Comparison of conventional methods with commercially available topical hemostat surgical snow (oxidized cellulose) for achieving hemostasis in canine model of partial splenectomy.

Spleen is highly vascularized organ and bleeding control during partial splenectomy is a big challenge. In this study conventional methods of electrocautery, absorbable suturing and advance methods of topical hemostat Surgicel® were compared to control bleeding during partial splenec- tomy. Twelve healthy dogs (n=4) were divided in A, B and C groups. After partial splenectomy Surgicel®, electrocautery and absorbable horizontal mattress sutures were used to control hemor- rhages in group A, B and C respectively. Bleeding time and loss of blood volume was evaluated during surgery. In addition, blood samples were taken on day 0 pre-surgery and on days 3, 10 and 17 post-surgery to evaluate changes in biochemical parameters after the application of dif- ferent hemostatic techniques. Ultrasonography was also performed at alternative days to check any gross changes in the spleen. Dogs in group A showed minimum bleeding time and loss of blood volume as compared to group B and C. Drop in red blood cells count was compared be- tween group A, B and C showing significant change (p≤0.05) at day 3, 10 and 17, while a sig- nificant decline in hemoglobin was found in group C followed by groups B and A at 3rd and 10th day. There was no difference between platelet counts in various groups. Ultrasonography showed no significant changes in the spleen parenchyma. It was concluded that Surgicel® was an effective material for controlling hemorrhage in veterinary patients.

Effectiveness of barrier agents for preventing postoperative bowel obstruction after laparoscopic surgery: a retrospective cohort study.

PURPOSE: The effectiveness of using anti-adhesion agents in laparoscopic surgery is controversial. We compared the outcomes of patients exposed to anti-adhesion agents (barrier group) with those of patients not exposed (no barrier group) in laparoscopic surgery. METHODS: Using a nationwide claim-based database in Japan, we analyzed data from patients who underwent laparoscopic surgery between 2005 and 2019 and compared the patient characteristics and the proportion of those with bowel obstruction between the barrier and no barrier groups. We also performed several sensitivity and subgroup analyses. RESULTS: Of the 57,499 patients who met the inclusion criteria, 14,360 and 43,139 were assigned to the barrier and no barrier groups, respectively. The proportion of patients with a bowel obstruction in the two groups did not differ among all patients hospitalized for obstruction (1.1 vs. 1.1%, p = 0.63) and those requiring surgery (0.2 vs. 0.2%, p = 0.39). In the sensitivity analysis with propensity score matching, the incidences of bowel obstruction between the barrier and non-barrier groups were equivocal (1.3 vs. 1.6%), but statistically marginal (chi-square test, p = 0.035; log-rank test, p = 0.09). CONCLUSION: The use of barrier agents for adhesive prevention did not show clear effectiveness for the prevention of bowel obstruction after laparoscopic surgery for unselected cases. Further studies focusing on more specific procedures are needed.

Adhesion barriers in laparoscopic myomectomy: Evidence from randomized clinical trials.

OBJECTIVE: To evaluate the effectiveness of different adhesion barriers in the prevention of de novo adhesion development after laparoscopic myomectomy. METHODS: A systematic review was performed by searching seven electronic databases for all randomized clinical trials (RCTs) comparing the use of any absorbable adhesion barrier (i.e. intervention group) with either no treatment or placebo (i.e. control group) in the prevention of adhesion development after laparoscopic myomectomy. RESULTS: Eight RCTs with a total of 748 participants (392 in the intervention group and 356 in the control group) were included. The assessed adhesion barrier methods were: oxidized regenerated cellulose (ORC) in two studies, auto-crosslinked hyaluronic acid (HA) gel in two studies, 4% icodextrin solution in one study, modified HA and carboxy-methylcellulose in one study, polyethylene glycol ester trilysine amine solution plus a borate buffer solution in one study, and polyethylene glycol amine plus dextran aldehyde polymers in another study. CONCLUSION: Adhesion barrier methods showing the most promising results were: ORC, auto-crosslinked HA gel, and polyethylene glycol amine plus dextran aldehyde polymers.

