The effect of FloSeal on mucosal healing after endoscopic sinus surgery: a comparison with thrombin-soaked gelatin foam.
BACKGROUND
The optimal form of nasal packing after endoscopic sinus surgery (ESS) still has not been established Although wide variations exist among sinus surgeons, the goals are adequate hemostasis, rapid healing, and patient comfort. Preliminary studies indicated that FloSeal (FS), a novel absorbable hemostatic paste used as a nasal pack, was associated with minimal postoperative discomfort and effective hemostasis. This study was designed to evaluate the effects of this agent on mucosal healing in ESS.


METHODS
Twenty consecutive patients underwent bilateral ESS. For each patient, one ethmoid cavity was randomized to receive FS and the other received thrombin-soaked gelatin foam. The extent of granulation tissue and adhesion formation was evaluated at 6-8 weeks after surgery.


RESULTS
No significant differences were observed between the FS and the thrombin-soaked gelatin foam groups with respect to the preoperative Lund-Mackay score, extent of surgery performed, or need for additional nasal packing. However, the FS group showed clear trends toward increased granulation tissue (p = 0.007) and adhesion (p = 0.006) formation.


CONCLUSIONS
Absorbable hemostatic agents are associated with a high degree of patient comfort and provide hemostasis comparable with traditional techniques. Different materials may induce differential patterns of mucosal healing, potentially affecting the ultimate result of ESS.
Chandra
Rakesh K
RK
Department of Otolaryngology, Head and Neck Surgery, Northwestern University School of Medicine, Chicago, Illinois, USA.
Conley
David B
DB
Kern
Robert C
RC
D004724:Endoscopy; D004844:Epistaxis / Q000601:surgery; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006489:Hemostatic Techniques; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007430:Intraoperative Care; D008443:Maxillary Sinus / Q000601:surgery*; D009297:Nasal Mucosa / Q000187:drug effects* / Q000601:surgery*; D011446:Prospective Studies; D011897:Random Allocation; D012720:Severity of Illness Index; D013917:Thrombin / Q000627:therapeutic use; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*
C411004:FloSeal Matrix; D006490:Hemostatics; D013917:Thrombin