Topical hemostatic agents and tissue adhesives are used as an adjunct or alternative to standard suturing techniques to control bleeding or for wound closure.
The mechanism of action, indications, and the clinical application of the most common topical hemostatic agents and tissue adhesives used in surgery are reviewed here. Devices used to achieve surgical hemostasis through vascular control during dissection are discussed elsewhere. (See "Overview of electrosurgery" and "Instruments and devices used in laparoscopic surgery".)
Topical hemostatic agents are used when surgical hemostasis is inadequate or impractical. The majority of routine, elective operations are performed in patients with normal hemostasis and with minimal blood loss. The two main categories of topical hemostatic agents are physical agents, which promote hemostasis using a passive substrate, and biologically active agents, which enhance coagulation at the bleeding site (table 1). (See 'Physical agents' below and 'Biologically active agents' below.)
Indications for use — Intraoperative bleeding is controlled using standard surgical techniques and electrocautery with the adjunctive use of topical hemostatic agents.
Electrocautery may not be useful for controlling bleeding in some surgical fields such as around nerves, medullary bone surfaces, needle-hole bleeding from vascular grafts, and raw areas on cut surfaces. Patients who are anticoagulated and those with bleeding diatheses (eg, factor deficiencies, disseminated intravascular coagulation), or have platelet dysfunction (eg, aspirin therapy) can continue to ooze from surgical surfaces in spite of adequate surgical hemostasis.