Hemostatic materials in wound care

Abstract

Blood plays an essential role in the human body. Hemorrhage is a critical cause of both military and civilian casualties. The human body has its own hemostatic mechanism that involves complex processes and has limited capacity. However, in emergency situations such as battlefields and hospitals, when the hemostatic mechanism of the human body itself cannot stop bleeding effectively, hemostatic materials are needed for saving lives. In this review, the hemostatic mechanisms and performance of the most commonly used hemostatic materials, (including fibrin, collagen, zeolite, gelatin, alginate, chitosan, cellulose and cyanoacrylate) and the commercial wound dressings based on these materials, will be discussed. These materials may have limitations, such as poor tissue adhesion, risk of infection and exothermic reactions, that may lessen their hemostatic efficacy and cause secondary injuries. High-performance hemostatic materials, therefore, have been designed and developed to improve hemostatic efficiency in clinical use. In this review, hemostatic materials with advanced performances, such as antibacterial capacity, superhydrophobicity/superhydrophilicity, superelasticity, high porosity and/or biomimicry, will be introduced. Future prospects of hemostatic materials will also be discussed in this review.

Keywords: Conventional hemostatic materials; Hemorrhage; Hemostasis; Hemostatic materials; High-performance hemostatic materials; Wound healing.

Figure 1.

Schemes of the intrinsic hemostatic mechanisms of the human body [5] (Copyright 2017 by John Wiley & Sons, Inc., New Jersey, USA)

Figure 2.

The chemical structures of fibrin (a), collagen (b), zeolite (c), gelatin (d), sodium alginate (e), chitosan (f), cellulose (g) and cyanoacrylate (h)

Figure 3.

Scheme of preparing ibuprofen-loaded chitosan/gelatin composite films [70]. (Copyright 2017 by John Wiley & Sons, Inc., New Jersey, USA)

Figure 4.

The process of preparing electrospun fibers. PEU polyester urethane, CA cellulose acetate, E-spinning tip electrospinning tip. [12] (Copyright 2012 by John Wiley & Sons, Inc., New Jersey, USA)

Figure 5.

A hyperbranched polymer (HBP) with hydrophilicity. (a) Michael addition reaction process of HBP adhesives; (b) Contact angles of HBP adhesives (I) and water (II) on ceramic (Ia,IIa), iron sheet (Ib,IIb), PMMA (Ic,IIc), PET (Id,IId), PTFE (Ie,IIe), PE (If,IIf), and glass (Ig,IIg). PMMA poly(methyl methacrylate), PTFE poly(tetrafluoroethylene), PE polyethylene HBP hyperbranched polymer. [95] (Copyright 2019 by John Wiley & Sons, Inc., New Jersey, USA)

Figure 6.

Superhydrophobic property of carbon nanofibers (CNFs). (a) Scanning electron microscopy image of the superhydrophobic CNF/PTFE Ti surface and water contact angle of the surface. (b) Blood and platelet-poor plasma droplets with anti-thrombin rolled down rapidly on the CNF/PTFE Ti surface with a small tilt angle [96]. PTFE poly(tetrafluoroethylene)

Figure 7.

In vivo hemostatic assay of Janus fabric. (a) Hemostatic performance in the rat model: The rat with injured femoral artery wrapped with bilayer common gauze, bilayer modified gauze, and Janus gauze, respectively; (b) The wounds after removing the gauze and the used gauze. [94] (Copyright 2018 by JohnWiley & Sons, Inc., New Jersey, USA)

Figure 8.

Blood gelation mechanism of hm-chitosan. [97] (Copyright 2018 by Elsevier Ltd, Amsterdam, Netherlands)

Figure 9.

Recovery process of the OCSG/CNT cryogel in a deep and irregularly shaped wound [3] (open access). QCSG quaternized chitosan, CNT carbon nanotubes

Figure 10.

Picture (a) and scanning electron microscopy image (b) of the graphene oxide-poly(vinyl alcohol) aerogels [139] (Copyright 2018 by American Chemical Society, Washington, USA)

Figure 11.

Scanning electron microscopy images of nanofibers with RADA16-I (a), red blood cells and platelets in the anticoagulation whole blood (b), RADA16-I nanofiber blood clot (c), fibrin blood clot (d) and images of fibrin and RADA16-I nanofiber blood clots (e) [145]. (f) Low-magnification images of material surfaces adhering platelets indicating the platelet density; (g) high-magnification images showing platelet spreading and clumping to indicate the higher platelet activation [147] (Copyright 2014 by American Chemical Society, Washington, USA). TCP tissue culture polystyrene, RTT rat tail tendon, KOD collagen mimetic peptides, Pura Puramatrix, RADA16-I 16-residue peptide RADARADARADARADA