Application of chitosan-based materials in surgical or postoperative hemostasis

Uncontrolled bleeding from trauma or surgery remains an important factor affecting the survival and prognosis of surgical patients. Failure to timeously stop bleeding will not only prolong the operative time but also threaten the patient’s life. Timely hemostasis after bleeding has become the most concerned event for surgeons. At present, the most commonly used hemostasis methods in the operating room include ligation of blood vessels, electrocautery, and gauze compression to stop bleeding. However, These hemostatic methods do great harm to surrounding tissues while achieving hemostasis. Based on tissue engineering repair strategies, the use of natural polymer materials as hemostatic agents has achieved clinical success. Gelatin sponge and cellulose gauze have been used clinically with good results. However, gelatin sponges are very expensive and place enormous financial pressure on patients. Therefore, there is an urgent need for new hemostatic materials for surgical hemostasis. Chitosan is a natural polysaccharide with biocompatibility and biodegradability, which plays an important role in tissue engineering and regenerative medicine. Chitosan gauze has been proven to have good hemostatic effects. The positive charge on the surface of chitosan can adsorb red blood cells and platelets at the bleeding site to form platelet thrombosis. However, chitosan is not easily soluble in water and has poor adsorption, which makes it a weak local hemostatic agent. Therefore, it is important to improve chitosan-based hemostatic material such that it l has an excellent hemostatic effect. In this review, we introduce the physiological coagulation process and discuss the physicochemical properties of chitosan and its role in hemostasis. Furthermore, we discuss the advantages and disadvantages of chitosan-based hemostatic materials. Finally, we summarize and discuss chitosan-based hemostatic materials.