Comparison of regenerated and non-regenerated oxidized cellulose hemostatic agents
K M Lewis, D Spazierer, M D Urban, L Lin, H Redl, A Goppelt, K M Lewis, D Spazierer, M D Urban, L Lin, H Redl, A Goppelt
Abstract
Background: Oxidized cellulose is a well known and widely used surgical hemostat. It is available in many forms, but manufactured using either a nonregenerated or regenerated process.
Objective: This study compares the fiber structure, pH in solution, bactericidal effectiveness, and hemostatic effectiveness of an oxidized nonregenerated cellulose (ONRC; Traumastem®) and an oxidized regenerated cellulose (ORC; Surgicel® Original).
Methods: In vitro, fiber structures were compared using scanning electron microscopy, pH of phosphate buffer solution (PBS) and human plasma were measured after each cellulose was submerged, and bactericidal effect was measured by plating each cellulose with four bacteria. In vivo, time to hemostasis and hemostatic success were compared using a general surgery nonheparinized porcine liver abrasion model and a peripheral vascular surgery heparinized leporine femoral vessel bleeding model.
Results: Ultrastructure of ONRC fiber is frayed, while ORC is smooth. ORC pH is statistically more acidic than ONRC in PBS, but equal in plasma. No difference in bactericidal effectiveness was observed. In vivo, ONRC provided superior time to hemostasis relative to ORC (211.2 vs 384.6 s, N = 60/group) in the general surgery model; and superior hemostatic success relative to ORC at 30 (60 vs. 15 %; OR: 13.5; 95 % CI: 3.72-49.1, N = 40/group), 60 (85 vs. 37.5 %; OR: 12.3; 95 % CI: 3.66-41.6), and 90 s (97.5 vs 70.0 %; OR: 21.1, 95 % CI: 2.28-195.9) in the peripheral vascular model.
Conclusion: ONRC provides superior hemostasis and equivalent bactericidal effectiveness relative to ORC, which is likely due to its fiber structure than acidity.
Keywords: Cellulose; Celstat; Fibrin pad; Hemostasis; Liver abrasion; Liver square; Oxidized cellulose; Surgicel; Traumastem.
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References
- Spotnitz WD, Burks SG. Hemostats, sealants, and adhesives II: update as well as how and when to use the components of the surgical toolbox. Clin Appl Thromb Hemost. 2010;16:497–514. doi: 10.1177/1076029610363589.
- Frantz VK, Lattes R. Oxidized cellulose-absorbable gauze (cellulosic acid) JAMA. 1945;129:798–801. doi: 10.1001/jama.1945.02860460022006.
- Pierce AM, Wiebkin OW, Wilson DF. Surgicel®: its fate following implantation. J Oral Pathol. 1984;13(6):661–70. doi: 10.1111/j.1600-0714.1984.tb01468.x.
- Miller JM, Jackson DA, Collier CS. An investigation of the chemical reactions of oxidized regenerated cellulose. Exp Med Surgery. 1961;19:196.
- Dimitrijevich SD, Tatarko M, Gracy RW. Biodegradation of oxidized regenerated cellulose. Carbohydr Res. 1990;195:247–56. doi: 10.1016/0008-6215(90)84169-U.
- Dimitrijevich SD, Tatarko M, Gracy RW, Wise GE. Oakford LX. In vivo degradation of oxidized, regenerated cellulose. Carbohydr Res. 1990;198:331–41. doi: 10.1016/0008-6215(90)84303-C.
- Dineen P. The effect of oxidized regenerated cellulose on experimental infected splenotomies. J Surg Res. 1977;23:114–6. doi: 10.1016/0022-4804(77)90198-6.
- Abaev Y, Kaputsky V, Adarchenko A, Sobeshchuk O. Mechanism of antibacterial effects of monocarboxyl cellulose and other ion exchange derivatives of cellulose. Antibiot Med Bioteckhnol. 1986;31:624–8.
- Spangler D, Rothenburger S, Nguyen K, Jampani H, Weiss S, Bhende S. In vitro antimicrobial activity of oxidized regenerated cellulose against antibiotic-resistant microorganisms. Surg Infect. 2003;4:255–62. doi: 10.1089/109629603322419599.
- Adams G, Manson J, Hasselblad V, Shaw LK, Lawson JH. Acute in-vivo evaluation of bleeding with GelfoamTM plus saline and GelfoamTM plus human thrombin using a liver square lesion model in swine. J Thromb Thrombolysis. 2009;28:1–5. doi: 10.1007/s11239-008-0249-3.
- Thornton JA. Estimation of blood loss during surgery. Ann R Coll Surg Engl. 1963;33:164–74.
- Ribalta T, McCutcheon IE, Neto AG, Gupta D, Kumar AJ, Biddle DA, Langford LA, Bruner JM, Leeds NE, Fuller G. Textiloma (Gossypiboma) mimicking recurrent intracranial tumor. Arch Pathol Lab Med. 2004;128:749–58.
- Kheirabadi BS, Arnaud F, McCarron R, Murdock AD, Hodge DL, Ritter B, Dubick MA, Blackbourne LH. Development of a standard swine hemorrhage model for efficacy assessment of topical hemostatic agents. J Trauma. 2011;71(1 Suppl):S139–46. doi: 10.1097/TA.0b013e318221931e.
- Mabry CD, Thompson BW, Read RC. Activated clotting time (ACT) monitoring of intraoperative heparinization in peripheral vascular surgery. Am J Surg. 1979;138(6):894–900. doi: 10.1016/0002-9610(79)90318-0.
- Vytrasova J, Tylsova A, Brozkova I, Cervenka L, Pejchalova M, Havelka P. Antimicrobial effect of oxidized cellulose salts. J Ind Microbiol Biotechnol. 2008;35:1247–52. doi: 10.1007/s10295-008-0421-y.
Source: PubMed