Mussel-inspired modified regenerated cellulose as tissue adhesive and antibacterial gauze: A promising approach for rapid hemostasis in non-compressible hemorrhage.

Uncontrollable hemorrhage leads to high mortality rates; thus, engineering effective hemostatic materials is crucial for rapid hemostasis. Developing hemostatic materials for rapid coagulation, antibacterial activity, and easy removal without compromising clot integrity remains a challenge. Herein, a multifunctional hemostatic gauze was engineered by modifying regenerated cellulose textile through multiple sequential chemical reactions, including carboxymethylation, crosslinking with CaCl/ZnCl solution, oxidation, and polymerization with dopamine. Provided gauze demonstrated remarkable wet-tissue adhesion (890 kPa) that physically sealing the area to prevent blood loss. The engineered gauze exhibits excellent antibacterial activity (against S. aureus and E. coli) and enhanced hemostatic ability (clotting time (20S), attachment of red blood cells (∼93 %) and platelets (∼80 %)). The complete hemostasis and stable clot formation without secondary bleeding were achieved by synthesized gauze in 20s, 50s, and 100s for the rat and rabbit liver, and rat femoral artery injury models, respectively. That was significantly faster hemostasis (4-14-fold reduction in time) and lower blood loss (3-fold reduction) compared to the commercial hemostatic textiles (p < 0.001). Biochemical, hematological, and pathological examinations revealed no evidence of systemic and local inflammation or toxic effects in the rat organs. The engineered hemostatic gauze exhibits outstanding characteristics of a hemostatic material for clinical applications.