Acellular dermal matrix combined with oxidized regenerated cellulose for partial breast reconstruction: Two case reports.

RATIONALE: Filling materials for partial defect of the breast have rarely been developed because of safety and durability. PATIENT CONCERNS: Two female patients (ages, 53 and 50 years) with breast cancer underwent partial mastectomy with sentinel lymph node biopsy. DIAGNOSIS: Core needle biopsy revealed an invasive ductal carcinoma in both patients. Breast ultrasound showed hypoechoic nodules with irregular margins. Breast magnetic resonance imaging showed an irregularly shaped enhancing mass with duct extension in Patient 1 and irregularly shaped multifocal, enhancing masses with non-mass enhancement in Patient 2. INTERVENTION: A combination method using acellular dermal matrix and oxidized regenerated cellulose was used for partial breast reconstruction. The safety and cosmetic outcomes were evaluated for both patients. OUTCOMES: There were no significant complications, and the breast shape and volume were well maintained, even 2 years after surgery. There was no postoperative tumor recurrence. CONCLUSION: The combination of acellular dermal matrix and oxidized regenerated cellulose for partial breast reconstruction can be a good option based on oncological safety and cosmetic outcome.

Regenerated oxidised cellulose versus calcium alginate in controlling bleeding from malignant breast cancer wounds: randomised control trial study protocol.

OBJECTIVE: Malignant wounds due to breast cancer can present with recurrent episodes of bleeding in the tumour tissue. This study will compare the efficacy of a calcium alginate dressing (Biatain, Coloplast A/S, Denmark) and a regenerated oxidised cellulose dressing (Surgicel, Ethicon, LLC, Puerto Rico). PROTOCOL: A total of 24 patients with breast cancer and bleeding, malignant wounds will be enrolled in the randomised, controlled, open study, conducted at a hospital specialising in breast cancer treatment and at another hospital specialising in palliative care. Patients over 18 years old, with bleeding and willing to undergo venipuncture for blood collection will be included. All enrolled patients will be randomised for allocation to an experimental group (regenerated oxidised cellulose dressing) or a control group (calcium alginate dressing). The main intervention will consist of the application of the haemostatic product, assessment of digital pressure and estimation of the time required for haemostasis. OUTCOMES: Key outcome measures will be the percentage of patients with haemostasis within 20 minutes, observation of haemostasis after three, five and 10 minutes, in addition to recurrence of bleeding and the quantity of product used. DISCUSSION: To our knowledge, this is the first study to evaluate the effectiveness of haemostatic products in malignant wounds. This type of wound is poorly explored in the literature and, among its signs and symptoms, bleeding is poorly studied. The completion of this study will provide a more robust rationale for clinical decision-making related to the control of bleeding in malignant breast cancer wounds in the context of evidence-based nursing practices.

Cellulose absorbable barrier for prevention of de-novo adhesion formation at the time of laparoscopic myomectomy: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Myomectomy is the standard surgical treatment for symptomatic uterine leiomyomas, especially for patients wishing to preserve their fertility. However, this procedure is associated with adhesion formation. Several strategies have been proposed to reduce them. Cellulose absorbable barrier is widely used. We aimed to assess its effectiveness in the prevention of de-novo adhesion formation after laparoscopic myomectomy. STUDY DESIGN: A systematic review and meta-analysis was performed by searching electronic databases (i.e. MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) from their inception until May 2019. We included all randomized clinical trials (RCT) comparing use of cellulose absorbable barrier (i.e. intervention group) with either placebo or no treatment (i.e. control group) in the prevention of de-novo adhesion formation at the time of laparoscopic myomectomy. Primary and secondary outcomes were defined before data extraction. The primary outcome was the incidence of adhesions at second-look laparoscopy. The secondary outcome was the operative time. RESULTS: Three RCT, including 366 participants, were included. All trials evaluated women undergoing laparoscopic myomectomy who were randomized to intervention (either oxidized regenerated cellulose or carboxymethylcellulose powder adhesion barrier) or no treatment (control group). Women who received treatment had significantly lower incidence of adhesions at the second look laparoscopy (RR 0.63, 95 % CI 0.40-0.99). Interventions with use of cellulose absorbable barrier were 4 min longer (MD 4 min, 95 % CI 2.82-5.18). CONCLUSION: Use of cellulose absorbable barrier at the time of laparoscopic myomectomy reduces the risk of postoperative adhesions.

