title: Neurosurgical patties: adhesion and damage mitigation.
abstract: OBJECTIVE
  Neurosurgical patties are textile pads used during most neurosurgical operations to protect tissues, manage the fluid environment, control hemostasis, and aid tissue manipulation. Recent research has suggested that, contrary to their aim, patties adhere to brain tissue and cause damage during removal. This study aimed to characterize and quantify the degree of and consequences resulting from adhesion between neurosurgical patties and brain tissue.
  
  
  METHODS
  Using a customized peel apparatus, the authors performed 90° peel tests on 5 patty products: Policot, Telfa, Americot, Delicot, and Ray-Cot (n = 247) from American Surgical Company. They tested 4 conditions: wet patty on glass (control), wet patty on wet brain peeled at 5 mm/sec (wet), dry patty on wet brain peeled at 5 mm/sec (dry), and wet patty on wet brain peeled at 20 mm/sec (speed). The interaction between patty and tissue was analyzed using peel-force traces and pre-peel histological analysis.
  
  
  RESULTS
  Adhesion strength differed between patty products (p < 0.001) and conditions (p < 0.001). Adhesion strength was greatest for Delicot patties under wet (2.22 mN/mm) and dry (9.88 mN/mm) conditions. For all patties, damage at the patty-tissue interface was proportional to the degree of fiber contact. When patties were irrigated, mechanical adhesion was reduced by up to 550% compared with dry usage.
  
  
  CONCLUSIONS
  For all patty products, mechanical (destructive) and liquid-mediated (nondestructive) adhesion caused damage to neural tissue. The greatest adhesion occurred with Delicot patties. To mitigate patty adhesion and neural tissue damage, surgeons should consider regular irrigation to be essential during neurosurgical procedures.
authors.affiliation: School of Mechanical Engineering, University of Leeds; and.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Stratton-Powell
authors.affiliation: Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom.
authors.forename: Ian A
authors.initials: IA
authors.lastname: Anderson
authors.affiliation: Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom.
authors.forename: Jake
authors.initials: J
authors.lastname: Timothy
authors.affiliation: School of Mechanical Engineering, University of Leeds; and.
authors.forename: Nikil
authors.initials: N
authors.lastname: Kapur
authors.affiliation: School of Mechanical Engineering, University of Leeds; and.
authors.forename: Peter
authors.initials: P
authors.lastname: Culmer
mesh_terms: D000818:Animals; D001930:Brain Injuries / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D008422:Materials Testing; D023421:Models, Animal; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D015503:Surgical Sponges / Q000009:adverse effects*; D013552:Swine; D013784:Textiles; D000267:Tissue Adhesions / Q000209:etiology* / Q000517:prevention & control
keywords: PBS = phosphate-buffered saline; adhesion; iatrogenic damage; irrigation; neurosurgical patty