Heliyon (Nov 2024)
Comparison of gauze packing, sponge-based, and hemostatic surgicel wound stasis dressings to treat hemorrhages from grade IV liver injuries: An experimental study
Abstract
Background: Uncontrolled bleeding is still the major factor leading to preventable deaths following trauma. This study sought to assess the effectiveness of mini sponge-based wound stasis, cellulose-based local hemostatic, and traditional gauze dressings for the control of hemorrhages resulting from grade 4 liver injuries in rats. Methods: Thirty Sprague-Dawley rats were divided into three equal groups. In the first group, a liver laceration was treated with gauze packing. The second group received XStat minisponge dressing (MDS), and the third group was administered a combination of MDS dressing and Surgicel hemostatic agent. After gaining access to the intra-abdominal cavity, a liver laceration measuring 10 mm in length, 5 mm in depth, and extending to the middle lobe was created. The dressings were removed after 2 and 10 min to assess the amount of bleeding, and any bleeding was documented again after 48 h. Intraperitoneal adhesions were evaluated during euthanasia. Results: At 2 min post-injury, the gauze packing group had an average bleeding volume of 0.97 ± 0.15 mL, compared to 1.08 ± 0.25 mL in the MDS group (P = 0.26) and 1.02 ± 0.18 mL in the MDS + Surgicel group (P = 0.69). At 10 min, the bleeding volumes were 0.13 ± 0.05 mL, 0.22 ± 0.01 mL (P = 0.09), and 0.14 ± 0.05 mL (P = 0.19), respectively. At 48 h, significant differences were observed in bleeding volumes (gauze: 0.55 ± 0.18 mL, MDS: 1.15 ± 0.21 mL, MDS + Surgicel: 0.82 ± 0.06 mL, P < 0.001). Mortality rates after 14 days were 0 % in the gauze packing group, 60 % in the MDS group (P = 0.001), and 60 % in the MDS + Surgicel group (P = 0.001). The gauze packing group displayed no adhesions, while the other groups exhibited adhesions in the liver, bowel, omentum, and abdominal wall. Conclusion: Our results indicate that, when it comes to managing bleeding in severe liver injuries, traditional gauze packing remains the tried-and-true method, showing superior effectiveness in terms of blood loss and mortality when compared to XStat minisponge dressings and the fibrillar Surgicel hemostatic agents.
