Case Report
Life Threatening Complication Arterial Bleeding During Atlas-Axis Fusion Surgery Stopped with Wound Clot
Djabbarov Rustam1 and Yoffe Boris2*
1Department of Orthopedics, General and Vascular Surgery, Barzilai University Medical Center, Israel
2Department of General and Vascular Surgery and the Vascular Surgery Clinic, Barzilai Medical Center, Israel
*Corresponding author: Yoffe Boris, Department of General and Vascular Surgery and the Vascular Surgery Clinic, Barzilai Medical Center, Israel
Published: 09 Mar, 2018
Cite this article as: Rustam D, Boris Y. Life Threatening
Complication Arterial Bleeding During
Atlas-Axis Fusion Surgery Stopped with
Wound Clot. Clin Surg. 2018; 3: 1932.
Abstract
The C1-C2 motion segment is a unique and complex articulation which contributes half of the rotational motion in the cervical spine. Although congenital conditions, such as Down’s syndrome or Osteogenesis imperfecta, can cause atlanto axial instability, the main etiologies in adults are acute trauma, or inflammatory pannus of rheumatoid arthritis. Infection can also be implicated, due to the rich arterial supply and venous plexus in the region providing a pathway for infectious agents.
Introduction
A 68 year old male patient, in the Department of Orthopedics, Barzilai Hospital, Ashkelon,
Israel, who presented with C1-C2 instability, was undergoing Harms's posterior fixation surgical
arthrodesis of the atlas-axis complex. During the insertion of a fixation screw into the atlas, the screw
penetrated the right vertebral artery, resulting in immediate profuse arterial bleeding which would
not stop by the screw insertion because of bone splitting. Several methods were attempted to control
the hemorrhage but at no avail. The lack of direct access to the bleeding source and the pressure of
the blood flow caused Bone Wax to break down and to float out. Furthermore, any attempts to press
directly onto the bleeding source failed due to the location under the atlas. A vascular surgeon was
urgently called to the OR as the patient had already lost 1 liter of blood. Recommended Wound Clot
Hemostat (WCH) as an intermediate emergency solution while he was scrubbing in.
WCH, manufactured by Core Scientific Creations, is a novel hemostat for bleeding control
based on non-oxidized bio-absorbable cellulose. Due to its unique non-oxidation technology, the
product can control mild to severe hemorrhage without applying compression onto the bleeding
site. WCH may be applied to multiple tissue types, including blood vessels, internal organs, bones
and complex wounds. It is bio-resorbable and absorbed in the body within c.a. 7 days.
5 cm × 5 cm Wound Clot Surgical gauze was placed directly onto the tear in the vertebral artery
without any compression application. WCH was immediately able to reach the bleeding source
using the blood saturated gel as an anchor to adhere to the source of hemorrhage. Bleeding from the
artery instantly decreased, reaching complete stasis in less than 2 min (before the vascular surgeon
was sterile and ready to operate).
As of which, the vascular surgeon decided the hemostasis was
stable and did not require any further surgical intervention. He
instructed the surgeons to place two more 5x5 cm pieces of WCH
and continue with an alternate fixation method.
The head surgeon stated, "We are sure that this product managed
to save the patient’s life and avoided an unnecessary extension of the
surgery by very difficult exploration of the vertebral artery or the use
of endo-vascular technique for embolization of the bleeding artery."
During the follow-up examination, no re-bleeding could be
detected. The patient felt very well and was walking the next day, with
no apparent negative sequelae from the surgery.
Discussion
Wound Clot Surgical was placed on the bleeding source to treat
un-controlled high pressure severe arterial hemorrhage. Although
blood continuously flowed, once WCH was placed onto the bleeding
site it began to absorb blood and transform into a gel state. WCH selfadhered
to the artery, as it rapidly absorbed blood, utilizing mucoadhesion
principles to counter forces exerted from the blood flow,
without the need to apply pressure onto the bleeding vessel. Wound
Clot’s absorption capability, over 2500% its own weight, is a result
of its unique capacity to form a stable gel when exposed to a large
volume of blood. The elevated absorption, along with its maintenance
of a stable membrane, aids in coagulation by pooling coagulants in
significant quantities in the vicinity of the injured site and activating
them. Patented structured groups on the molecular level stimulates
the intrinsic clotting mechanism and significantly multiplies the
quantity and interaction of the different factors, enhancing the
coagulation process and reducing the coagulation time by more than
50%. Therefore, the entire clotting cascade activity is enhanced and
optimized to result in a stable biological clot and achieve natural
hemostasis based on the blood’s coagulation capabilities.
In conclusion, during this life-threatening complication in C1-
C2 fixation surgery, Wound Clot Hemostat managed to stop highpressure
high-volume hemorrhage from the vertebral artery within
less than 2 min without applying pressure onto the bleeding vessel.