Clinical experience with the surgicel family of absorbable hemostats (oxidized regenerated cellulose) in neurosurgical applications: a review.

Introduction. Oxidized regenerated cellulose has a long his- tory of safe and effective use in the surgical setting. Surgicel Origi- nal, Fibrillar and Nu-Knit absorbable hemostats are composed of oxi- dized regenerated cellulose and are sterile, absorbable knitted fabrics that are flexible and adhere readily to bleeding surfaces. The purpose of this paper is to discuss neurosurgical applications for these absorbable hemostatic agents. Methods. The authors reviewed the literature and described their clinical experience with Surgicel hemostatic products. Results. Neurosurgical applications of the hemostatic products include the management of diffuse capillary oozing following bipolar cautery in brain tumor resection beds and the control of epidural oozing during spinal surgery. As an adjunct to standard hemostatic procedures, these products facilitate rapid hemostasis and have bactericidal activity that extend to antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumonia, as well as Pseudomonas aeruginosa. Although generally safe and well-tolerated, these hemostatic agents should be removed when used around, in, or in proximity to, foramina in bone, areas of bony con- fine, the spinal cord, and/or the optic nerve or chiasm because it may otherwise swell and cause unwanted pressure. Conclusion. The physical, hemostatic, and bactericidal characteristics of this material makes it a useful adjunct for conventional hemostatic and controlling capillary, venous, and small arterial hemorrhage during neurosurgery.