Use of Chitosan Granules for Refractory Intraoperative Bleeding in Orbital Vascular Malformations

Severe intraoperative bleeding unresponsive to conventional hemostatic methods occurred in 4 patients with distensible orbital venous malformations (n = 3) or orbitotemporal arteriovenous malformations (n = 1) (ages: 15-27 years; 3 women, 1 man) during surgical excision of the vascular masses. The bleeding originated from the intraorbital soft-tissue or intraosseous components of the lesions. In all cases, hemostasis was achieved following the application of chitosan granules with compression. Estimated blood loss ranged from 150 to 700 ml, and 1 patient required a blood transfusion. No postoperative hemorrhage developed, and no ocular toxicity or abnormal healing attributable to the intraorbital use of chitosan granules was observed. Chitosan granules may be useful for managing refractory intraoperative bleeding during orbital surgery. Further studies are warranted to validate these observations.