Hemostatic Efficacy of Absorbable Gelatin Sponges for Surgical Nail Matrixectomy after Phenolization-A Blinded Randomized Controlled Trial.

Background: Some studies have recommended combining germinal matrix excision with phenol ablation in the treatment of onychocryptosis. Matrixectomy after phenolization has been shown to be an effective modification to reduce the drawbacks associated with phenolization alone, although it increases the risk of minor postoperative bleeding. The present study aims to assess the effectiveness and safety of gelatin sponges as hemostatic agents in partial matrixectomy after phenolization. Methods: A comparative clinical trial in parallel groups was designed in 74 halluces (44 patients) with stage I, II, and III onychocryptosis. All participants were randomly assigned to 3 groups: Group A (control group), Group B (conventional gelatin sponge), and Group C (high porosity gelatin sponge). Results: The quantified mean blood loss in the first 48 h after surgery in patients in both experimental groups was significantly lower compared to the control group. The lowest mean blood loss was recorded in Group C (p < 0.001) and followed by Group B (p = 0.005). No adverse effects were recorded in any of the patients included in the experimental groups. Conclusions: Hemostatic gelatin sponges were demonstrated to be effective and safe devices for the control of minor postoperative bleeding associated with matrixectomy after segmental phenolization.

The role of hemostatic devices in neurosurgery. A systematic review.

Hemostasis represents a fundamental step in every surgical procedure. During neurosurgical procedures, proper and robust hemostasis into confined spaces can significantly reduce the odds of perioperative complications. Over the decades, multiple methods have been applied, and several medical devices have been developed to promote and guarantee proper hemostasis. This study presents a systematic review of the most used intraoperative hemostatic methods and devices in neurosurgery. Insightful research was performed on the PubMed database according to the PRISMA guidelines. This comprehensive review of scientific literature represents a synoptic panel where the most used intraoperative hemostatic methods and devices available today in neurosurgery are classified and described.

In vitro mitomycin C absorption and delivery with different sponge materials used in filtering surgery.

PURPOSE: The purpose of this study is to evaluate and compare mitomycin C (MMC) absorption and delivery in different materials used in filtering surgery. METHODS: This is an in vitro study comparing polyvinyl alcohol triangular sponges (TS6, TS8), polyvinyl alcohol fluid wicks (EFW), and absorbable gelatin sponges (AGS3, AGS5), from which five different types of transport units were obtained. Seven pieces of sponge of each transport unit type were obtained as follows: two transverse strips were obtained at 6 and 8 mm from the apex of TS and divided into three equal pieces; 4×4 mm pieces of EFW; 3×3 and 5×5 mm pieces of absorbable gelatin sponges were cut. Filter paper was placed on a precision scale (0.01 mg). The seven sponge pieces of each type were weighed three times consecutively in dry and wet states, the latter after immersion for 15 seconds in 0.2 mg/mL MMC. The difference between the weights of the dry and wet filter paper at the end of each measurement sequence was also calculated and considered as an estimate of the amount of mitomycin delivered. RESULTS: The amounts of MMC absorbed by each transport unit were as follows: (mean ± standard deviation) 27.43±5.13 for TS6, 31.91±6.63 for TS8, 15.96±2.23 for EFW, 17.96±2.05 for AGS3, and 33.81±2.05 for AGS5. The amounts of MMC delivered to the filter paper were as follows: 21.70±2.84 for TS6, 23.83±4.03 for TS8, 12.93±1.75 for EFW, 14.69±1.79 for AGS3, and 27.30±1.58 for AGS5. CONCLUSION: Percentage MMC delivered was similar for all materials, but there was a tendency for greater delivery using larger sponges and greater homogeneity in delivery with AGS5. No statistical differences were found in percentage delivered by the different transport materials.

Dental pulp stem cells from traumatically exposed pulps exhibited an enhanced osteogenic potential and weakened odontogenic capacity.

OBJECTIVES: Traumatic pulp exposure can bring about some permanent damages to tooth tissues including dental pulps. This study was designed to evaluate the effects of traumatic pulp exposure on the osteo/odontogenic capacity of dental pulp stem cells (DPSCs). METHODS: Rat incisors were artificially fractured and dental pulps were exposed to the oral environment for 48 h. Then, multi-colony-derived DPSCs from the injured pulps (iDPSCs) were isolated. Their osteo/odontogenic differentiation and the involvement of NF-κB pathway were subsequently investigated. RESULTS: iDPSCs presented a lower proliferative capacity than normal DPSCs (nDPSCs), as indicated by MTT and FCM assay. ALP levels in iDPSCs were significantly higher (P<0.01) than those in nDPSCs. Alizarin red staining revealed that iDPSCs exhibited an increased capacity of calcium deposition. Moreover, iDPSCs expressed stronger osteogenic markers (Runx2/RUNX2 and Ocn/OCN) and less odontogenic gene/protein (Dspp/DSP) than nDPSCs in vitro. In vivo transplantation showed that nDPSCs implants generated the typical dentine-pulp complex while all iDPSCs pellets formed the osteodentin-like tissues which were immunopositive for OCN. Mechanistically, iDPSCs expressed the higher levels of cytoplasmic phosphorylated IκBα/P65 and nuclear P65 than nDPSCs, indicating an active cellular NF-κB pathway in iDPSCs. After the inhibition of NF-κB pathway, the osteogenic potential in iDPSCs was significantly down-regulated while odontogenic differentiation was up-regulated, as indicated by the decreased Alp/Runx2/Ocn and uprised Dspp expression. CONCLUSIONS: Pulp exposure for 48 h decreased the odontogenic capacity and enhanced the osteogenic potential of DPSCs via the NF-κB signalling pathway.

Preliminary Study on Effectiveness of Dexamethasone-Soaked Gelatin Sponges for Reducing Pain after Lumbar Microdiscectomy: A Randomized Controlled Trial

OBJECTIVE: A prospective, randomized, controlled clinical study is performed to verify the effectiveness of epidural dexamethasone-soaked gelatin sponges to reduce postoperative pain following lumbar microdiscectomy. METHODS: Twenty-three patients (10 men and 13 women) undergoing lumbar microdiscectomy were included. Five pieces of gelatin sponge measuring 1 x 1 cm (Gelfoam; Pharmacia & Upjohn, Kalamazoo, MI, USA), soaked with either 5mg dexamethasone or an equal amount (2 mL) of saline, were left on the decompressed nerve root after unilateral hemilaminectomy, flavectomy and discectomy. RESULTS: Subjective visual analog scale(VAS) scores of leg pain in the dexamethasone group on the first, third and fifth postoperative days (2.5, 2.5, 1.7, respectively) were significantly lower than in the control group (5.0, 4.8, 3.6) ( P<0.05). No side effects related to the dexamethasone-soaked gelatin sponges were observed. CONCLUSION: The intraoperative application of dexamethasone-soaked gelatin sponges during lumbar microdiscectomy can provide effective postoperative analgesia without complications.