A Prospective, Single-Blind, Randomized, Phase III Study to Evaluate the Safety and Efficacy of Fibrin Sealant Grifols as an Adjunct to Hemostasis During Soft Tissue Open Surgery.

BACKGROUND/PURPOSE: Rapid hemostasis, an essential prerequisite of good surgical practice during surgical bleeding, including soft tissue open surgery, often requires adjunctive treatment. We evaluated the safety and hemostatic effectiveness of a human plasma-derived fibrin sealant (FS Grifols) in soft tissue open surgery. METHODS: Patients with moderate soft tissue bleeding during open, urologic, gynecologic or general surgery were studied. The trial consisted of a preliminary phase (to familiarize investigators with the technique for FS Grifols application and the intraoperative procedures required by the clinical protocol) and a primary phase: in both phases, patients were randomized 1:1 to FS Grifols or Surgicel®. The primary efficacy endpoint, based on analysis of subjects in the primary phase of the study, was to evaluate whether FS Grifols was non-inferior to Surgicel® in achieving hemostasis, based on the proportion of subjects in both treatment groups who achieved hemostasis at the target bleeding site (TBS) by 4 min (T4) following the start of treatment application. Safety assessments included adverse events (AEs), vital signs, physical assessments, common clinical laboratory tests, viral markers, and immunogenicity. RESULTS: A total of 224 subjects were randomized (primary phase): FS Grifols (N = 116), Surgicel® (N = 108). The 95% CI at T4 for the ratio of the proportion of patients achieving hemostasis in the two treatment groups was 1.064 (0.934, 1.213), indicating non-inferiority for FS Grifols vs. Surgicel®. The rate of hemostasis at the TBS by T4 in both phases of the study was higher in the FS Grifols treatment group (preliminary phase: 90.2%; primary phase: 82.8%) than in the Surgicel® treatment group (preliminary phase: 78.8%; primary phase: 77.8%). Overall, reported AEs were as expected in surgical patients and were similar between the two treatment groups. CONCLUSIONS: This study shows the non-inferiority in time to hemostasis of FS Grifols vs. Surgicel as an adjunct to hemostasis in patients undergoing soft tissue open surgery, and a similar rate of AEs.

Comparative Effectiveness of Two Collagen-containing Dressings: Oxidized Regenerated Cellulose (ORC)/Collagen/Silver-ORC Dressing Versus Ovine Collagen Extracellular Matrix.

INTRODUCTION: Chronic wounds are characterized by impaired tissue physiology that stalls healing. The prevalence of wound chronicity presents challenges in wound management and health care cost-containment. OBJECTIVE: This comparative effectiveness study evaluates the value proposition of 2 collagen-containing wound dressings - oxidized regenerated cellulose (ORC)/collagen/silver-ORC dressing and ovine collagen extracellular matrix (ECM) - in matched cohorts of patients undergoing treatment for diabetic foot ulcers (DFUs). MATERIALS AND METHODS: Data extracted from the US Wound Registry identified DFUs treated with either dressing and included wounds with complete data records (n = 3230). Thirty-seven variables were considered in propensity score matching to develop a case-matched cohort of 844 DFUs (n = 422 DFUs/group). RESULTS: The ORC/collagen/silver-ORC dressing group yielded a significantly higher percentage of DFUs that healed or improved (82% vs. 74.6%; P = .0096). The ovine collagen ECM dressing group yielded a significantly higher percentage of DFUs that worsened (15.2% vs. 23.9%; P = .0013). The ORC/collagen/silver-ORC dressing group demonstrated a higher percentage of DFUs that attained 75% to 100% granulation at zero depth at 4, 8, 12, and 16 weeks. Median time to 75% to 100% granulation was 42 days for the ORC/collagen/silver-ORC dressing group versus 60 days for the ovine collagen ECM dressing group (P = .0109). CONCLUSIONS: According to this comparative effectiveness study using real world data, ORC/collagen/silver-ORC dressing appears to afford improved healing and reduced time to granulation relative to ovine collagen ECM dressing.

