Surgicel®: its fate following implantation

Abstract

Surgicel®, a loeal haemostatic gauze, is claimed to consist of oxidised regenerated cellulose. It is a polyanion, the functional unit of which is termed polyan‐hydroglucuronic acid. The ability of tissues to absorb Surgicel® and its inherent haemostatic properties have been extensively investigated. This study was undertaken a) to determine the time required for absorption of Surgicel® from implantation sites in the chest wall muscles of rats, and b) to establish mechanisms for its removal. Data derived from sequential uronic acid assays, histochemistry using the stain alcian blue, and transmission electron microscopy of implanted Surgicclwwerc interpreted to reveal that Surgicel® consists of at least two active components. These are a soluble uronic acid component which is lost after 6 h, and a fibrous component which persists. The latter material resembles Surgicel® in the electron microscope and is still evident at the implantation site at 48 h post‐implantation. Moreover, Surgicel8 can be characterized in vitro into at least two components according to its solubility under dissociative salt conditions (4M guanidinium chloride). A residual fibrous material could then be hydrolysed with 0.3N sodium hydroxide. We postulate that the absorption of the former salt soluble uronate in vivo is by early degradation and/or systemic clearance, whilst removal of the fibrous material requires phagocytosis.

Pontine compression caused by “surgiceloma” after trigeminal decompression: case report and literature review

“…Twentieth century advances in hemostatic agents and anticoagulatory devices led to the widespread adoption of bio-absorbable Surgicel ® , which is often left in situ. Preliminary studies suggested that the hemostatic mechanism of Surgicel ® was mechanical, promoting coagulation through physical pressure, but later studies showed that oxidation of the product causes it to have a very low pH and results in the formation of an artificial clot through a caustic process [6,9] . The product begins to undergo absorption within 24 h of placement, and is absorbed at a variable rate depending on the amount of the product, type of tissue involved, and degree of tissue perfusion [6,9] .…”

“…Preliminary studies suggested that the hemostatic mechanism of Surgicel ® was mechanical, promoting coagulation through physical pressure, but later studies showed that oxidation of the product causes it to have a very low pH and results in the formation of an artificial clot through a caustic process [6,9] . The product begins to undergo absorption within 24 h of placement, and is absorbed at a variable rate depending on the amount of the product, type of tissue involved, and degree of tissue perfusion [6,9] . The presence of giant cells has been reported within 1 week, disappearing with the product 1-2 months after surgery [10] .…”

Topical Collagen-Based Biomaterials for Chronic Wounds: Rationale and Clinical Application

“…Breakdown products may stimulate macrophage influx when ORC is implanted. 70,72 ORC/collagen significantly reduced all key proteases in diabetic foot ulcer wound fluid via physical binding 4 and was shown to increase fibroblast chemotaxis and proliferation in a dose-dependent fashion. It is hypothesized that these effects are secondary to the effects of peptides released from collagen and hydrolyzed breakdown products of ORC.…”

Oxidized Cellulose Binding to Allergens with a Carbohydrate-Binding Module Attenuates Allergic Reactions

“…adsorbable (28,29,32), will presumably be well tolerated in the airways and lungs. Although it is assumed that OC particles that reach the deeper regions of the lungs will dissolve, degrade, and undergo macrophagial clearance (33), we propose use of 5-15 mM OC particles to allow for their deposition in the extrathoracic and upper bronchial regions, to further decrease risk of toxicity and enhance airway clearance (34).…”