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Role of hydrogen peroxide in intra-operative wound preparation based on an in vitro fibrin clot degradation model
,
Elena García-Gareta ,
YADAN ZHANG,
Thomas Jovic,
Nafiseh Badiei,
Vaibhav Sharma,
Iain Whitaker,
Norbert Kang
JPRAS Open, Volume: 29, Pages: 113 - 122
Swansea University Authors:
Zita Jessop , YADAN ZHANG, Thomas Jovic, Nafiseh Badiei, Iain Whitaker
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DOI (Published version): 10.1016/j.jpra.2021.04.008
Abstract
Three per cent hydrogen peroxide (H2O2) is widely used to irrigate acute and chronic wounds in the surgical setting and clinical experience tells us that it is more effective at removing dried-on blood than normal saline alone. We hypothesise that this is due to the effect of H2O2 on fibrin clot arc...
| Published in: | JPRAS Open |
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| ISSN: | 2352-5878 |
| Published: |
Elsevier BV
2021
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa60415 |
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| Abstract: |
Three per cent hydrogen peroxide (H2O2) is widely used to irrigate acute and chronic wounds in the surgical setting and clinical experience tells us that it is more effective at removing dried-on blood than normal saline alone. We hypothesise that this is due to the effect of H2O2 on fibrin clot architecture via fibrinolysis. We investigate the mechanisms and discuss the clinical implications using an in vitro model. Coagulation assays with normal saline (NaCl), 1% and 3% concentrations of H2O2 were performed to determine the effect on fibrin clot formation. These effects were confirmed by spectrophotometry. The effects of 1%, 3% and 10% H2O2 on the macroscopic and microscopic features of fibrin clots were assessed at set time intervals and compared to a NaCl control. Quantitative analysis of fibrin networks was undertaken to determine the fibre length, diameter, branch point density and pore size. Fibrin clots immersed in 1%, 3% and 10% H2O2 demonstrated volume losses of 0.09-0.25mm3/min, whereas those immersed in the normal saline gained in volume by 0.02±0.13 mm3/min. Quantitative analysis showed that H2O2 affects the structure of the fibrin clot in a concentration-dependent manner, with the increase in fibre length, diameter and consequently pore sizes. Our results support our hypothesis that the efficacy of H2O2 in cleaning blood from wounds is enhanced by its effects on fibrin clot architecture in a concentration- and time-dependent manner. The observed changes in fibre size and branch point density suggest that H2O2 is acting on the quaternary structure of the fibrin clot, most likely via its effect on cross-linking of the fibrin monomers and may therefore be of benefit for the removal of other fibrin-dependent structures such as wound slough. |
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| Keywords: |
Wound irrigation, hydrogen peroxide, fibrinolysis, fibrin clot, coagulation assay |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
This work was supported by the Restoration of Appearance and Function Trust (Registered Charity No 299811, United Kingdom), the Medical Research Council (MR/N002431/1), the Welsh Clinical Academic Training Pathway, ABM University Health Board / Health Research Wales, the Oakgrove Foundation (Registered charity No 1164926, United Kingdom), Royal College of Surgeons of England, British Association of Plastic and Reconstructive Surgeons, and the Fulbright Commission. We thank Dr A. Al-Sabah for the statistical analysis advice. |
| Start Page: |
113 |
| End Page: |
122 |