Neurology India, Vol. 59, No. 5, September-October, 2011, pp. 785-786
Letter to Editor
Absorbable gelatin sponge for postoperative dressing: A novel use to reduce pain and bleeding during dressing removal after neurosurgical procedures
Gopalakrishnan M Sasidharan
Department of Neurosurgery, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, India
Postoperative wound dressing after cranial neurosurgical procedures varies widely from centre to centre. With larger number of neurosurgeons preferring to avoid a full head shave, instead, doing only a limited clipping or shaving at the incision site, the earlier ubiquitous elastic adhesive bandage dressing, which was notoriously painful to remove, has become less common. Despite availability of modern, non-adherent moisture retaining occlusive dressings, the current trend in many countries including India is the use of gauze dressing secured with adhesive tapes. , Removal of such dressing causes considerable pain and occasionally even bleeding from the wound edges due to propensity of gauze to get stuck at wound edges, although this common observation is contested by a recent randomized controlled trial.  Discomfort to the patient and disruption to wound during removal of dressing has not been reported widely despite the fact that it is all too common, perhaps because the procedure is often relegated to the junior most staff or residents.
The author has been using linear strips of manually compressed dry gelatin sponge (Spongostan; Ferrosan, Soeborg, Denmark), about a centimetre wide to apply directly on to the sutured surgical wound site before placing gauze and then securing the whole dressing either with adhesive paper tape (Hipore; Sutures India Inc, Bangalore, India), or nonadhesive bandage in over a hundred cases [Figure - 1]. Gelatin sponge absorbs any ooze or bleeding from the wound edges and prevents soakage of dressing which is otherwise sometimes seen in the immediate postoperative period because of the richly vascular nature of scalp tissue [Figure - 2]. Also gelatin foam adheres with much less tenacity to wound edges compared to gauze. Gelatin sponge is a time tested, commonly used, relatively inexpensive bioabsorbable hemostatic agent believed to act by virtue of its ability to absorb fluids many times its weight and also by providing a physical matrix promoting hemostasis. 
Removal of the dressing, usually by the third postoperative day, is much less painful and does not cause bleeding since any little adherent gelatin sponge gets broken away rather than causing undue traction on the wound edges while gauze and gelatin sponge are being peeled off [Figure - 2]. Care is also taken while adhesive paper tape is removed using ether to dissolve the glue that sticks to hair to avoid patient's discomfort. Typically, the patient is then advised to take a head bath after the removal of dressing when any further adherent sponge is washed away.
This method of application of the absorbable gelatin sponge has resulted in much easier and near painless removal of dressing while eliminating trauma to wound edges. The author has not found any complications, infective or otherwise, related to this technique and highly recommend this simple solution to colleagues in Neurosurgery as well as to those in other surgical fields.
Copyright 2011 - Neurology India
The following images related to this document are available:
Photo images[ni11242f2.jpg] [ni11242f1.jpg]