Nanofibrous hemostatic materials: Structural design, fabrication methods, and hemostatic mechanisms.

Development of rapid and effective hemostatic materials has always been the focus of research in the healthcare field. Nanofibrous materials which recapitulate the delicate nano-topography feature of fibrin fibers produced during natural hemostatic process, offer large length-to-diameter ratio and surface area, tunable porous structure, and precise control in architecture, showing great potential for staunching bleeding. Here we present a comprehensive review of advances in nanofibrous hemostatic materials, focusing on the following three important parts: structural design, fabrication methods, and hemostatic mechanisms. This review begins with an introduction to the physiological hemostatic mechanism and current commercial hemostatic agents. Then, it focuses on recent progress in electrospun nanofibrous hemostatic materials in terms of composition and structure control, surface modification, and in-situ deposition. The article emphasizes the development of three-dimensional (3D) electrospun nanofibrous materials and their emerging evolution for improving hemostatic function. Next, it discusses the fabrication of self-assembling peptide or protein-mimetic peptide nanofibers, co-assembling supramolecular nanofibers, as well as other nanofibrous hemostatic agents. Further, the article highlights the external and intracavitary hemostatic management based on various nanofiber aggregates. In the end, this review concludes with the current challenges and future perspectives of nanofibrous hemostatic materials. STATEMENT OF SIGNIFICANCE: This article reviews recent advances in nanofibrous hemostatic materials including fabrication methods, composition and structural control, performance improvement, and hemostatic mechanisms. A variety of methods including electrospinning, self-assembly, grinding and refining, template synthesis, and chemical vapor deposition, have been developed to prepare nanofibrous materials. These methods provide robustness in control of the nanofiber architecture in the forms of hydrogels, two-dimensional (2D) membranes, 3D sponges, or composites, showing promising potential in the external and intracavitary hemostasis and wound healing applications. This review will be of great interest to the broad readers in the field of hemostatic materials and multifunctional biomaterials.