Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-25T10:08:18.650Z Has data issue: false hasContentIssue false
  • English
  • Français

Successful use of a military-grade haemostatic agent for a major head and neck bleed

Published online by Cambridge University Press:  23 September 2013

R Crunkhorn ,
R Burnham  and
G Walton
R Crunkhorn*
Affiliation:
Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
R Burnham
Affiliation:
Department of Maxillofacial Surgery, University Hospital of North Staffordshire NHS Trust, Stoke on Trent, UK
G Walton
Affiliation:
Department of Maxillofacial Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
*
Address for correspondence: Dr R Crunkhorn, Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Rd, Coventry CV2 2DX, UK Fax: 02476 967729 E-mail: rosacrunkhorn@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Major haemorrhage is a catastrophic complication occurring in 3–4 per cent of head and neck cancer patients. Massive haemorrhage also causes 50 per cent of preventable deaths in combat situations. There has been a surge of interest in the development of effective haemostatic products in the military, with chitosan being one such product.

Case report:

A 48-year-old lady presented with a life-threatening head and neck bleed. She was known to have a malignant peripheral nerve sheath sarcoma originating from the left parapharyngeal space. Bleeding was successfully controlled with the application of Celox™ granules, a chitosan-based product currently used in the military.

Conclusion:

This paper describes the first known use of a military haemostatic agent to control a malignant head and neck bleed. Celox granules can be poured directly onto a wound to enhance haemorrhage control. The suggested mechanism of action and reports of current uses of haemostatic agents are described.

Keywords

HemorrhageHead And Neck CancerHemostatic TechniquesChitosanMilitary Personnel
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 10 , October 2013 , pp. 1031 - 1033
Copyright
Copyright © JLO (1984) Limited 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Upile, T, Triaridis, S, Kirkland, P, Archer, D, Searle, A, Irving, C et al. The management of carotid artery rupture. Eur Arch Otorhinolaryngol 2005;262:555–60CrossRefGoogle ScholarPubMed
2Powitzky, R, Vasan, N, Krempl, G, Medina, J. Carotid blowout in patients with head and neck cancer. Ann Otol Rhinol Laryngol 2010;119:476–84CrossRefGoogle ScholarPubMed
3Wedmore, I, McManus, JG, Pusateri, AE, Holcomb, JB. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J Trauma 2006;60:655–8CrossRefGoogle ScholarPubMed
4Millner, R, Lockhart, AS, Marr, R. Chitosan arrests bleeding in major hepatic injuries with clotting dysfunction: an in vivo experimental study in a model of hepatic injury in the presence of moderate systemic heparinisation. Ann R Coll Surg Engl 2010;92:559–61CrossRefGoogle Scholar
5Kourelis, K, Shikani, AH. Effectiveness of chitosan-based packing in 35 patients with recalcitrant epistaxis in the context of coagulopathy. Clin Otolaryngol 2012;37:309–13CrossRefGoogle ScholarPubMed
6Granville-Chapman, J, Jacobs, N, Midwinter, MJ. Pre-hospital haemostatic dressings: a systematic review. Injury 2011;42:447–59CrossRefGoogle ScholarPubMed
7Millner, RW, Lockhart, AS, Bird, H, Alexiou, C. A new hemostatic agent: initial life-saving experience with Celox (chitosan) in cardiothoracic surgery. Ann Thorac Surg 2009;87:e13–14CrossRefGoogle ScholarPubMed
8Valentine, R, Athanasiadis, T, Moratti, S, Hanton, L, Robinson, S, Wormald, PJ. The efficacy of a novel chitosan gel on hemostasis and wound healing after endoscopic sinus surgery. Am J Rhinol Allergy 2010;24:70–5CrossRefGoogle ScholarPubMed
9Schmid, BC, Rezniczek, GA, Rolf, N, Maul, H. Postpartum hemorrhage: use of hemostatic combat gauze. Am J Obstet Gynecol 2012;206:e12–13CrossRefGoogle ScholarPubMed
10Klokkevold, PR, Fukayama, H, Sung, EC, Bertolami, CN. The effect of chitosan (poly-N-acetyl glucosamine) on lingual hemostasis in heparinized rabbits. J Oral Maxillofac Surg 1999;57:49–52CrossRefGoogle ScholarPubMed