Effetto emostatico di un gel bioadesivo a base di oli essenziali nelle biopsie orali

OBJECTIVES The main objective of this study was to evaluate the efficacy of a bio-adhesive gel based on essential oils, used in patients who received biopsies for oral mucosal lesions. Primary outcome: to verify the hemostatic activity of the gel. Secondary outcomes: to verify antiseptic, pain-relieving and re-epithelizing properties of the gel. MATERIALS AND METHODS The present study was conducted at the Oral medicine clinics of the Azienda socio sanitaria territoriale Santi Paolo e Carlo, presidio San Paolo (Università degli studi di Milano). Patients were consecutively recruited at first visit. After the surgical procedure, a thin layer of double-sided gel (Hobagel Plus ®) was applied on the surgical site which healed by secondary intention. Patients were instructed to repeat the application of the gel 3 times a day for 21 days. At the end of the intervention, the patients received questionnaires, to be filled out daily during the first week, to evaluate presence of bleeding, degree of pain, intake of painkillers and possible adverse effects. Each patient was reassessed after 3, 7, 21 and 28 days. During the follow-up visits, an expert clinician made a careful examination of the oral cavity with particular attention to the surgical wound, verifying the possible presence of bleeding, signs of infection and the degree of re-epithelialization of the wound. RESULTS From January 2018 to July 2018, 25 patients were recruited; 32 biopsies were performed. All patients were discharged with a stable clot, not needing sutures, and in absence of perioperative bleeding. There were 3 minor wound bleedings, resolved autonomously by the patients. In all 3 cases, the bleeding occurred during the same day of the intervention, soon after the patient’s discharge. During the post-operative days, no bleeding was reported. No signs of infection were recorded during the follow-up visits. Seven patients experienced mild pain during the post-operative week, 5 of them only on the first day. The remaining 18 patients reported a total absence of pain. None of the 25 patients took painkillers. There were no delays in the healing of surgical wounds and no patient reported adverse effects related to the use of the bioadhesive gel. The gel showed excellent hemostatic, antiseptic, pain-relieving and re-epithelizing properties. There were no delays in the healing of surgical wounds, nor other adverse effects. CONCLUSIONS The gel showed excellent haemostatic, antiseptic, pain-relieving and re-epithelizing properties and it could be proposed as promising alternative to the use of suture and chlorhexidine. CLINICAL SIGNIFICANCE The use of the gel can be particularly useful for the clinician in case of biopsy on oral mucosa difficult to be sutured, such as friable tissues due to chronic inflammatory diseases or keratinized mucosa, adherent to underlying hard tissues (hard palate, adherent gingiva). Further advantages related to the use of the gel are the reduction of operating time, avoiding the suture of the surgical wound, and also the reduction of the number of appointments, since the visit for the suture removal becomes, thus, unnecessary.