Skip to main content

Advertisement

SpringerLink
Log in

Use of Floseal and effects on wound healing and pain in adults undergoing tonsillectomy: randomised comparison versus electrocautery

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

The objective of this study was to evaluate the effect of FloSeal® (FS, Baxter Healthcare, Deerfield, IL, USA) as a haemostatic matrix in comparison to bipolar electrocautery (EC) after tonsillectomy. Eligible patients were adults undergoing cold-knife tonsillectomy because of recurrent tonsillitis, tonsillar hypertrophy, or peritonsillar abscess (more than 3 months previously). Patients were randomly allocated, on a single-blind basis, to either FS or EC for haemostasis during tonsillectomy. Five experienced surgeons judged the handling of FS application using a five-point scale (very good, good, fair, poor, very poor). Postoperative pain scores were evaluated with a visual analogue scale for 20 days, and the duration under pain medication together with the consumption of pain medication was compared. Wound healing was documented on Days 1–5, 10, and 20. A total of 176 patients were enrolled. Overall, 76/77 (98.7%) of surgeon evaluations of FS handling were judged at least “good”. FS-treated patients showed significantly improved wound healing (less thickness of wound plaques) throughout the postoperative observation period, a trend for less postoperative pain (cumulative pain intensity score; P = 0.074), and a significantly shorter duration of pain-medication use (9.5 vs. 11.6 days; P = 0.014) as well as reduced pain-medication consumption/demand (P = 0.032). No difference in the rate of postoperative haemorrhage was observed between the two treatment groups (4.9% for FS patients, 6.0% for EC patients, P = 0.76). In conclusion, this study demonstrates the easy handling of FS application in tonsillectomy. Its use instead of EC after cold-steel tonsillectomy shows beneficial effects on mucosal recovery, as assessed by a decrease in the thickness of wound coating. Furthermore, FS is associated with a significantly shortened duration of pain-medication use and overall reduction in consumption/demand.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Maddern BR (2002) Electrosurgery for tonsillectomy. Laryngoscope 112:11–13

    Article  PubMed  Google Scholar 

  2. Gross WC, Gallagher R, Schloser RJ et al (2001) Autologous fibrin sealant reduces pain after tonsillectomy. Laryngoscope 11:259–263

    Article  Google Scholar 

  3. Castellano P, Lopez-Escamaz JA (2003) American Society of Anesthesiology classification may predict severe post-tonsillectomy haemorrhage in children. J Otolaryngol 32:302–307

    Article  PubMed  Google Scholar 

  4. Randall DA, Hoffer ME (1998) Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 118:61–68

    Article  PubMed  CAS  Google Scholar 

  5. Oz MC, Cosgrove DM, Badduke BR et al (2000) Controlled clinical trial of a novel hemostatic agent in cardiac surgery. Ann Thorac Surg 69:1376–1382

    Article  PubMed  CAS  Google Scholar 

  6. Jacobs JB (2001) Innovative techniques: use of FloSeal in endoscopic sinus surgery: operative techniques. Otolaryngol Head Neck Surg 12:83–84

    Article  Google Scholar 

  7. Mathiasen RA, Cruz R (2004) Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in children undergoing adenoidectomy. Laryngoscope 131:601–605

    Google Scholar 

  8. Jo SH, Mathiasen RA, Gurushanthaiah D (2007) Prospective, randomized, controlled trial of a hemostatic sealant in children undergoing adenotonsillectomy. Otolaryngol Head Neck Surg 137:454–458

    Article  PubMed  Google Scholar 

  9. Huskisson EC (1974) Measurement of pain. Lancet 2:1227–1231

    Google Scholar 

  10. Silvola J, Salonen A, Nieminen J, Kokki H (2011) Tissue welding tonsillectomy provides an enhanced recovery compared to that after monopolar electrocautery technique in adults: a prospective randomized clinical trial. Eur Arch Otorhinolaryngol 268:255–260

    Article  PubMed  Google Scholar 

  11. Mitic S, Tvinnereim M, Lie E, Saltyte BJ (2007) A pilot randomized controlled trial of coblation tonsillectomy versus dissection tonsillectomy with bipolar diathermy haemostasis. Clin Otolaryngol 32:261–267

    Article  PubMed  CAS  Google Scholar 

  12. Wilson YSL, Merer DM, Moscatello AL (2009) Comparison of three common tonsillectomy techniques: a prospective randomized double-blinded clinical study. Laryngoscope 119:162–170

