Effect of hemostatic agents on properties of gelatin-alginate soft tissue adhesives.

Lacerations and traumatic wounds are considered to be among the most prevalent scenarios encountered in hospitals and emergency rooms. Reattachment of the lacerated soft tissue edges is traditionally performed using sutures. Use of tissue adhesives, i.e. substances that have the ability to firmly attach lacerated tissues back together, has raised interest as an alternative, due to several advantages. Novel tissue adhesives based on the natural polymers gelatin and alginate, and cross-linked by carbodiimide (EDC), were recently developed by our research group. In the current research, two types of hemostatic agents, tranexamic acid and kaolin, were loaded into our gelatin-alginate bioadhesive, in order to improve the adhesion abilities in the hemorrhagic environment of the wound. Their effects on the ex vivo adherence properties, physical properties, and biocompatibility were investigated. Incorporation of kaolin significantly improved the ex vivo bonding strength of the gelatin-alginate-EDC bioadhesives through a combination of three physical mechanisms and decreased the swelling ratio without affecting weight loss. In contradiction, incorporation of tranexamic acid into the bioadhesive formulation resulted in a lower ex vivo bonding strength and a higher swelling ratio and weight loss, probably due to reduced efficiency of the cross-linking reaction between the molecules of the natural polymers and the cross-linking agent EDC. The hemostatic agent-loaded bioadhesives showed good biocompatibility when tested in vitro on fibroblast cells. This research clearly shows that the incorporation of kaolin in our gelatin-alginate tissue adhesives may be a very promising novel approach for improving the bonding strength and physical properties of the tissue adhesives for use in hemorrhagic environments.