Title: A Systematic Review of Polymeric Adhesives for Wound Closure: Strategies for Enhancing Hemostasis and Economic Viability
Authors: Ibrahim Y. I. Elgady¹, Muhab S. S. Hassanien², Yousif A. A.³, Akram I. Omara ?
Volume: 10
Issue: 5
Pages: 63-79
Publication Date: 2026/05/28
Abstract:
Background: The management of acute hemorrhage remains a critical challenge in modern surgery and emergency medicine. Conventional wound-closure modalities-including sutures, surgical staples, and standard gauze dressings-demonstrate significant limitations in controlling profuse bleeding from fragile or highly vascularized tissues. Polymeric adhesives and hemostatic biomaterials have emerged as transformative alternatives, yet a rigorous comparative synthesis of their physicochemical performance and economic feasibility is lacking. Objectives: This systematic review evaluates the efficacy of natural, synthetic, and hybrid polymeric adhesives for wound closure and hemostasis, with particular emphasis on chitosan as a model biopolymer. Performance metrics including adhesion strength, hemostatic time, biocompatibility index, and degradation kinetics are analyzed alongside a scenario-based cost-effectiveness framework for resource-limited settings. Methods: A PRISMA 2020-compliant systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar. A total of 1,247 records were screened; 38 studies meeting eligibility criteria were included in qualitative synthesis. Due to substantial heterogeneity in outcome definitions, wound models, and polymer formulations across included studies, quantitative meta-analysis was not performed; findings are synthesized narratively with supporting conceptual engineering frameworks. Results: The evidence base suggests that biopolymers, particularly chitosan, demonstrate superior adhesion to hydrated tissues and are strongly associated with activation of the coagulation cascade through electrostatic interaction with platelet membranes. Synthetic polymers (PEG, cyanoacrylates) indicate faster mechanical sealing times (<30 s) but are associated with lower biocompatibility indices. Hybrid nanocomposite systems appear to offer the most balanced hemostatic profile (hemostatic time: 1-2 min; adhesion strength: 10?-10? N/m²). Scenario-based economic modeling indicates that domestically produced chitosan dressings in Sudan may be manufacturable for approximately USD 0.60 per patient per day, compared to USD 8-20 for imported alternatives. Conclusions: Available evidence suggests that chitosan-based polymeric adhesives represent a clinically effective, biologically safe, and potentially economically viable hemostatic strategy. The scenario-based cost model warrants validation through a formal techno-economic feasibility study and prospective clinical comparison.