Comparison of gauze packing, sponge-based, and hemostatic surgicel wound stasis dressings to treat hemorrhages from grade IV liver injuries: An experimental study.

BACKGROUND

Uncontrolled bleeding is still the major factor leading to preventable deaths following trauma. This study sought to assess the effectiveness of mini sponge-based wound stasis, cellulose-based local hemostatic, and traditional gauze dressings for the control of hemorrhages resulting from grade 4 liver injuries in rats.

METHODS

Thirty Sprague-Dawley rats were divided into three equal groups. In the first group, a liver laceration was treated with gauze packing. The second group received XStat minisponge dressing (MDS), and the third group was administered a combination of MDS dressing and Surgicel hemostatic agent. After gaining access to the intra-abdominal cavity, a liver laceration measuring 10 mm in length, 5 mm in depth, and extending to the middle lobe was created. The dressings were removed after 2 and 10 min to assess the amount of bleeding, and any bleeding was documented again after 48 h. Intraperitoneal adhesions were evaluated during euthanasia.

RESULTS

At 2 min post-injury, the gauze packing group had an average bleeding volume of 0.97 ± 0.15 mL, compared to 1.08 ± 0.25 mL in the MDS group (P = 0.26) and 1.02 ± 0.18 mL in the MDS + Surgicel group (P = 0.69). At 10 min, the bleeding volumes were 0.13 ± 0.05 mL, 0.22 ± 0.01 mL (P = 0.09), and 0.14 ± 0.05 mL (P = 0.19), respectively. At 48 h, significant differences were observed in bleeding volumes (gauze: 0.55 ± 0.18 mL, MDS: 1.15 ± 0.21 mL, MDS + Surgicel: 0.82 ± 0.06 mL, P < 0.001). Mortality rates after 14 days were 0 % in the gauze packing group, 60 % in the MDS group (P = 0.001), and 60 % in the MDS + Surgicel group (P = 0.001). The gauze packing group displayed no adhesions, while the other groups exhibited adhesions in the liver, bowel, omentum, and abdominal wall.

CONCLUSION

Our results indicate that, when it comes to managing bleeding in severe liver injuries, traditional gauze packing remains the tried-and-true method, showing superior effectiveness in terms of blood loss and mortality when compared to XStat minisponge dressings and the fibrillar Surgicel hemostatic agents.