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, andsurgical resection is the mainstay of therapy. The goal of therapy is directed at control of thetumor 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 wavelengththat provides deep thermal coagulation. This allows its use for these vascular lesions. Withlaser surgery, hemorrhage is the most frequent and dangerous complication, and its control isextremely important. Ligation and suture remain the traditional methods of hemostasis inmost surgical situations. However, on certain occasions problems arise, particularly withlarge oozing surfaces or when surgical access is poor. Topical hemostatic agents are widelyused in a variety of surgical procedures to successfully solve such problems. Microfibrillarcollagen (Avitene) is one of the absorbable, topical, hemostatic agents, and is used effectivelyto control bleeding in many surgical situations. Since we began to use microfibrillar collagen(AviteneTM, MedchemProduct, Inc., Woburn, MA01801) to stop the massive oozing ofthe laser-induced surgical wound, no episodes of bleeding had ever occurred. It is concludedthat 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.