Advances in absorbable biomaterials and nasal packing.

Department of Surgery-Otorhinolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, University of Adelaide, 28 Woodville Road, Woodville, Adelaide, SA 5011, Australia.
Otolaryngologic Clinics of North America (Impact Factor: 1.34). 10/2009; 42(5):813-28, ix. DOI: 10.1016/j.otc.2009.07.009
Source: PubMed

ABSTRACT Absorbable biomaterials are commonly used after endoscopic sinus surgery, both for hemostatic and wound healing considerations. Although removable nasal packing is the traditional method of controlling ongoing bleeding and modulating wound healing, it is uncomfortable for patients and associated with several complications. Currently available absorbable agents frequently incite an inflammatory reaction and have been shown in animal and human trials to adversely affect the wound healing process. Newer agents offer distinct advantages because of their unique composition and rapid clearance profiles. The selection of packing material used in any given sinus procedure should be based on surgeon preference and the details of the specific case.

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    ABSTRACT: To assess biodegradable nasal packing effectiveness for improving postoperative symptoms and mucosal healing after endoscopic sinonasal surgery as compared with conventional/non-packing groups. Relevant articles were searched on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials (RCTs) that compared biodegradable packings with conventional packings or no packing, reporting postoperative symptoms and/or mucosal healing outcomes. This review included 19 studies, of which 11 compared biodegradable packings with conventional packings. Meta-analysis found that biodegradable packings significantly improved postoperative symptoms: bleeding at removal, pain at removal, pain in situ, and nasal blockage. Mucosal healing outcomes were inconsistent within studies, with no data could be pooled. Eight studies compared biodegradable packings with non-packing group. Postoperative symptom data in this comparison could not be pooled: A protective or equal effect on postoperative bleeding was reported in different studies; no difference was reported in pain status and nasal blockage. As for mucosal healing, meta-analysis showed that two arms of comparison had similar effect on synechiae, edema, infection and granulation at each time point. The limiting evidence suggests that biodegradable nasal packings are statistically better than conventional packings in postoperative symptoms, and probably comparable to non-packing group, as in this comparison we could not carry out meta-analysis. No beneficial or detrimental effect on postoperative mucosal healing could be determined based on existing evidence.
    PLoS ONE 12/2014; 9(12):e115458. · 3.53 Impact Factor
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    ABSTRACT: Background Topical hemostatic agents are used to reduce bleeding and transfusion need during cardiothoracic surgery. We report our experience with Arista® AH Absorbable Hemostatic Particles (Arista® AH), a novel plant-based microporous polysaccharide hemostatic powder.Methods Data were retrospectively collected for patients (n¿=¿240) that received cardiothoracic surgery at our institution from January 2009 to January 2013 with (n¿=¿103) or without (n¿=¿137) the use of Arista® AH. Endpoints included protamine to skin closure time (hemostasis time), cardiopulmonary bypass time, quantity of Arista® AH applied, intraoperative blood product usage, intraoperative blood loss, chest tube output 48 hours postoperatively, blood products required 48 hours postoperatively, length of stay in the intensive care unit, 30-day morbidity, and 30-day mortality.Results240 patients (176 M : 64 F) underwent 240 cardiothoracic procedures including heart transplantation (n¿=¿53), cardiac assist devices (n¿=¿113), coronary artery bypass grafts (n¿=¿20), valve procedures (n¿=¿19), lung transplantation (n¿=¿17), aortic dissection (n¿=¿8), and other (n¿=¿10). Application of Arista® AH led to significant reduction in hemostasis time versus the untreated control group (Arista® AH: 97.8¿±¿40 min. vs. Control: 114¿±¿59 min., p¿=¿0.026). Postoperative chest tube output in the first 48 hours was also significantly reduced (Arista® AH: 1659¿±¿987 mL vs. Control: 2110¿±¿1585 mL, p¿<¿0.001), as well as transfusion of packed red blood cells (Arista® AH: 2.4¿±¿2.5 units vs. Control: 4.2¿±¿5.1 units, p¿<¿0.001). There was no significant difference in 30-day mortality or postoperative complications.Conclusion Use of Arista® AH in complex cardiothoracic surgery resulted in a significant reduction in hemostasis time, postoperative chest tube output, and need for postoperative blood transfusion.
    Journal of Cardiothoracic Surgery 08/2014; 9(1):134. · 1.02 Impact Factor
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    S Goldie, M Shakeel, A Trinidade, V Vallamkondu, B Ram, KW Ah-See
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    ABSTRACT: Background: Nasal packing is often used after functional endoscopic sinus surgery (FESS). Variousnon-absorbable agents are used but these packs can be uncomfortable and cause pain and bleeding on removal. Increasingly, biodegradable nasal packs are being used and have shown promising effects on post-operative bleeding and healing after FESS. Aim: We evaluate the safety and efficacy of biodegradable Nasopore ® (polyurethane glycol) in FESS, particularly in the day-case setting. . Methods: A retrospective chart review of 100 consecutive patients receiving Nasopore following FESS. Results: Our patients had chronic rhinosinusitis not responding to medical therapy and the extent of the surgery was determined by the extent of disease. Procedures performed in addition to FESS included septoplasty, trimming of the inferior turbinates and polypectomy. Approximately half of patients were discharged home the same day and post-operative complications were minimal. Only two patients developed post-operative bleeding, and four reported post-operative sinus infection requiring oral antibiotics. One patient developed minor intranasal adhesions of no functional significance. Conclusions: Nasopore is a safe and effective option after FESS. It is associated with minimal discomfort, no pain on removal and few post-operative complications. Nasopore is useful in achieving day-case FESS. Keywords Epistaxis; Sinusitis; Nasal polyps; Rhinitis; Haemostatic technique; Paranasal sinus Disease; Endoscopy; Surgery induced tissue adhesions.
    Journal of Otolaryngology-ENT Research. 12/2014; J Otolaryngol ENT Res 2014, 1(1): 00003.

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