The management of hemorrhage is one of the top priorities in emergency medicine, as uncontrolled bleeding accounts for a significant proportion of mortality in both trauma and surgical settings. It is now clear that time is a decisive factor: every minute lost in controlling hemorrhage exponentially increases the risk of hypovolemic shock and fatal outcomes. For decades, the response has relied on traditional methods such as direct compression, ligatures, and suturing, which, while effective, are not always applicable—particularly in cases of non-compressible bleeding or in anatomically inaccessible areas. In this scenario, the introduction of advanced protein-based hemostatics, including silk fibroin, has opened new possibilities, enabling immediate and targeted action even under particularly complex clinical conditions.
Application in acute trauma
Major trauma is the setting where the potential of next-generation hemostatics is most evident. Road accidents, gunshot wounds, or blast injuries often cause extensive lesions with bleeding that exceeds the capacity of conventional methods. In such cases, blood loss not only compromises hemodynamic stability but also worsens trauma-induced coagulopathy. Protein-based hemostatics, including fibroin, act by rapidly forming a network that traps blood cells and plasma proteins, accelerating the coagulation cascade within seconds. Clinical studies have shown that the time required to achieve stable hemostasis is reduced by more than 40% compared to standard treatments, with a direct impact on the survival of polytrauma patients. Their simple and rapid application makes them usable even in the prehospital phase, allowing healthcare providers to gain precious minutes before surgical transfer.
Intraoperative use in vascular surgery
Vascular surgery is notoriously challenging in terms of bleeding control, especially in procedures involving medium- to large-caliber vessels or in patients at high risk of thrombotic complications. Intraoperative use of protein-based hemostatics has demonstrated significant efficacy in shortening operative time, reducing transfusion requirements, and preventing complications from persistent bleeding. Several randomized clinical trials have reported a marked reduction in hemostasis times and improved surgical field visibility—a crucial factor for accuracy in vascular procedures. Fibroin, thanks to its mechanical strength and ability to integrate with tissues, also represents a promising platform in reconstructive and transplant surgery, where precision and stable hemostasis are essential.
Immediate hemostasis in out-of-hospital settings
One of the main advantages of protein-based hemostatics is their applicability outside the hospital environment. In prehospital emergency care, such as road accidents or combat scenarios, uncontrolled hemorrhage remains the leading cause of preventable death. The use of these biomaterials has significantly improved survival, enabling rapid and stable bleeding control where manual compression and bandages prove ineffective. Fibroin has shown efficacy even under extreme conditions, maintaining functionality in the presence of hypothermia, acidosis, or dilutional coagulopathy—conditions typically associated with major trauma. The availability of an easy-to-use device capable of stopping massive bleeding within seconds makes it a highly valuable option for military emergency kits, air rescue services, and mobile intervention units.
Biocompatibility and safety
Hemostatic efficacy must always be balanced with safety. One of the main advantages of protein-based hemostatics is their high biocompatibility: being derived from natural structures, they integrate with tissues without causing significant adverse reactions. Local inflammatory responses are minimal and transient, and no relevant immunogenic phenomena have been reported. Progressive absorption of the material reduces the risk of foreign body reactions and promotes wound healing, making them suitable not only for life-saving emergency interventions but also for scheduled surgical applications. In this regard, fibroin stands out as a particularly suitable natural protein, thanks to its mechanical strength, versatility in processing into films, sponges, or gels, and its ability to integrate with tissues without impairing repair processes.
Future perspectives
Research in this field is rapidly evolving. Current development lines aim to make protein-based hemostatics increasingly customizable, with formulations tailored to specific types of lesions and clinical scenarios. Integration with nanoparticles, targeted delivery systems for pro-coagulant factors, and antimicrobial properties represents one of the most promising frontiers, paving the way for multifunctional devices capable not only of stopping bleeding but also of preventing infections and promoting tissue regeneration. In this context, fibroin is an ideal material, serving as a support for bioactive agents while ensuring high biocompatibility and mechanical stability. At the same time, miniaturization of formats and improved portability will enable widespread use in civilian emergency systems, making these devices an integral part of standard emergency and surgical protocols.
