Gelatin sponges aid hemostasis in veterinary surgery
MedWire News: Hemostatic gelatin sponges appear feasible for use in veterinary surgery in cats and dogs, a case review suggests.
Writing in the Journal of Small Animal Practice, the researchers say their data support the use of gelatin sponges to augment hemostasis but note that surgeons should remain alert for delayed hypersensitivity reactions.
Absorbable sponges derived from porcine dermal gelatin have been used to aid hemostasis during human surgery since 1945. They are also widely recommended for use in veterinary surgery, yet there is limited published data from the animal setting.
To address this shortfall, Tim Charlesworth (Eastcott Veterinary Hospital, Swindon, UK) and colleagues searched their practice databases for procedures that used either Gelfoam (Ferrosan) or Spongostan (Pfizer) gelatin sponges.
A total of 56 sponges were used in 50 cases (44 dogs and six cats). Twenty-eight surgeries were classified as clean, 12 were clean-contaminated, eight were contaminated, and two were infected.
The most common surgical procedures were those involving the hepatobiliary system (n=19). Other procedures included decompressive spinal surgery, sublumbar lymph node resection, total ear canal ablation with lateral bulla osteotomy, maxillectomy, cranial mediastinal mass removal, perilaryngeal dissection, and enucleation.
Hemostasis was satisfactorily achieved in 49 of 50 cases, report Charlesworth et al. One case underwent repeat surgery for inadequate hemostasis and was the only case that needed a blood transfusion.
The site of sponge implantation was peritoneal (n=31), thoracic (n=5), cranial/cervical (n=13), vertebral (n=4), or perineal (n=3), and the number of sponges ranged from one to three.
In terms of postoperative course, no animal had a significant rise in postoperative temperature, the median duration of hospitalization was 2.5 days, and a sponge was detected on postoperative imaging in just one animal.
"There were no detected hypersensitivity responses or confirmed postoperative complications relating to the use of gelatin sponges during the follow-up period (median 13 months)," state Charlesworth et al.
They conclude: "Gelatin sponges are safe to use as an adjunct to conventional hemostatic techniques and [we] are unaware of any contraindication other than known pre-existing hypersensitivity to porcine gelatin.
"It is essential for surgeons to detail the use of gelatin sponges in their surgical report as future gelatin sponge use may have an increased risk of hypersensitivity response and misinterpretation of postoperative imaging may lead to erroneous reoperation."
By Joanna Lyford