Can New Hemostatic Dressings Facilitate Sharp Debridement In High-Risk Patients?

Start Page: 20
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Author(s): 
Clark Schierle, MD, PhD, and Julie Krol, MS, PA-C

   Chitosan, in a freeze-dried form, provides primary hemostasis by sealing the wound and stopping the bleeding. Specific chitosan dressings can create an adhesive structure with a positive charge that attracts red blood cells and platelets, which have a negative charge. As the red blood cells and platelets are drawn towards the chitosan through this ionic interaction, a strong seal forms at the dermal wound site. The platelets and red blood cells continue to be drawn towards the chitosan and form the frontline hemostatic support structure. The platelets and red blood cells will continue to aggregate until hemostasis and clotting occur.

   Chitosan-based dressings have rapidly gained acceptance in military and traumatic wound settings where massive hemorrhage often leads to the depletion of clotting factors. Chitosan’s mechanism of action functions independently of either the intrinsic or extrinsic clotting cascades, and forms an immediate seal on wounds. This allows time for the patient’s native coagulation pathway to take effect. Furthermore, the use of chitosan has been implemented in order to address bleeding specifically while minimizing collateral tissue injury inherent with electrocautery.

   One generally uses hemostatic bandages in the first 24 hours after removing the necrotic tissue and there is substantial bleeding at the wound site. After getting the initial heavy bleeding under control, one may apply moist dressings to promote wound healing. Wet-to-dry wound dressings can prevent infection but recent studies have shown that this method may actually enable bacterial proliferation. Chitosan-based hemostatic bandages offer physicians an added advantage because they also have an antibacterial barrier.

What One Study Reveals

   In a study conducted last year, we found that chitosan-based hemostatic bandages are an ideal choice for sharp debridements.1 The study involved 44 wounds in 35 patients undergoing sharp debridement. We applied HemCon Bandages (HemCon Medical Technologies) to the wounds along with two minutes of direct pressure. After two minutes, we packed the wounds with a dry dressing and left the dressing in place for a full 24 hours. We then changed the dressings to routine wound dressings and assessed the wounds for successful hemostasis.

   The results showed that the bandages allowed for safe yet adequately aggressive sharp debridement. The patients’ wounds could not have otherwise been adequately debrided due to bleeding concerns or the procedure would have required a trip to the OR. All patients underwent successful debridement at the bedside without the need for electrocautery.1

Are These Dressings A Cost-Effective Option?

   Using chitosan-based hemostatic bandages after sharp debridement is advantageous for several reasons. Wound care specialists can now perform bedside debridement, in an ambulatory or inpatient setting, in a more timely and safe manner. If there is a complication like unexpected severe bleeding, one can stabilize the wound until the patient receives emergency care.

   On-call caregivers now have an alternative to staying at the bedside holding bandages on the wound for long periods. This saves both time and money. In the past, if there was a chance of heavy bleeding, doctors were usually more conservative and did not cut out as much of the dangerous, necrotic tissue. Now more patients can have clean wounds with a minimal amount of necrotic tissue, reducing the need for additional debridement and expensive dressings.

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