Kang Bum Sik, Na Young Cheon, Jin Young Wan
Department of Plastic and Reconstructive Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea.
Arch Plast Surg. 2012 Jul;39(4):317-21. doi: 10.5999/aps.2012.39.4.317. Epub 2012 Jul 13.
Many topical hemostatics are widely applied for bleeding control. They can be classified into two categories according to their mechanism of action on the clotting cascade in a biologically active or passive manner. Passive hemostatics include cellulose and gelatin. We performed an experimental study to compare the effect of passive hemostatics in wound healing by applying them to a rectus abdominis muscle defect of white mice.
Surgicel is a sterile absorbable knitted fabric prepared by the controlled oxidation of regenerated cellulose. Spongostan is an absorbable hemostatic gelatin sponge. In 30 mice, a 1×1 cm defect was created on the rectus abdominis muscle and the materials were applied in three ways: control group, cellulose (Surgicel) group, gelatin (Spongostan) group. For the histologic analysis, biopsies were performed at 3 and 28 days.
After 3 days, the cellulose group showed limited granulation formation with acute inflammatory reactions similar to the control group. At the 28th day, moderate amounts of granulation tissue formation was observed with milder inflammatory reactions than the control group. In the gelatin group, after 3 days, gelatin remnants were observed surrounded by severe inflammatory changes. After 28 days, the same quantity of gelatin remnants could be still observed.
This study suggests that cellulose is associated with minimal morbidity in wound healing, while the use of gelatin shows severe adverse tissue reactions with delayed wound healing. Consequently, cellulose is better than gelatin when considering wound healing.
许多局部止血剂被广泛用于控制出血。根据其对凝血级联反应的作用机制,它们可分为生物活性或被动方式两类。被动止血剂包括纤维素和明胶。我们进行了一项实验研究,通过将被动止血剂应用于小白鼠的腹直肌缺损来比较其在伤口愈合中的效果。
速即纱是一种通过对再生纤维素进行受控氧化制备的无菌可吸收针织织物。海绵明胶是一种可吸收的止血明胶海绵。在30只小鼠中,在腹直肌上制造一个1×1厘米的缺损,并以三种方式应用材料:对照组、纤维素(速即纱)组、明胶(海绵明胶)组。为了进行组织学分析,在第3天和第28天进行活检。
3天后,纤维素组显示出有限的肉芽形成,伴有与对照组相似的急性炎症反应。在第28天,观察到中等量的肉芽组织形成,炎症反应比对照组轻。在明胶组中,3天后观察到明胶残余物被严重的炎症变化包围。28天后,仍可观察到相同数量的明胶残余物。
本研究表明,纤维素在伤口愈合中引起的发病率最低,而明胶的使用显示出严重的不良组织反应,伤口愈合延迟。因此,在考虑伤口愈合时,纤维素优于明胶。