Skip to main content Accessibility help
×
Home

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

  • R Crunkhorn (a1), R Burnham (a2) and G Walton (a3)

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.

Copyright

Corresponding author

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

References

Hide All
1Upile, T, Triaridis, S, Kirkland, P, Archer, D, Searle, A, Irving, C et al. The management of carotid artery rupture. Eur Arch Otorhinolaryngol 2005;262:555–60
2Powitzky, R, Vasan, N, Krempl, G, Medina, J. Carotid blowout in patients with head and neck cancer. Ann Otol Rhinol Laryngol 2010;119:476–84
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;60:655–8
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;92:559–61
5Kourelis, K, Shikani, AH. Effectiveness of chitosan-based packing in 35 patients with recalcitrant epistaxis in the context of coagulopathy. Clin Otolaryngol 2012;37:309–13
6Granville-Chapman, J, Jacobs, N, Midwinter, MJ. Pre-hospital haemostatic dressings: a systematic review. Injury 2011;42:447–59
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:e13–14
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;24:70–5
9Schmid, BC, Rezniczek, GA, Rolf, N, Maul, H. Postpartum hemorrhage: use of hemostatic combat gauze. Am J Obstet Gynecol 2012;206:e12–13
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;57:4952

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed