Modified starch powder versus epinephrine gauze for hemostasis during burn wound debridement: A randomized intra-patient trial.

BACKGROUND

Severe intraoperative hemorrhage during burn wound debridement is a major challenge. Topical hemostatics help rapidly control bleeding, but agents must be effective, safe, and easy to use. This study compared a modified starch powder with standard epinephrine-saturated gauze for hemorrhage control during burn wound debridement.

METHODS

A prospective, randomized, intra-patient-controlled trial was conducted with 30 patients undergoing burn debridement. For each patient, two comparable wound sites were randomized to receive starch powder (AriClot) or epinephrine-saturated gauze. The primary outcomes were time to hemostasis and bleeding flow rate. Secondary outcomes included surgeon satisfaction, early graft loss, ischemia, and wound infection. Statistical analysis was performed using appropriate paired tests.

RESULTS

The starch powder-treated sites had a significantly shorter time to hemostasis (median 1.5 min vs. 5 min; p < 0.001) and a significantly lower bleeding flow rate than the control sites (median 3 ml/min/TBSA% vs. 7 ml/min/TBSA%; p < 0.001). Surgeon satisfaction was notably higher with starch powder, with 76.67% of applications rated as "Perfect" compared with 10% for the control treatment (p < 0.001). Wound site infection was significantly lower with starch powder (p = 0.027). There were no statistically significant differences in graft rejection (p = 0.275) or ischemia (p = 0.220) between the two intervention sites.

CONCLUSION

Carboxymethyl starch-based hemostatic agent improved hemostasis compared with epinephrine-saturated gauze during burn wound debridement. Its use was associated with faster hemostasis and higher surgeon satisfaction, without increasing the risk of adverse wound outcomes.

CLINICAL TRIAL REGISTRATION NUMBER: IRCT20180609040016N6 (https://irct.behdasht.gov.ir/trial/78594).