A comparative evaluation of hemostatic agents in the management of soft tissue graft donor site bleeding

Background: Periodontal plastic surgery has increased the use of palatal wo unds for donor tissue, with the most common complication being excessive bl eeding from the palate after harvesting tissue. This study was conducted to evaluate the efficacy of 3 methods for achieving hemostasis on the palate after harvesting donor tissue for autogenous soft tissue grafts. Methods: Thirty sites were evaluated at surgery for hemostasis and followed over 21 days for healing and adverse events. Three treatment groups were r andomly selected and patients received either a test product or control com prising: 1) oxidized regenerated cellulose; 2) absorbable gelatin sponge; o r 3) sterile gauze with external pressure as the control. All patients rece ived a surgical stent for the palate. Results: The results were analyzed for smokers and non-smokers, and the med ian time to hemostasis was significantly shorter when a hemostatic agent wa s applied to the palatal wounds compared to controls in both groups. Pain a ssessment showed no differences across treatment groups. However, by 21 day s, only the oxidized regenerated cellulose group had complete healing based on blinded clinical evaluation with all sites rated as normal to rapid hea ling, compared to the absorbable gelatin sponge group where 40% of the site s were rated as slow healing. Adverse events, primarily bleeding episodes d uring the first 7 days after surgery, were found in 40% of the oxidized reg enerated cellulose and gauze control groups, while no sites in the absorbab le gelatin sponge group had an adverse event. The patients were followed fo r an average of 10 months and demonstrated a mean shrinkage of their recipi ent grafts of 24% in total surface area. Conclusions: This study concluded that the use of hemostatic agents for pal atal wounds is confirmed as the treatment of choice when performing free so ft tissue grafts.