    Article  PubMed  Google Scholar 

  13. Gallagher TQ, Wilcox L, McGuire E, Derkay CS (2010) Analyzing factors associated with major complications after adenotonsillectomy in 4776 patients: comparing three tonsillectomy techniques. Otolaryngol Head Neck Surg 142:886–892

    Article  PubMed  Google Scholar 

  14. Apfelbaum JL, Chen C, Mehta SS, Gan T (2003) Postoperative pain experience: results from a national survey suggests postoperative pain continues to be undermanaged. Anesth Analg 97:534–540

    Article  PubMed  Google Scholar 

  15. Baumann A, Caversaccio M (2004) Hemostasis in endoscopic sinus surgery using a specific gelatine-thrombin based agent (FloSeal). Rhinology 41:244–249

    Google Scholar 

  16. Mann KG (1999) Biochemistry physiology of blood coagulation. Thromb Haemost 82:165–174

    PubMed  CAS  Google Scholar 

  17. Dorion RP, Hamati HF, Landis B, Frey C, Heydt D, Carey D (1998) Risk and clinical significance of developing antibodies induced by topical thrombin preparations. Arch Pathol Lab Med 122:887–894

    PubMed  CAS  Google Scholar 

  18. Neschis DG, Heyman MR, Cheanvechai V, Benja min ME, Flinn WR (2002) Coagulopathy as a result of factor V inhibitor after exposure to bovine topical thrombin. J Vasc Surg 35:400–402

    Article  PubMed  Google Scholar 

  19. 19th Association of University Hospitals of Germany (2009) Tonsillectomy hemorrhage. In: Quality of life-art medicine of the German Academic Medicine, Berlin, pp 24–25

  20. Windfuhr JP, Schloendorff G, Baburi D, Kremer B (2008) Lethal outcome of post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol 265:1527–1534

    Article  PubMed  CAS  Google Scholar 

  21. Stoeckli SJ, Moe KS, Huber A, Schmid S (1999) A prospective randomized double-blind trial of fibrin glue for pain and bleeding after tonsillectomy. Laryngoscope 109:652–655

    Article  PubMed  CAS  Google Scholar 

  22. Blackmore KJ, O`Hara J, Flood LM, Martin FW (2008) The effect of FloSeal on postoperative pain: a randomised controlled pilot study. Clin Otolaryngol 33:265–284

    Article  Google Scholar 

  23. Toma AG, Blanshard J, Eynon-Lewis N, Bridger MW (1995) Post-tonsillectomy pain: the first ten days. J Laryngol Otol 109:963–964

    Article  PubMed  CAS  Google Scholar 

  24. Jorgensen S, Bascom DA, Partsafa A, Wax MK (2003) The effect of 2 sealants (FloSeal and Tisseel) on fasciocutaneous flap revascularization. Arch Facial Plast Surg 5:399–401

    Article  PubMed  Google Scholar 

  25. Attner P, Hemlin C, Söderman AC (2010) Ligasure versus diathermy scissors tonsillectomy: a controlled randomized study. Acta Otolaryngol 130:1180–1184

    Article  PubMed  Google Scholar 

  26. Werner MU, Duun P, Kehlet H (2004) Prediction of postoperative pain by preoperative nociceptive responses to heat stimulation. Anesthesiology 100:115–119

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We especially thank the Coordination Centre of Clinical Trial, Leipzig (CCCTL) for the support in data management in all statistical questions and analysis. Editorial support for this manuscript was funded by Baxter and provided by Alpha-Plus Medical Communications Ltd.

Conflict of interest

This study was sponsored by Baxter, who provided the study medication (FloSeal). No further payments were received by the authors. The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, University of Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Germany

    Christian Mozet, Maria Dietze, Ulrich Fickweiler & Andreas Dietz

  2. Clinical Trial Centre Leipzig-CTC Leipzig, University of Leipzig, Leipzig, Germany

    Christiane Prettin

Authors
  1. Christian Mozet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christiane Prettin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Dietze
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulrich Fickweiler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas Dietz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Mozet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mozet, C., Prettin, C., Dietze, M. et al. Use of Floseal and effects on wound healing and pain in adults undergoing tonsillectomy: randomised comparison versus electrocautery. Eur Arch Otorhinolaryngol 269, 2247–2254 (2012). https://doi.org/10.1007/s00405-011-1904-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-011-1904-4

Keywords

Search

Navigation