Damage control management of experimental grade 5 renal injuries

further evaluation of FloSeal gelatin matrix.

Nathan F. Pursifull, Michael S. Morris, Richard A. Harris, Allen F. Morey

Research output: Contribution to journalArticle

Abstract

BACKGROUND: We developed a porcine grade 5 renal laceration damage control model to evaluate the hemostatic efficacy of FloSeal gelatin matrix (Baxter Healthcare, Corp., Deerfield, Ill). METHODS: Ten commercial swine underwent celiotomy, contralateral nephrectomy, and cooling to 32 degrees C after a well-established hypothermia protocol to simulate a damage control scenario. Following prospective randomization, a complex grade 5 renal injury was uniformly produced on the remaining kidney. Control animals (group 1, n = 5) were treated with direct manual compression with a gelatin sponge. Experimental animals (group 2, n = 5) were treated by application of FloSeal gelatin matrix followed by direct compression with a gelatin sponge. Operative blood loss and efficacy of hemostasis were compared. Creatinine levels were obtained daily until postoperative day 7. Abdominal computed tomography was performed at 10 days. RESULTS: Use of FloSeal gelatin matrix hemostatic sealant resulted in significantly less mean blood loss than gelatin sponge bolster compression alone (202.4 mL vs. 540.4 mL, respectively, p = 0.016). Hemostasis was complete in 60% (three out of five) of experimental animals after 2 minutes, but was incomplete in all control animals. After an initial increase, serum creatinine approached baseline by postoperative day 7 in all animals. Axial imaging 10 days postoperatively revealed no evidence of significant delayed perirenal hemorrhage. CONCLUSIONS: FloSeal gelatin matrix performed well as a rapidly deployable, effective hemostatic agent in a hypothermic grade 5 renal injury damage control model. The absence of delayed bleeding and nephrotoxicity suggests a possible increased role for FloSeal in the treatment of devastating renal injuries in damage control surgery.

Original languageEnglish (US)
Pages (from-to)346-350
Number of pages5
JournalThe Journal of trauma.
Volume60
Issue number2
StatePublished - Feb 2006

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Gelatin
Kidney
Wounds and Injuries
Porifera
Hemostatics
Hemostasis
Creatinine
Swine
Hemorrhage
Lacerations
Random Allocation
FloSeal Matrix
Hypothermia
Nephrectomy
Tomography
Delivery of Health Care
Control Groups
Serum

ASJC Scopus subject areas

  • Surgery

Cite this

Damage control management of experimental grade 5 renal injuries : further evaluation of FloSeal gelatin matrix. / Pursifull, Nathan F.; Morris, Michael S.; Harris, Richard A.; Morey, Allen F.

In: The Journal of trauma., Vol. 60, No. 2, 02.2006, p. 346-350.

Research output: Contribution to journalArticle

Pursifull, Nathan F. ; Morris, Michael S. ; Harris, Richard A. ; Morey, Allen F. / Damage control management of experimental grade 5 renal injuries : further evaluation of FloSeal gelatin matrix. In: The Journal of trauma. 2006 ; Vol. 60, No. 2. pp. 346-350.
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abstract = "BACKGROUND: We developed a porcine grade 5 renal laceration damage control model to evaluate the hemostatic efficacy of FloSeal gelatin matrix (Baxter Healthcare, Corp., Deerfield, Ill). METHODS: Ten commercial swine underwent celiotomy, contralateral nephrectomy, and cooling to 32 degrees C after a well-established hypothermia protocol to simulate a damage control scenario. Following prospective randomization, a complex grade 5 renal injury was uniformly produced on the remaining kidney. Control animals (group 1, n = 5) were treated with direct manual compression with a gelatin sponge. Experimental animals (group 2, n = 5) were treated by application of FloSeal gelatin matrix followed by direct compression with a gelatin sponge. Operative blood loss and efficacy of hemostasis were compared. Creatinine levels were obtained daily until postoperative day 7. Abdominal computed tomography was performed at 10 days. RESULTS: Use of FloSeal gelatin matrix hemostatic sealant resulted in significantly less mean blood loss than gelatin sponge bolster compression alone (202.4 mL vs. 540.4 mL, respectively, p = 0.016). Hemostasis was complete in 60{\%} (three out of five) of experimental animals after 2 minutes, but was incomplete in all control animals. After an initial increase, serum creatinine approached baseline by postoperative day 7 in all animals. Axial imaging 10 days postoperatively revealed no evidence of significant delayed perirenal hemorrhage. CONCLUSIONS: FloSeal gelatin matrix performed well as a rapidly deployable, effective hemostatic agent in a hypothermic grade 5 renal injury damage control model. The absence of delayed bleeding and nephrotoxicity suggests a possible increased role for FloSeal in the treatment of devastating renal injuries in damage control surgery.",
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