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Table 1 Summary of topical biomaterials to prevent PTH

From: Topical biomaterials to prevent post-tonsillectomy hemorrhage

Biomaterial

Decrease PTH severity (Y/N)

Decrease PTH incidence (Y/N)

Reduce pain (Y/N)

Study type

Commercial Products

Administer type

Other outcomes

FDA approval for human (Y/N)

Fibrin-based Hemostasis glue/fleece/ patch/

Fibrin glue: Fibrinogen and/or thrombin

N [31, 34, 35]

Y [36]

N [31, 34, 35],

Y (spray) [38]

randomized double-blind study on 50 adults patients [34], prospective randomized double-blind study on 168 consecutive patients and systematic review [31]

Tissucol™/ Tisseel™, and Crosseal™ / Quixil®, Evicel®

Post-op

Easy to use, maybe time efficient in operation but storage at low temperatures, and long thawing time [31]. decreased immediate inflammatory response following adenotonsillectomy [37]. Not enough sample sizes were studied [31].

Y [59, 65]

Fibrin-based collagen fleece/patch

reduced emergency surgery for severe PTH without an apparent adverse effect [66]

N [66]

Y [66]

Clinical study on 1057 children patients [66]

TachoComb®, TachoSil®, Evarrest® fibrin sealant patch

Post-op

provided a mechanical scaffold on which vascular regeneration occurred. Not cost efficient. Too expansive for some surgical units [58]

Y TachoSil [48]

Y Evarrest® [54]

N TachoComb

Gelatin-based Hemostat

Gelatin-Thrombin Hemostatic Matrix (GTHM)

Y [67]

N

Y [61], [67]

N [68]

Case study by reviewing 42 pediatric patients and retrospective data analysis [61], randomized, controlled trial in adults [68, 69] and children [67, 70] and a review [71]

Flosealâ„¢ Hemostatic Matrix

Post-op [61, 71]

simple, safe, and efficacious and cost-effective [61, 70]

Y [72]

Absorbable cellulose-based Hemostat

oxidized cellulose polymer hemostatic agent

Y [73]

Y (when combine with suturation) [74]

N (when combine with suturation) [74]

Surgicel plus saturation on total of 760 patients (393 males, 367 females) between the ages of 4 and 35 years [74]

Surgicel®, Cellistypt®, Pahacel®, Oxycel®, Gelita®, GuraTamp®

Intra-op

aids in clot formation by activation of the extrinsic and intrinsic coagulation pathways,

Introduced a risk of aspiration and suffocation [75]; Possible inflammation [76].

Y Surgicel® [77]

N for others

Bismuth subgallate-based

BSG- adrenaline paste, BSG- phenylephrine hydrochloride mixture

Y [78]

Y (BSG mixed with phenylephrine hydrochloride) [79]

Y BSG with adrenaline for primary PTH [80], N for secondary PTH [81]

N [81]

Clinical study on patients underwent tonsillectomy [78, 81]

Spectrum Chemical (powder), mixing 26 g of BSG powder to 20 ml of normal saline with 0.7 ml of 1:1000 adrenaline

Post-op

decreases operating time by significantly reducing the hemostasis time and the number of ligatures [78, 81]; accelerates the cascade of blood clotting [79]; accelerate the intrinsic clotting pathway through the activation of factor XII (Hageman factor) [82].

Y [62]

Antifibrinolytics

tranexamic acid (TXA) liquid

Y [83, 84]

N [83, 84]

–

Clinical reports analysis of 246 patients topically treated with TA and 248 control [84]

Systematic review [83]

Cyklokapron®

Postop

no device or site for infection, reduce intraoperative blood loss during Orthognathic Surgery, prevent postop hemorrhage after oral or dental surgery in hemophilia A patients and those on warfarin anticoagulation [85]

N for Topical application

Natural material

Propolis

–

Y [86]

Y [86]

Randomized controlled study on 65 patients [86]

Topical propolis gel

gargle immediately after surgery [86]

accelerated wound healing of tonsillar fossae

N

Herbal ingredients

Y [87]

–

–

Clinical trial in 47 consecutive children patients

Ankaferd Blood Stopper®

Intra-op

safe and efficient, and it reduces operating time [87], and contains no synthetic additives [88]

N

Autologous serum

–

Y [89]

Y [89]

A preliminary study on 32 patients (4–15 years old) [89]

Centrifuge peripheral venous blood at 1500–2000 g for 10 min to separate the serum and then topically administered

Intra and post 8 and 24 h

Contributed to tonsillar fossa epithelization in postoperative period

Only preliminary study was performed

N