Microfibrillar collagen for hemostasis in laryngomicrosurgery of hypopharyngeal hemangioma

Hypopharyngeal hemangiomas are uncommon neoplasms that can cause dysphagia, recurrent bleeding, and airway obstruction. These lesions are a therapeutic challenge, and surgical resection is the mainstay of therapy. The goal of therapy is directed at control of the tumor and relief of symptoms rather than total eradication of the lesion. Laser therapy is a very useful adjunct in the management of these vascular neoplasms. The neodymium: yttrium-aluminum-garnet laser (Nd: YAG laser) functions at a wavelength that provides deep thermal coagulation. This allows its use for these vascular lesions. With laser surgery, hemorrhage is the most frequent and dangerous complication, and its control is extremely important. Ligation and suture remain the traditional methods of hemostasis in most surgical situations. However, on certain occasional problems arise, particularly with large oozing surfaces or when surgical access is poor. Topical hemostatic agents are widely used in a variety of surgical procedures to successfully solve such problems. Microfibrillar collagen (Avitene) is one of the absorbable, topical, hemostatic agents, and is used effectively to control bleeding in many surgical situations. Since we began to use microfibrillar collagen (AviteneTM, MedchemProduct, Inc., Woburn, MA01801) to stop the massive oozing of the laser-induced surgical wound, no episodes of bleeding had ever occurred. It is concluded that Avitene is an effective agent for maintaining hemostasis in many surgical procedures, and we consider it a good remedy for management of laser-induced bleeding complications.