Hemostasis

4 Hemostasis



Achieving hemostasis is an essential component of all surgery. The goal of hemostasis in surgery is to control bleeding while avoiding unnecessary tissue destruction. It is important to understand the advantages and disadvantages of all methods of hemostasis to be able to choose the appropriate methods for each surgical situation. Hemostasis can be achieved by chemical agents that produce superficial hemostasis or by electrocoagulation for deeper hemostasis. Hemostasis may also be achieved by physical methods that involve pressure, sutures, or gelatin sponges.




Chemical Hemostatic Agents








Aluminum Chloride




Aluminum chloride comes in strengths from 20% to 70% available in water- or alcohol-based solutions (Figure 4-1). Alcohol alone (anhydrous alcohol) will support a solution of up to 20%, so the stronger concentrations are either in water or a mixture of water and alcohol. I prefer to use aluminum chloride in an aqueous solution because it can be used safely with electrosurgery and comes in higher concentrations. With an alcohol-based solution, it is possible to ignite the alcohol when electrosurgery is performed in the same field. However, drying the field after applying the alcohol-based solution makes it safe to use with electrosurgery.



Aqueous aluminum chloride can be ordered as a 35% or 70% solution from Delasco (see the Resources section at the end of the chapter for ordering information). Both are inexpensive and excellent for hemostasis. No studies are available to determine whether one percentage is better than another. I use 70% with good results. These solutions have a 3-year shelf life. Drysol, the brand name of 20% aluminum chloride in anhydrous ethyl alcohol that is sold by prescription to treat hyperhidrosis, also produces hemostasis but is more expensive to purchase and messier to use.


The major advantage of aluminum chloride is that it is a clear solution that does not stain or tattoo the tissue. It does not cause tissue necrosis and does not damage the normal skin surrounding the wound. Aluminum chloride should not be used in deep wounds that will be sutured because it can delay healing and increase scarring.1


When using aluminum chloride after a shave or punch biopsy, first dry the field with a cotton-tipped applicator or gauze. The aluminum chloride should then be applied to the dry field by rolling or twisting the moist applicator against the open wound (Figure 4-2). Although light pressure may work, it often helps to use heavier pressure while twisting the applicator clockwise and counterclockwise against the area. After a 2- to 4-mm punch biopsy, a dry cotton-tipped applicator can be held with downward pressure against the open hole to dry the field. If sutures are not to be used, the aluminum chloride should be applied with downward pressure and held against the wound until hemostasis is achieved (Figure 4-3).






Mar 12, 2016 | Posted by in General Surgery | Comments Off on Hemostasis

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