[Application of anti-adhesive barrier for recurrent acute adhesive intestinal obstruction]. / Applikatsiya protivospaechnogo bar'era pri retsidiviruyushchei ostroi spaechnoi kishechnoi neprokhodimosti.

Surgical treatment of a patient with recurrent acute adhesive intestinal obstruction is described. Seven plates of anti-adhesive barrier agent made from oxidized regenerated cellulose were applied to small bowel in order to prevent adhesions. Control examination did not reveal viscero-parietal adhesions between hollow organs and delayed passage through the gastrointestinal tract. Long-term results indicate the need for intraoperative prevention of intra-abdominal adhesions in patients with abdominal adhesive disease.

The safety and benefit of using oxidized regenerated cellulose to position free flap pedicle in head and neck reconstruction.

BACKGROUND: Oxidized regenerated cellulose (ORC; Surgicel®; Ethicon, Neuchâtel, Switzerland) is an absorbable hemostatic agent used for hemostasis in operation, although some surgeons use it to position free flap pedicles. The increasing risk of vessel compromise is a huge concern. However, no scientific data to date demonstrate the safety and benefit of using ORC in microvascular surgery. In the present study, we compared the outcome of microvascular head and neck reconstruction with and without pedicle placement using ORC. MATERIALS AND METHODS: From January 2015 to December 2017, we reviewed patients undergoing microvascular surgery with free fibular osteocutaneous flap in our hospital. The patients were divided into the ORC group and non-ORC group and their baseline characteristics and outcomes were compared. RESULTS: In total, there were 27 patients in the ORC group and 67 in the non-ORC group. The non-ORC group had significantly higher cigarette consumption (70.4% vs. 89.6%; p = .022). The outcome of the ORC group was better regarding arterial thrombosis (0% vs. 3%), flap failure (0% vs. 4.5%), hematoma (7.4% vs. 10.4%), and wound complications (25.9% vs. 44.8%). The ORC group had a worse result than the non-ORC group for vein thrombosis (7.4% vs. 4.5%) and duration of hospitalization (24.111 days vs. 23.627 days). However, none of above results was significant. CONCLUSIONS: Though this study was underpowered to detect the differences, the results showed a trend toward better outcomes of flaps and wounds in the ORC group. It seems that using ORC in this field is safe and beneficial.

Hemostatic effect and psychological impact of an oxidized regenerated cellulose patch after transrectal ultrasound-guided prostate biopsy: A prospective and retrospective study.

