A silk nanofiber and hyaluronic acid composite hemostatic sponge for compressible hemostasis

Uncontrolled traumatic blood loss is a leading cause of hemorrhagic shock and death, highlighting the critical need for compressible and rapid hemostatic first-aid materials. In this study, silk nanofibers (MA-SNFs) were prepared through maleic acid (MA) hydrolysis decorated with enriched carboxyl groups. The MA-SNFs were then combined with hyaluronic acid (HA) through EDC/NHS crosslinking to form a porous sponge (i.e., MA-SNF/HA) through freeze-drying. The fabricated MA-SNF/HA sponges demonstrated excellent blood compatibility (hemolysis ratio < 5 %), outstanding hemocompatibility (blood clotting index (BCI) < 35 % within 60 s), and good cytocompatibility (cell viability >85 %). Among the different sponges prepared, M4-H6 (MA-SNFs: HA = 4:6) exhibited the best liquid reabsorption capacity after 80 % compression, outperforming M6-H4 and M5-H5 sponges. Furthermore, M4-H6 sponge absorbed liquid rapidly (~30 s) while matching the liquid absorption capacity of commercial gelatin sponge (GS), which require over 5 min for similar absorption (2232.84 ± 141.69 %). These findings suggest that M4-H6 sponge is highly suitable for compressible hemostasis applications and provide further insights into its potential hemostatic mechanism.