A Qualitative Morphological Comparison of Two Haemostatic Agents in a Porcine Liver Trauma Model

Abstract

Background: Surgical haemostasis in certain parts of the body can be difficult and hazardous. Commercial products are promoted to accomplish this task at a reasonable cost. Objectives: In this study we compared the effectiveness of two topical gelatin-based haemostatic agents, Floseal and Surgiflo in a porcine liver trauma model. Methods: We compared the activity of Floseal (with human or bovine thrombin), Surgiflo and Surgiflo with added bovine thrombin in two porcine models. One anesthetised piglet mimicked "normal" conditions, while the other was kept in a status of hypotension, hypothermia and haemodilution, necessitating inotropic support ("critically ill"). Laparotomy was performed, after which we inflicted five identical stab wounds on each liver lobe. Each wound was treated with one of the four agents, while one wound was kept as a control. Haemostasis was evaluated clinically. After euthanizing the piglets, the pathologist performed a macroscopic, microscopic and electron microscopic evaluation, blinded for which agent was used in which wound. Results: Clinically, Surgiflo was able to produce a clot in some of its applications in the healthy piglet ("normal" conditions), which was not the case in the critically ill animal, not even with the added thrombin. Floseal induced clotting in every wound. Both microscopic (hematoxylin and eosin and Mallory stain) and electron microscopic examination of the stab wounds confirmed that Floseal created a stable and dense agglomerate of gelatin and fibrin, firmly attached to the adjacent liver tissue, whereas with Surgiflo, the gelatin contained more air bubbles, there was a lot less fibrin included in the clot and the clot was not strongly adherent to liver tissue. Conclusion: It would seem that Floseal is a superior haemostatic agent, creating a dense and stable blood clot, even in a critically ill animal, hence ensuring haemostasis.