Use of Purastat, a novel haemostatic matrix based on self-assembling peptides in the prevention of nasopharyngeal adhesion formation

Eugene Wong, Joyce Ho, Murray Smith, Niranjan Sritharan, Faruque Riffat, Mark C Smith, Eugene Wong, Joyce Ho, Murray Smith, Niranjan Sritharan, Faruque Riffat, Mark C Smith

Abstract

Introduction: Purastat is a novel haemostatic agent that has recently been used effectively in nasal procedures, specifically in functional endoscopic endonasal surgery in the prevention of post-operative epistaxis while minimising adhesion formation. This study presents a case of successful application of Purastat following division of a nasopharyngeal/palatal stenosis following radiotherapy.

Presentation of case: A 49-year-old male developed severe nasopharyngeal stenosis following concurrent chemoradiotherapy with curative intent a HPV positive base of tongue squamous cell carcinoma. Following treatment, while the patient experienced excellent metabolic response, he began to progressive nasal obstruction which he reported to be significantly affecting his quality of life. Following multidisciplinary team discussion, division of the stenosis was considered appropriate. Under general anaesthesia, the patient was positioned lying supine with the neck extended. A Boyle-Davis gag with lip and teeth protection was placed and a Y-suction catheter inserted to lift the palate from the posterior pharyngeal wall. Coblation using a PDW wand was used to divide the area of fibrosis bilaterally toward the superior tonsillar pillar until palatopharyngeus musculature was visible. Injection of 4 mg of Dexamethasone with a hypodermic needle was then performed followed by application of 4 ml of topical Purastat onto the raw surfaces after haemostasis was confirmed. The patient was discharged the same day on simple analgesia and instructions to avoid exertion for two weeks. He attended follow-up in the outpatient department two months later and reported persisting resolution of his nasal obstructive symptoms. No evidence of recurrence or residual adhesion tissue was noted.

Keywords: Adhesion; Haemostasis; Nasopharyngeal stenosis; Purastat.

Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Intraoperative photograph during the application of PuraStat® to the raw mucosal surface. PuraStat® is applied using the provided prefilled syringe over the newly exposed raw mucosal surface following exposure of the pharynx using a Boyle-Davis mouth gag and coblation assisted division of the nasopharyngeal stenosis.
Fig. 2
Fig. 2
Intraoperative photograph following application of PuraStat®. PuraStat® has now been applied as a thin layer. The transparent property of the agent allows inspection for adequate haemostasis of the underlying tissues.

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