A Qualitative Morphological Comparison of Two Haemostatic Agents in a Porcine Liver Trauma Model

Background: Many surgical haemostatic agents are available which aim to reduce morbidity and mortality of bleeding, as well as associated costs. We used qualitative techniques to compare the effectiveness of two topical gelatine-based haemostatic agents in a porcine liver trauma model. Methods: We compared the activity of Floseal (with human or bovine thrombin), Surgiflo and Surgiflo plus 5000 IU bovine thrombin per 10 mL of product (n = 6 test sites/group). Different clinical scenarios were evaluated in two anaesthetised piglets; normal physiological conditions (normotension and normothermia), and a status of hypotension, hypothermia and haemodilution, requiring inotropic support. Laparotomy was performed, and five identical stab wounds were made on each liver lobe. Four of these wounds were randomly treated with one of the agents under investigation, while one wound was kept as an untreated control. Haemostasis was observed during and immediately following surgery. After euthanisation, wounds were examined (blinded for treatment) macroscopically, microscopically and using scanning electron microscopic evaluation. Results: Surgiflo produced some degree of clotting in 1/3 applications in both piglets. Co-treatment with thrombin resulted in a minor improvement in performance in the animal with normal physiological conditions (some degree of clotting in all wounds); no improvement was seen in the animal in a status of hypotension, hypothermia and haemodilution. Floseal induced clotting in all wounds for both piglets. Microscopic and scanning electron microscope examination of the stab wounds demonstrated that Floseal created a stable, dense agglomerate of gelatine and fibrin, which firmly adhered to the adjacent liver tissue. In wounds treated with Surgiflo or Surgiflo plus thrombin, the gelatine contained more air bubbles, resulting in less fibrin inclusion in the clot and weaker adhesion of the clot to the liver tissue. Conclusion: Floseal created a dense and stable blood clot, even in a piglet with hypotension, hypothermia and haemodilution.