To investigate the usefulness of the oxidized regenerated cellulose patch (ORCP) for postbiopsy hemostasis, anxiety, and depression in patients undergoing transrectal ultrasound-guided prostate biopsy.This was a prospective-retrospective study of 300 patients who underwent systematic 12-core prostate biopsy from August 2016 through March 2018. The ORCP was inserted into the rectum immediately after prostate biopsy in the prospective group (n = 150), while the retrospective group (n = 150) underwent prostate biopsy alone. The frequency rate and duration of hematuria, rectal bleeding, and hematospermia were compared between the 2 groups. Anxiety and depression were assessed with the hospital anxiety and depression scale before and after prostate biopsy in the prospective group.The frequency rates of hematuria and hematospermia showed no significant differences between the prospective versus retrospective groups (64.7% vs 66.7%, P = .881; 18 vs 20%, P = .718; respectively). Frequency of rectal bleeding was significantly lower in the prospective group than in the retrospective group (26.7% vs 42.7%, P = .018). However, there were no significant differences in median duration of rectal bleeding, hematuria, or hematospermia between the 2 groups (2, 5, and 2 days vs 2, 7, and 1 day, P > .05, respectively, for the prospective vs retrospective group). Multivariate analysis found that ORCP insertion was a significant protective factor against postbiopsy rectal bleeding (P = .038, odds ratio 0.52). Only anxiety level in the prospective group before versus after prostate biopsy was significantly reduced (5 vs 4, P = .011).ORCP insertion after prostate biopsy is an effective and simple method for decreasing rectal bleeding. ORCP insertion may also alleviate anxiety in patients undergoing prostate biopsy.

The Prevention of Hepatectomy-Induced Adhesions by Bilayer Sponge Composed of Ultrapure Alginate.

BACKGROUND: Adhesion formation is a critical issue in surgery, particularly in hepatectomy. The present study aimed to develop a bilayer adhesion barrier comprising alginate (Alg) of different molecular weight (Mw). It was expected that a slowly dissolving layer remains on the cut surface, functioning as a physical barrier, whereas a rapidly dissolving layer widely distributes in the peritoneal cavity to prevent de novo adhesions. METHODS: Bilayer Alg sponges were fabricated using low Mw Alg for the upper layer and high Mw Alg for the bottom layer. The dissolution behavior of each layer was evaluated in vitro in peritoneum-like environments. We constructed a Pean crush hepatectomy-induced adhesion model in rats. The effects of the bilayer sponge on cut surface and de novo adhesions were separately evaluated in terms of their extent and grade. RESULTS: The Alg sponge layer with low Mw dissolved faster than that with high Mw in vitro. One week after the hepatectomy, although no significant decrease in adhesion extent on the cut surface was observed in rats that received Seprafilm and Interceed, treatment with Alg bilayer sponge significantly decreased the adhesion extent to 38% of that without treatment. Moreover, a significant decrease in de novo adhesion extent was observed in the Alg bilayer sponge compared with the Interceed group. CONCLUSIONS: The Alg bilayer sponge was effective for preventing both cut surface and de novo adhesions in the rat Pean crush hepatectomy model. The simple yet functional design of the Alg bilayer sponge can facilitate its use in future clinical practice.

Prospective randomized single-blind study of post-operative bleeding after minor oral surgery in patients with cirrhosis.

BACKGROUND/AIMS: The management of patients with cirrhosis requiring dental extractions is complicated due to an increased risk of post-operative bleeding. Topical hemostatic agents are usually required to control bleeding in these cases, as an adjunct to systemic measures of hemostasis. The aims of this randomized, prospective, single-blind clinical study are twofold. The primary aim is to compare the hemostatic efficacy of chitosan and surgicel in patients with cirrhosis after a tooth extraction, and the secondary aim is to assess the value of the current setting as a clinical model of post-operative bleeding following minor oral surgery. MATERIAL AND METHODS: Fifty patients with cirrhosis scheduled for a tooth extraction under local anesthesia were prospectively included in the study in a randomized fashion. Patients were blinded to the treatment group they were in. The cirrhosis classification, bleeding time, trauma score, and corrected bleeding time (during post-operative reviews) were recorded. Statistical evaluations were done. RESULTS: Study groups had an equal number of teeth extractions (40 teeth each). There were no statistically significant differences between the groups with respect to patient demographics, cirrhosis classification, trauma score, and bleeding time. No side effects were noted. CONCLUSION: Both Celox and Surgicel are effective for controlling bleeding and are safe after a tooth extraction in patients with cirrhosis.

