Attempts to bypass the need for splenectomy in splenic injury

Within the last decade spleen salvage has been a controversial issue. Only recently, with the advances and utilization of modern technology in surgery, spurred by a better understanding of this immunologically important organ, preservation has become a reality. Numerous approaches have been suggested. Reported is a simple method of applying a new agent, Fibrin Seal (FS), to control hemorrhage from splenic injury. In a controlled study using 14 mongrel dogs, it is compared to the hemostatic ability of cryoprecipitate with thrombin and Avitene. FS is an adhesive material with hemostatic qualities consisting of fibrinogen, factor XIII, antiplasmin, cold-insoluble globulin, and platelet growth factor. FS appears to have cohesive and adhesive properties that result in more efficient hemostasis than the controls. FS conforms to the spleen surface, allowing manipulation of the organ without dislodgement of the coagulum. Follow-up laparotomy showed minimal tissue reaction. On the basis of these data, consideration of FS as an important hemostatic agent warrants clinical investigation.