum amount of the liver tissue and minimize the use of partial liver resections.
Conclusions: The excessive blood loss and the long time needed to control the bleeding during liver surgery impose several side effects and complications on patients. Topical hemostatic agents such as ferric chloride, potassium aluminum sulfate (alum) and aluminum chloride are safely applicable in patients. These agents might be used along with other current methods to minimize the blood loss and the need for blood products during liver surgeries.
Nurse practitioners (NPs) are frequently called on to assess and diagnose patients presenting with suspicious or aggravated skin lesions. Performing shave biopsies and removing small neoplasms can be within the scope of a general NP. We offer a thorough review of shave biopsy methods, including required materials, photographic documentation, blade preparation and orientation, and hemostasis techniques. Diagnostic considerations when choosing a shave versus other biopsy techniques are reviewed as is the removal of lesions in cosmetically sensitive areas. Finally, a unique tip to diminish intraprocedure bleeding using aluminum chloride before procedure initiation is presented.
Uncontrolled hemorrhages during accidents or surgery require non-compressible dressings to halt bleeding and avoid damage to soft tissue and organs. Here, we report the synthesis of a sodium tripolyphosphate crosslinked chitosan-based hemostatic hydrogel dressing incorporating hemostasis agonists like aluminum chloride, an aggregation enhancer and silica nanoparticles, a contact activator, as confirmed by FTIR analyses. Rheology studies displayed G” > G’ values confirming typical soft gel-like behavior that was maintained upto shear rate 10/s. Further, composite had excellent water absorption capacity (737 ± 50 %) and showed 6-fold enhanced in vitro hemostasis as compared to bare hydrogel. Platelet aggregation was enhanced with composite as compared to SFLLRN peptide (a thrombin mimic) and adenosine diphosphate (calcium release activator) while it was absent with heparin (thrombin inhibitor). Enhanced activation and release of calcium were observed by composite with a specific fluorescent calcium dye in A549 cell model. The composite was biocompatible and in vivo evaluation of hemostatic efficiency in rat liver injury revealed enhanced blood clotting (16 ± 2.1 s) of hydrogel composite as compared to commercial HemoStat Clear gel (55 ± 5 s). Thus, developed soft hydrogel composite has potential for application as a safe, easy-to-apply, rapid, non-compressible hemostatic agent.