Oxidized Regenerated Cellulose Can Reduce Hidden Blood Loss after Total Hip Arthroplasty: A Retrospective Study.

Background: There is a large amount of hidden blood loss (HBL) after total hip arthroplasty (THA), but the effective and safe methods to reduce HBL are still controversial. Methods: Sixty-nine consecutive patients who underwent THA in our hospital from January 2015 to December 2015 were analyzed retrospectively. The patients were divided into two groups, Group A (THA without oxidized regenerated cellulose) and Group B (THA with oxidized regenerated cellulose). Demographics, perioperative laboratory values, intraoperative data, blood loss, transfusion rate, transfusion reactions, and surgical complications were collected and analyzed. Results: A total of 37 (54%) patients used oxidized regenerated cellulose (ORC) in operation. The total blood loss (TBL), postoperative blood loss (PBL), hemoglobin (Hb) loss, and hidden blood loss (HBL) in group B were significantly lower than in group A. Conclusions: The use of ORC to fill the bone surface and soft tissue gap before incision closure can effectively reduce HBL and may be a potential treatment for blood prevention after THA.

A novel endobronchial approach to massive hemoptysis complicating silicone Y-stent placement for tracheobronchomalacia: A case report.

RATIONALE: Airway stabilization for severe, symptomatic tracheobronchomalacia (TBM) may be accomplished by silicone Y-stent placement. Common complications of the Y-stent include mucus plugging and granulation tissue formation. PATIENT CONCERNS: We describe a rare case of massive hemoptysis originating from a silicone Y-stent placed for TBM. DIAGNOSES: An emergent bronchoscopy showed an actively bleeding, pulsatile vessel at the distal end of the left bronchial limb of the Y-stent. It was felt that the bleeding was caused by, or at least impacted by, the distal left bronchial limb of the Y-stent eroding into the airway wall. INTERVENTIONS: We hypothesized that placement of oxidized regenerated cellulose (ORC) would provide initial hemostasis, and the subsequent placement of a biocompatible surgical sealant would lead to definitive resolution. OUTCOMES: ORC provided sufficient hemostasis and the subsequent synthetic polymer reinforced the tissue for complete cessation of the bleed. LESSONS: The combined use of ORC and a biocompatible surgical sealant provided long-term management for life-threatening hemoptysis, and potentially morbid procedures such as embolization or surgery were avoided by advanced endobronchial therapy.

Use of Hemostatic Nasal Plugs in Emergency Medical Services in the Netherlands: A Prospective Study of 33 Cases.

BACKGROUND: Epistaxis is a common medical emergency with possible life-threatening complications. In the prehospital setting, epistaxis can be treated with nasal tampons. HemCon® Nasal Plug is a nasal tampon impregnated with oxidized cellulose, which has hemostatic properties. OBJECTIVE: The objective of this study was to determine the effectiveness and usability of HemCon Nasal Plugs in the treatment of severe epistaxis in the prehospital setting. METHODS: From June 2012 to December 2014, all ambulances of two emergency medical services in the Netherlands were equipped with HemCon Nasal Plugs. The plug was used according to protocol; if conventional treatment failed to control severe epistaxis or if conventional treatment was unlikely to achieve hemostasis. The ambulance personnel filled in an evaluation form after each use. RESULTS: A total of 33 patients were treated with HemCon Nasal Plugs. Twenty-four patients were taking anticoagulants or suffered from a clotting disorder. The cause of epistaxis was idiopathic in the majority of the patients. Inserting HemCon Nasal Plugs resulted in cessation of epistaxis in 25/33 patients and resulted in reduction of epistaxis in 4/33 patients. HemCon Nasal Plugs failed to control epistaxis in 4/33 patients, possible due to an unreachable site of bleeding. CONCLUSION: This study demonstrated that HemCon Nasal Plug is an effective adjunct in the prehospital treatment of severe and uncontrolled epistaxis.

