Massive Swelling of Surgicel® Fibrillar™ Hemostat after Spinal Surgery. Case Report and a Review of the Literature

Abstract

On the basis of this experience, we advise caution with the use of hemostatic agents during spinal surgery and - if used - strongly advise the removal of Surgicel® Fibrillar™ after the hemostasis has been achieved to avoid the development of complications due to a mass effect.

Acute-onset Paraplegia in Post-operative D3-D5 Meningioma Excision due to Intraspinal Oxidized Cellulose

“…Sassan et al [23] recommended that oxidized cellulose be removed whenever possible after hemostasis is achieved. This is particularly true when the product is applied in confined areas [21][22][23][24]. In fact, even the manufacturers recommend its removal following use for laminectomy, arthroplasty and from neural pathways.…”

Surgicel Induced Intraoperative Cardiovascular Collapse in a Child with Midbrain Glioma

“…Some patients notice irritation and report of "burning" sensation related to low pH of surgicel after use it as packing in epistaxis, and other rhinological procedures [3]. Moreover, paralysis and nerve damage (spinal cord, optic nerve) have been reported as result of application of the surgicel during neurosurgical procedures [7] [13] [14]. These complications were explained by mechanical compression of neurological structures caused by oxidize cellulose (surgicel) [7] [13] Hemodynamic parameters related to sympathetic storm epizode duringthe neurosurgical procedure systolic diastolic heart arte [14].…”

“…Moreover, paralysis and nerve damage (spinal cord, optic nerve) have been reported as result of application of the surgicel during neurosurgical procedures [7] [13] [14]. These complications were explained by mechanical compression of neurological structures caused by oxidize cellulose (surgicel) [7] [13] Hemodynamic parameters related to sympathetic storm epizode duringthe neurosurgical procedure systolic diastolic heart arte [14]. Most of those adverse effects [7] [13] [14] have been described as later findings after several hours of direct operating field compression by swollen surgicel mass.…”

New Hemostatic Powder (GelitaCel Ca Powder<sup>TM</sup>) and Its Application in Cranial Neurosurgery

“…The incidence of complications is relatively low considering the frequent usage of the product. However, swelling leading to neurological deficit has been reported both in the neurosur-gical, thoracic, and orthopedic literature [3]- [6].…”

“…However, cellulose may swell in the postoperative period and cause severe neurological deficits [3]- [6]. Granuloma formation has also been reported as a complication of the use of cellulose [7].…”