Page 70 - Journal of Special Operations Medicine - Winter 2015

pad, we can calculate that this would require roughly 115 Disclosures
standard cotton lap pads. Interestingly, this also showed The authors have no financial interests related to this
us that the standard cotton lap pad can absorb around project. No outside funding was acquired or used for
130–150g of blood. It is important to recognize that any this study.
multiple-casualty scenario would leave few or no sponges
for superficial wounds, burns, or other injuries.
References
Study Limitations 1. Clarke JR, Trooskin SZ, Doshi PJ, et al. Time to laparotomy
This is a preliminary study that evaluated the absorp- for intra-abdominal bleeding from trauma does affect sur-
tion of heparinized blood. When using sponges in the vival for delays up to 90 minutes. J Trauma Acute Care Surg.
2002;52:420–425.
operating room to control hemorrhage, the sponges 2. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battle-
must not only be able to absorb but also provide effec- field (2001-2011): implications for the future of combat ca-
tive exposure and visualization of the injury to prevent sualty care. J Trauma Acute Care Surg. 2012;73(6 suppl 5):
431–437.
further blood loss and allow for surgical correction of 3. Cichon K, Schon CA. Influences on the amount of in-
the problem. While it is not entirely certain what as- traperitoneal haemorrhage after blunt liver injury: a ret-
pects of a sponge allow for better tamponade of blood rospective autopsy study. Eur J Gastroenterol Hepatol.
2012;24:1333–1340.
flow, the only way to compare this characteristic would 4. Rotondo MF, Fildes J, Brasel KJ, et al. Advanced trauma life
be side-by-side live tissue studies, which are being es- support, student course manual. 9th ed. Chicago, IL: The
tablished. Live-tissue studies would allow creation of an American College of Surgeons; 2012.
injury and use different packing material to see if rayon 5. Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review:
hemorrhagic shock. Crit Care, 2004;8:373–381.
could absorb more blood with less fabric than cotton 6. Das B, Das A, Kothari V, et al. Moisture flow through
and also create a superior tamponade effect. blended fabrics—effect of hydrophilicity. J Eng Fiber Fabr,
2009;4:20–28.
7. US Patent Office. Laparotomy sponge. Patent No. US3971381
While similar to human blood, bovine blood is not identi- A. 27 July 1976. Inventor: Robert T. Gibson.
cal to human blood and the results of our study should 8. Owens N. Rayon, an ideal surgical dressing for surface
wounds. Surgery. 1946;19:482–485.
take this into consideration. While we do not foresee this 9. Chatterjee PK, Gupta BS. Absorbent technology: textile sci-
being a major limitation, it should be mentioned and hu- ence and technology. 13th ed. Amsterdam, The Netherlands:
man whole-blood studies should be performed to confirm Elsevier Science BV; 2002.
our findings. Heparin, on the other hand, prevented the 10. Wirz M. The touch, the feel—of rayon? The Wall Street Jour-
nal: Market, Online Edition. 6 January 2011.
blood from clotting and made our study easier to perform 11. Sturdy JH, Baird RM, Gerein AN. Surgical sponges: a cause
without time limitations. This being said, unless there is of granuloma and adhesion formation. Ann Surg. 1967;165:
128–134.
substantial loss of coagulation factors, which is common 12. Derbyshire RC. Complications following the use of cotton as
in massive hemorrhage, blood in a live patient will clot. suture material. Surg Gynecol Obstet. 1947;84:31–35.
Thus, we were unable to compare the fabrics’ ability to 13. Laird JR. Keeping the room out of the patient: reducing the
absorb clotted or clotting blood. Because of the larger risk of foreign body embolization during interventional pro-
cedures. Endovascular Today. 2014:1–4.
pore and tensile size of cotton, there may be a theoretical
advantage of cotton over rayon in its ability to absorb
clotting blood but this has not yet been demonstrated. CPT Sirkin, US Army Medical Corps, is a graduate of the Medical
College of Virginia. He is a fourth-year resident in general surgery
Again, live-tissue studies in nonheparinized animals at William Beaumont Army Medical Center, Ft. Bliss, El Paso,
would allow investigation to see if this difference exists. Texas. CPT Sirkin is interested in perusing a career in operational
surgery and medicine. E-mail: max.sirkin@gmail.com.
COL Cook is a 1998 graduate of Western University of Health
Conclusion Sciences Medical School. He graduated his general surgery resi-
An equivalent mass of rayon is more effective than dency at William Beaumont Army Medical Center, Ft. Bliss, El
Paso, Texas, in 2003, where he went on to complete his fellowship
cotton for both initial and repeated uses in absorbing in vascular surgery at Scripps/University of California, San Diego,
blood. This, coupled with a decrease in space, could al- in 2008. He is currently a staff vascular surgeon at William Beau-
low providers in austere and remote locations to give mont Army Medical Center. COL Cook has served many years
care to a greater number of hemorrhaging patients and multiple deployments as a surgeon with forward elements in
austere environments
while using less space in their medical kits. Rayon-based
sponges could positively impact surgical patient care at COL Davis is a 1997 graduate of East Tennessee State Medical
School. He graduated his general surgery residency at William
the point of injury. Beaumont Army Medical Center, Ft. Bliss, El Paso, Texas, in
2004, where he went on to complete his fellowship in colorectal
surgery at Georgia Colon and Rectal Surgical Associates in 2007.
Acknowledgments He is currently a staff colorectal surgeon at William Beaumont
Army Medical Center. COL Davis has served many years and mul-
We thank Mathews Custom Meat Processing from tiple deployments as a surgeon with forward elements in austere
Belen, New Mexico, for their assistance with this study. environments.

58 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015