A Special Report on the Chitosan-based Hemostatic Dressing: Experience in Current Combat Operations

Madigan Army Medical Center, Tacoma, Washington, United States
The Journal of trauma (Impact Factor: 2.96). 04/2006; 60(3):655-8. DOI: 10.1097/01.ta.0000199392.91772.44
Source: PubMed


Hemorrhage remains a leading cause of death in both civilian and military trauma patients. The HemCon chitosan-based hemostatic dressing is approved by the US Food and Drug Administration (FDA) for hemorrhage control. Animal data have shown the HemCon dressing to reduce hemorrhage and improve survival. The purpose of this article is to report preliminary results of the hemostatic efficacy of the HemCon dressing used in the prehospital setting on combat casualties.
A request for case information on use of HemCon dressings in Operation Iraqi Freedom and Operation Enduring Freedom was sent to deployed Special Forces combat medics, physicians, and physician assistants.
Sixty-eight uses of the HemCon dressing were reported and reviewed by two US Army physicians. Four of the 68 cases were determined duplicative resulting in a total of 64 combat uses. Dressings were utilized externally on the chest, groin, buttock, and abdomen in 25 cases; on extremities in 35 cases; and on neck or facial wounds in 4 cases. In 66% of cases, dressings were utilized following gauze failure and were 100% successful. In 62 (97%) of the cases, the use of the HemCon dressing resulted in cessation of bleeding or improvement in hemostasis. There were two reported dressing failures that occurred with blind application of bandages up into large cavitational injuries. Dressings were reported to be most useful on areas where tourniquets could not be applied to control bleeding. The dressings were reported to be most difficult to use in extremity injuries where they could not be placed easily onto or into the wounds. No complications or adverse events were reported.
This report on the field use of the HemCon dressing by medics suggests that it is a useful hemostatic dressing for prehospital combat casualties and supports further study to confirm efficacy.

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    • "The degradation products of chitosan are N-acetyl-glucosamine and glucosamine, natural constituents of the human body, and thus bioabsorbable[122,123]. Chitosan has shown good biocompatibility[124], and was approved by the FDA for use in wound dressings[125]. All these distinct advantages together indicate chitosan is one of the most remarkable candidates for cell therapy applications. However, similar to other biomaterials, in most cases, the requirements for cell therapy applications cannot be fulfilled by chitosan alone. "

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    • "Chitosan has a positive charge and attracts red blood cells (RBC) and platelets, which are negatively charged through ionic interaction; thus, a strong seal is formed at the wound site. [25] This supportive, primary seal allows the body to activate its coagulation pathway effectively, initially forming organized platelets. Therefore, HDDs are designed to maintain this seal and serve as a frontline support structure as the platelets and red blood cells continue to aggregate until hemostasis is achieved [23] [27]. "
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