The PEG-coated collagen patch Hemopatch ® for hemostasis and dural sealing in neurosurgery

Jakob Rossmann^1*Apio CM Antunes²Guy G Broc³Danny TM Chan⁴Se-Yi Chen⁵Nicolas Dea⁶Jacob Fairhall⁷Pablo De Andrés Guijarro⁸Nicola Montano⁹Karl-Michael Schebesch¹Jake Timothy¹⁰Vamsi Krishna Yerramneni¹¹

• ¹Universitätsklinik für Neurochirurgie, Klinikum Nürnberg, Nürnberg, Germany
• ²Universidade Federal do Rio Grande do Sul and Hospital de Clínicas de Porto Alegre, Neurosurgery Department, Porto Alegre, Rio Grande do Sul, Brazil
• ³Neurosurgery Department, The American British Cowdray Hospital, Mexico City, Mexico
• ⁴Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong (SAR), China
• ⁵Department of Neurosurgery, Chung Shan Medical University Hospital, Taichung City, Taiwan
• ⁶Division of Neurosurgery, Department of Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, Canada
• ⁷BrainSpine Neurosurgery, Prince of Wales Hospital, Randwick, Australia
• ⁸Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
• ⁹Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS – Università Cattolica del Sacro Cuore, Rome, Italy
• ¹⁰Consultant Spinal Neurosurgeon at Nuffield Hospital, Leeds, United Kingdom
• ¹¹Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India

Postoperative cerebrospinal fluid (CSF) leakage and bleeding cause major postoperative complications that increase the costs for the healthcare system. The use of Hemopatch ® Sealing Hemostat has been already shown to reduce the incidence of such postoperative complications. The goal of this technical report is to provide neurosurgeons with the best recommendations for using these patches as hemostatic and dural sealant in cranial and spinal procedures.Clinical experiences of 10 neurosurgeons with Hemopatch ® from around the world were evaluated using an online survey followed by a hands-on preclinical workshop on adult pigs and concluding with an in-depth discussion about the use of both patches.Survey results provide an overview of how and when experts use different types of dural repair material, including decision-making factors. During the workshop, Hemopatch ® presented excellent tissue adherence on all evaluated defects. The new configuration of the patch showed improved tissue adherence, less curling of the patch, and easier removal of the gauze used for compression. Experts recommend using patches that overlap the defect for ≥1 cm. When closing defects that do not allow for a dried application site, Hemopatch ® can be put on a dry gauze, which can be bent to U-shape. This allows better targeting of the application site and enables immediate compression upon placement.Results provide information to improve the hands-on use of Hemopatch ® as dural sealant and therefore lower the patient's risk of postoperative complications such as CSF leaks, eventually reducing costs for the healthcare system.