Enhanced hemostasis with a sealant consisting of Hydrofit and Surgicel.

Bleeding is a serious concern during surgery for acute aortic dissections. We have used Hydrofit and Surgicel together to achieve hemostasis at the graft anastomotic sites during replacement of the ascending aorta and aortic arch. Complete hemostasis was achieved without further need for any additional sutures.

The Effects of Colchicine-Impregnated Oxidized Regenerated Cellulose on Capsular Contracture.

Capsular contracture is the most common complication of breast augmentation. Oxidized regenerated cellulose can be used as a matrix for drug transport. Colchicine is an antimitotic drug that interferes with various steps of wound healing. The aim of this study was to evaluate the effects of oxidized regenerated cellulose alone or in combination with colchicine on capsular contracture. Twenty-one adult female Wistar-Albino rats were divided into 3 groups. In group 1 silicone blocks only, in group 2 oxidized regenerated cellulose-wrapped silicone blocks, and in group 3 colchicine-impregnated oxidized regenerated cellulose-wrapped silicone blocks were inserted in the dorsal region. Four weeks later, implants were removed and histopathological examination was performed. Capsular thickness, inflammatory infiltrate degree, collagen fiber organization, and myofibroblast density were evaluated. Macroscopic examination revealed a distinct capsule formation only in group 1 animals, with average measurement being 134.65 µm on histopathological examination. In groups 2 and 3 animals, no distinct capsule formation was seen. Inflammatory infiltrate degree was found to be less in groups 2 and 3 animals than in group 1 animals. Collagen fiber organization around the implants was found to be parallel and organized in group 1 animals, whereas it was random and disorganized in animals in both groups 2 and 3. High myofibroblast density was observed in animals in groups 1 and 2, while no myofibroblast was found in animals in group 3. The results of our study suggest that coating silicone implants with oxidized regenerated cellulose or with colchicine-impregnated oxidized regenerated cellulose may be effective in preventing capsular contracture.

Oxidized Regenerated Cellulose (Fibrillar) Reduces Risk of Postoperative Corporal Bleeding Following Inflatable Penile Prosthesis Surgery.

OBJECTIVE: To report our initial experience with oxidized regenerated cellulose (ORC; Surgicel Fibrillar) as a hemostatic adjunct during inflatable penile prosthesis (IPP) surgery. MATERIALS AND METHODS: Beginning in April 2016, ORC pledgets were placed within the corporotomy closures of all men undergoing IPP insertion. Perioperative characteristics and outcomes including cumulative postoperative drain output were evaluated among consecutive cases with (April 2016 to October 2016) and without ORC (December 2015 to March 2016) using an identical surgical technique by a single surgeon. RESULTS: During the study period, 64 men underwent IPP implantation, of whom 32 (50%) received ORC. There was a significant reduction in median drain output relative to controls (33 mL vs 65 mL; P = .01). Postoperatively, ORC use was associated with a reduction in the number of patient phone calls for scrotal-related concerns in the immediate postoperative period (average 0.5 vs 1.1; P = .03). There were 3 IPP explantations in the non-ORC group (2/3 for infection)-one of which was directly related to an infected hematoma. After controlling for other clinical features, the use of ORC (ß -32, 95% confidence interval: -61 to -5; P = .02) was independently associated with a reduction in drain output. CONCLUSION: ORC use during IPP corporotomy closure reduces postoperative drain output, a known risk factor for hematoma-related complications.

[Topical haemostatic agents in neurosurgery].

Haemostasis is of fundamental significance in neurosurgery, and insufficient control of bleeding is associated with morbidity and mortality. Topical haemostatic agents play an important role, as the characteristics of neuronal tissue limit the use of classical surgical haemostasis techniques. Appropriate choice of agent depends on the location and type of bleeding, but also on knowledge of the products' mechanisms of action, indications, price and accessibility. Biological products are superior to the mechanical in efficacy but require more preparation and are significantly more cost-intensive.