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What is Gelatin Sponge ?
Gelfoam , also known as absorbable Gelfoam or gelfoam, is a porous, pliable and absorbent sponge-like material used primarily to control bleeding during surgical procedures. It is made of purified porcine gelatin that is sterilized and compressed into a dry, light yellow, pliable and highly porous sponge.
Composition and Properties
Gelatin Sponge is derived from purified porcine skin collagen. Once moistened, it expands to many times its compressed size. Its high porosity allows it to absorb up to 20 times its own weight in fluids. It is non-antigenic and non-pyrogenic. Gelfoam slowly disintegrates and dissolves in the presence of bodily fluids and is gradually resorbed by the body within 4-6 weeks through phagocytosis without causing any inflammatory reaction or foreign body response.
Mechanism of Hemostatic Action
When applied to bleeding sites, Gelfoam works by mechanical means to achieve hemostasis. As it expands upon hydration, it fills vascular and bony cavities, irregular surfaces and crypts, forming a protective mechanical barrier or tamponade over the bleeding site. Its porous structure allows escaped blood to permeate deep within the matrix forming a clot while fluid and blood absorption reduces localized bleeding. Platelets also aggregate over the rough collagen surfaces promoting the intrinsic clotting cascade.
Applications in Surgery
Due to its versatility, hemostatic efficacy and safety profile, Gelfoam finds diverse applications in surgical procedures:
– Neurosurgery: Used to control oozing from brain surfaces, vessel walls and dural edges during craniotomies or to fill defects created by tumor resection.
– General surgery: Commonly employed for hemostasis in laparotomies, laparoscopic port site bleeding, liver biopsies or resections and splenectomies.
– Orthopedic surgery: Provides cushioning and tamponade in bone tunnels or cavities created during bone grafting, fractures or tumor removals.
– Dental/oral surgery: Effective for controlling oozing after tooth extractions, cystectomies, biopsies or surgical excisions within the oral cavity.
– Cardiothoracic surgery: Absorbs mediastinal fluids and achieves hemostasis after cardiac or pulmonary procedures.
– Gynecological surgery: Used in hysterectomies, myomectomies and other procedures involving the uterus or ovaries.
Advantages and Disadvantages
The key advantages of Gelfoam include ease of application, adaptability to various site geometries, non-immunogenicity, rapid in vivo dissolution and proven hemostatic efficacy. However, being composed of collagen, it may hypersensitivity in some. It also lacks any adhesive ability requiring some manual pressure or additional hemostats for secure placement.
In summary, Gelfoam is a versatile hemostatic agent well suited for controlling surgical bleeding from diverse anatomical sites. Its benign safety profile along with proven hemostatic effectiveness through mechanical tamponade makes it a staple in operating rooms worldwide.
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