Chitosan/oxidized cellulose composite nanofiber sponges: a rapid and effective hemostasis strategy for non-compressible hemorrhage

Abstract

Non-compressible hemorrhagic wounds, prevalent in combat and mass trauma scenarios, are characterized by arterial injury-induced exsanguination and geometrically complex wound morphology that challenges conventional hemostatic interventions. This paper presents a novel nanofiber hemostatic sponge (CT@GP-HAc), made from 2,2,6,6-tetramethylpiperidine-1-oxyl radical (TEMPO) oxidized cellulose nanofibers (TOCN) and chitosan nanofibers (CSNF), crosslinked with genipin (GP) in an acetic acid atmosphere. The sponge features excellent shape memory and rapid hemostatic capabilities, specifically designed for deep, irregular wounds. Its unique micro-nano composite porous structure enhances blood absorption, blood cell capture, and coagulation factor recruitment. In vitro experiments show that CT@GP-HAc outperforms traditional iRegene® GEL sponges in whole blood coagulation index, coagulation time, and red blood cell and platelet adhesion. Prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) tests reveal that CT@GP-HAc's hemostatic action is independent of the human coagulation mechanism, making it suitable for patients with coagulation disorders. Biocompatibility tests indicate an extremely low hemolysis rate and non-cytotoxicity, supporting its clinical application. In vivo studies confirm CT@GP-HAc's effectiveness in reducing blood loss and shortening hemostasis time. These findings highlight the potential of CT@GP-HAc as a next-generation hemostatic material for managing non-compressible hemorrhagic wounds.