Gelatin thrombin granules for hemostasis in a severe traumatic liver and spleen rupture model in swine.
BACKGROUND
Treatment of traumatic liver and spleen rupture is a major challenge for the surgeon. Because of their excellent blood supply and tissue structure, rupture of the liver and spleen is often associated with massive abdominal hemorrhage. Frequently the surgeon's only feasible option is partial or total resection of the organ. The purpose of this study was to test the hemostatic efficacy of gelatin thrombin granules (FloSeal) in a standardized severe traumatic liver and spleen rupture model in swine (representing a grade IV-V rupture) during severe hemorrhagic shock and coagulation disorder.


METHODS
Standardized combined penetrating liver and spleen rupture was inflicted in 10 anesthetized swine. Hemorrhagic shock was induced after heparinization. Gelatin thrombin granules were used to treat both the ruptured liver and the ruptured spleen. Blood loss, hemostasis, and 48 hours survival rate were quantified. Cardiorespiratory parameters, activated clotting time, and plasma fibrinogen level were monitored. After 1 hour and 48 hours a second look evaluation was performed to detect any postoperative hemorrhage. Ruptures were then examined macroscopically and histologically.


RESULTS
Hemostasis was achieved with FloSeal in all swine. The mean amount of FloSeal used was 14 mL +/- 2.5 mL. Macroscopic and histologic findings after 48 hours showed excellent clot integration into the surrounding tissue without any adverse effects.


CONCLUSIONS
Gelatin thrombin granules (FloSeal) are effective in treating severe penetrating rupture of the liver and spleen even during hemorrhagic shock, retransfusion conditions, and coagulation disorder.
Leixnering
Martin
M
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and Research, Center for Traumatology of the Austrian Workers Compensation Board (AUVA), Vienna, Austria.
Reichetseder
Jürgen
J
Schultz
Arthur
A
Figl
Markus
M
Wassermann
Esther
E
Thurnher
Martin
M
Redl
Heinz
H
D000818:Animals; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy; D004195:Disease Models, Animal; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006490:Hemostatics; D008099:Liver / Q000293:injuries*; D008107:Liver Diseases / Q000150:complications / Q000628:therapy; D008297:Male; D012421:Rupture / Q000150:complications / Q000628:therapy; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy*; D013161:Splenic Rupture / Q000150:complications / Q000628:therapy*; D034421:Sus scrofa; D013917:Thrombin / Q000627:therapeutic use
C411004:FloSeal Matrix; D006454:Hemoglobins; D006490:Hemostatics; D013917:Thrombin