A super-efficient and biosafe hemostatic cotton gauze with controlled balance of hydrophilicity/hydrophobicity and tissue adhesiveness

Abstract Cotton gauze is a widely used topical hemostatic material for bleeding control in military and civil accidents and surgical operations, but its high blood absorption capacity tends to cause extra blood loss of the wounded person, which may increase the risk of shock and death. Therefore, development of rapid hemostatic cotton gauze with less blood loss is of great significance. Herein, we prepared a super-efficient hemostatic cotton gauze whose surface was slightly modified with a catechol compound which features a flexible long hydrophobic alkyl chain terminated with a catechol group. Its hemostatic performance in rat and pig injury models was far superior to standard cotton gauze and Combat GauzeTM. The latter is a well-known commercial gauze for controlling massive hemorrhaging. Additionally, after stoppage of bleeding, the wound sites hardly re-bleed upon the gauze was peeled off. Histological analysis proved that the novel cotton gauze well kept the biosafety of cotton gauze. Interestingly, a similar impressive hemostatic performance was also achieved for chitosan nonwoven gauze modified with the same procedure. Density functional theory calculation and instrumental measurements demonstrate that their extraordinary hemostatic capability is attributable to the highly efficient formation of big and thick primary blood clot made of massive aggregated erythrocytes, due to gauze’s effective controlling of blood movement through its blocking effect from tissue adhesion by catechol, platelet activation by cotton fiber, blood absorption by cotton, and hydrophobic effect from long alkyl chain. The methodology and hemostatic mechanisms presented in this work may open a new avenue for developing highly efficient hemostatic gauzes.