Gelatin Matrix and Thrombin

Floseal is a Food and Drug Administration-approved gelatin-matrix hemostatic sealant that has been well described in open cardiac, vascular, spine, and ear-nose-throat surgery (28-32).

Cross-linked gelatin granules comprise the gelatin matrix component of Floseal. The granules are manufactured after (i) extraction of collagen from bovine corium, (ii) gelatinization of the collagen, (iii ) cross-linking and stabilization with glutaraldehyde, and (iv) grinding of the gelatin into 500 to 600 ^m particles (33). Thrombin is bovine derived and similar to that used in the fibrin-sealant systems (Table 1). Hemostasis is achieved when the granules conform and swell by 10% to 20% upon contact with blood or body fluids (33). The outcome is blood flow restriction and a tamponade effect. Additionally, the presence of high concentrations of thrombin promotes long-term hemostasis by augmenting clot formation.

TABLE 1 ■ Characteristics of Pharmacologic and Physical Hemostatic Agents

Hemostatic

Available

Bovine

Intact coagulation

agent

Manufacturer

preparations

derived

pathway

Gelatin matrix and

Baxter Healthcare

Matrix

Yes

Partially (circulating

thrombin-F/osea/

Corp.

fibrinogen)

Microfibrillar collagen

C.R. Bard, Inc.

Powder, sponge,

Yes

Yes

-Avitene

and film

Oxidized cellulose

Johnson & Johnson

Fabric-like sheet

No (plant

Yes

-Surgice/

based)

Oxidized cellulose

Ethicon

Fabric-like sheet

No (plant

Yes

-Oxyce/

based)

Gelatin-Ge/foam

Pfizer

Powder, sponge

Yes

Yes

Gelatin-Surg/Toam

Johnson & Johnson

Powder, sponge

Yes

Yes

"American Red Cross, Washington, D.C.

"American Red Cross, Washington, D.C.

Floseal works in cases of fairly active bleeding, whereas fibrin sealants and physical agents are better suited for diffuse bleeding or oozing.

Floseal, unlike fibrin sealants, is not an adhesive and therefore should not be used to seal the urinary collecting system.

In contrast to the fibrin sealants, Floseal relies on endogenous fibrinogen to supply fibrin for clot formation.

■ It is ineffective in fibrinogenemic patients.

■ Some degree of bleeding is necessary for Floseal to function, whereas fibrin sealants require a relatively dry surface.

The gelatin granules are manually mixed with the thrombin prior to delivery of the slurry with a laparoscopic applicator. The slurry is somewhat thick and requires an applicator with a sufficient diameter for deployment. Furthermore, the slurry ought to be mixed just prior to delivery to insure even viscosity and prevent applicator clogging. After slurry delivery, the slurry remaining caught in the "deadspace" of the applicator may be utilized by injecting air (one syringe) into the applicator. Once completely delivered, pressure should be gently applied for several minutes, to allow the formation of fibrin clot.

Floseal works in cases of fairly active bleeding, whereas fibrin sealants and physical agents are better suited for diffuse bleeding or oozing. This most likely accounts for the common use of Floseal in urologic laparoscopy as a hemostatic adjunct during laparoscopic partial nephrectomy (34-36).

Floseal, unlike fibrin sealants, is not an adhesive and therefore should not be used to seal the urinary collecting system.

Fire Up Your Core

Fire Up Your Core

If you weaken the center of any freestanding structure it becomes unstable. Eventually, everyday wear-and-tear takes its toll, causing the structure to buckle under pressure. This is exactly what happens when the core muscles are weak – it compromises your body’s ability to support the frame properly. In recent years, there has been a lot of buzz about the importance of a strong core – and there is a valid reason for this. The core is where all of the powerful movements in the body originate – so it can essentially be thought of as your “center of power.”

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