Surgicel is the brand name for a sterile, absorbable hemostatic agent used in medical procedures to control bleeding. Surgeons use this product when conventional methods for stopping bleeding, such as sutures or cauterization, are impractical or ineffective. It is placed directly at the site of hemorrhage, where it works to facilitate clot formation.
The material is particularly useful for managing capillary, venous, and small arterial bleeding that is diffuse or difficult to access. Surgeons can cut and shape the material to precisely fit the contours of a specific surgical site. This adaptability allows for its use in both open and minimally invasive, or endoscopic, surgeries.
The Hemostatic Function of Surgicel
The primary way Surgicel works is by providing a physical structure for clot formation. When the material contacts blood, it becomes saturated and swells into a gelatinous mass that is brownish or black. This mass serves as a scaffold that allows blood platelets to gather and stick together. This aggregation of platelets is a key step in forming a blood clot.
This process is largely physical and does not rely on the body’s natural clotting factors to initiate hemostasis, making it effective in patients with impaired clotting abilities. The material also has a low, acidic pH. This acidic property helps constrict local blood vessels, reducing blood flow to the area.
The acidic environment also has bactericidal properties, making it inhospitable to a wide range of bacteria associated with surgical site infections. Hemostasis is typically achieved within two to eight minutes of application. If bleeding persists, cautery can be performed directly through the material.
Composition and Bodily Absorption
Surgicel is made from oxidized regenerated cellulose, a plant-based polymer derived from natural plant fibers. The cellulose undergoes a controlled oxidation process that gives it hemostatic and absorbable properties. The resulting sterile, knitted fabric has a pale yellow color.
After being placed in the body during surgery, the material is designed to be absorbed over time, eliminating the need for surgical removal in most cases. The body breaks down the oxidized regenerated cellulose through a process known as hydrolysis, a chemical reaction involving water. This process degrades the material into simpler compounds that the body can easily absorb.
The timeline for complete absorption can vary depending on several factors. These include the amount of material used, the degree to which it was saturated with blood, and the specific location within the body where it was placed. Generally, the material is fully absorbed within a period of four to six weeks, but in some cases, this can be as rapid as seven to fourteen days.
Safety Profile and Potential Complications
While Surgicel is generally considered safe, potential complications can arise. If an excessive amount is left in the body, its absorption can be delayed. This may lead to a foreign body reaction where the body’s immune system walls off the material, forming a mass called a granuloma.
The material’s presence after surgery can also complicate radiological imaging. On scans like CTs or ultrasounds, the gelatinous mass formed by Surgicel and blood can be mistaken for an abscess, hematoma, or tumor recurrence. This can lead to diagnostic confusion and potentially unnecessary interventions.
The use of this hemostatic agent is contraindicated in some situations. It should not be used to pack bony defects like fractures, as it may interfere with new bone formation. Caution is also required near openings in bone, the spinal cord, or the optic nerve, as the material swells and could exert pressure. Other reported adverse events include burning or stinging sensations, particularly in nasal procedures.
Varieties and Surgical Applications
Surgicel is available in several forms, each designed to suit specific surgical needs and bleeding situations:
- Original: A flexible, loose-knit fabric that allows surgeons to see the bleeding site through the material.
- Fibrillar: Has a consistency similar to cotton and can be separated into thin layers for precise placement on irregular surfaces.
- Nu-Knit: A denser, higher-tensile-strength fabric for heavier oozing that can hold a suture if needed.
- Powder: Can be applied to broad bleeding surfaces and is useful in hard-to-reach areas, including during laparoscopic procedures with a special applicator.
- SNoW: A felt-like version designed for easy handling and conformability in minimally invasive surgery.
These different forms make the hemostatic agent a versatile tool across numerous surgical specialties. It is commonly applied in general surgery, gynecological procedures, and urological operations. Its use is also well-established in delicate fields like neurosurgery to control oozing from the spinal epidural space or brain tissue.