Hemostasis of oral surgery wounds with the HemCon Dental Dressing.

PURPOSE This study evaluated the efficacy of the HemCon Dental Dressing (HDD; HemCon Medical Technologies, Inc, Beaverton, OR) hemostatic oral wound dressing derived from the US military HemCon Bandage combat wound dressing and whether early hemostasis affects postoperative care and surgical healing outcomes following oral surgical procedures. PATIENTS AND METHODS All patients aged 18 to 90, except those allergic to seafood, who consented to participate were eligible for enrollment into this study regardless of other medical history findings. All patients were required to have 2 or more surgical sites so they would have internal surgical control sites. All patients taking oral anticoagulation therapy (OAT) were included for treatment in this study without altering their anticoagulant medication regimens. All data were evaluated by biomedical statisticians and Institutional Review Board approval was obtained. RESULTS All HDD surgically treated sites, including all from patients taking OAT, achieved hemostasis in less than 1 minute and control wounds in 9.53 minutes (P < .001). All HDD sites achieved hemostasis sooner than control sites (P <.001). Approximately 32% of HDD treated sites had significantly better healing compared with control sites (P <.020) and no control sites healed better than HDD treated sites; 32% of HDD treated oral surgery wounds achieved statistically significant improved healing (P <.001). All patients taking OAT achieved hemostasis within 1 minute and were treated without altering their anticoagulant regimens. Although the pain scores and incidence of alveolar osteitis were lower for the HDD-treated sites, these scores were not significantly different than control-treated sites. There was no negative healing sequela associated with early hemostasis of oral surgical wounds. CONCLUSION The HDD has been proven to be a clinically effective hemostatic device that significantly shortens bleeding time following oral surgery procedures for all patients, including those patients taking OAT. Patients receiving the HDD had improved surgical wound healing compared with those receiving controls.

[1]  Michael R Hamblin,et al.  Use of chitosan bandage to prevent fatal infections developing from highly contaminated wounds in mice. , 2006, Biomaterials.

[2]  Anthony E. Pusateri,et al.  The Chitosan-Based Hemostatic Dressing: Experience in Current Combat Operations. , 2005, The Journal of trauma.

[3]  U. Martinowitz,et al.  Dental extractions in patients maintained on continued oral anticoagulant: comparison of local hemostatic modalities. , 1999, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[4]  Zheng Wang,et al.  Effect of chitosan molecular weight and deacetylation degree on hemostasis. , 2008, Journal of biomedical materials research. Part B, Applied biomaterials.

[5]  U. Martinowitz,et al.  Dental extractions in patients maintained on oral anticoagulant therapy: comparison of INR value with occurrence of postoperative bleeding. , 2001, International journal of oral and maxillofacial surgery.

[6]  F. Ferrari,et al.  Prevention of postoperative bleeding in anticoagulated patients undergoing oral surgery: use of platelet-rich plasma gel. , 2003, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[7]  R. Reis,et al.  Influence of porosity and fibre diameter on the degradation of chitosan fibre-mesh scaffolds and cell adhesion , 2007, Journal of materials science. Materials in medicine.

[8]  Hsiao-Pei Tu,et al.  Releasing growth factors from activated human platelets after chitosan stimulation: a possible bio-material for platelet-rich plasma preparation. , 2006, Clinical oral implants research.

[9]  A. Domb,et al.  Chitosan chemistry and pharmaceutical perspectives. , 2004, Chemical reviews.

[10]  E. Fu,et al.  Chitosan enhances platelet adhesion and aggregation. , 2003, Biochemical and biophysical research communications.

[11]  J. Holcomb,et al.  Comparison of hemorrhage control agents applied to lethal extremity arterial hemorrhages in swine. , 2005, The Journal of trauma.

[12]  Gautam A Madan,et al.  Minor oral surgery without stopping daily low-dose aspirin therapy: a study of 51 patients. , 2005, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[13]  Walter Steurbaut,et al.  Chitosan as antimicrobial agent: applications and mode of action. , 2003, Biomacromolecules.

[14]  O. Beirne.  Evidence to continue oral anticoagulant therapy for ambulatory oral surgery. , 2005, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[15]  J. Henderson,et al.  Management of the oral and maxillofacial surgery patient with thrombocytopenia. , 2001, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.