Antimicrobial Properties of Surgicel (Oxidized Cellulose)
Surgicel (oxidized cellulose) does have antimicrobial properties, particularly against various bacteria including antibiotic-resistant strains. 1
Antimicrobial Mechanism and Evidence
Surgicel products (oxidized regenerated cellulose) demonstrate bactericidal activity against multiple organisms, including methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Streptococcus pneumonia, and Pseudomonas aeruginosa 1
The antimicrobial effect is likely related to the acidic pH created when oxidized cellulose comes into contact with blood and body fluids, creating an environment inhospitable to bacterial growth 2
Studies comparing oxidized non-regenerated cellulose (ONRC) and oxidized regenerated cellulose (ORC/Surgicel) found that both have equivalent bactericidal effectiveness despite differences in acidity levels 2
Clinical Implications in Surgical Practice
The bactericidal properties of Surgicel make it a useful adjunct in neurosurgical applications and other surgical fields where infection prevention is critical 1
When used in experimental wounds, oxidized cellulose has shown superior infection resistance compared to other hemostatic agents like microfibrillar collagen (Avitene) 3
However, there is a dose-dependent effect - smaller amounts (5-10 mg) of oxidized cellulose did not lead to infection in experimentally contaminated wounds, while larger amounts (20-30 mg) significantly increased infection risk 3
Safety Considerations and Limitations
Despite its antimicrobial properties, Surgicel should be used judiciously as it can promote infection in certain circumstances, particularly when used in large quantities 3
Surgicel should be removed when used around or in proximity to foramina in bone, areas of bony confine, the spinal cord, or the optic nerve/chiasm, as it may swell and cause unwanted pressure 1
When used appropriately for positioning free flap pedicles in head and neck reconstruction, Surgicel appears safe and may even show a trend toward better outcomes for flaps and wounds 4
Comparison to Other Infection Prevention Strategies
While Surgicel has antimicrobial properties, other dedicated antimicrobial approaches like triclosan-coated sutures have been specifically developed to prevent microbial colonization and have shown significant reduction in surgical site infection risk in controlled studies 5
The World Journal of Emergency Surgery guidelines emphasize multiple approaches to prevent surgical site infections, with antimicrobial-coated materials being one component of a comprehensive strategy 5
In conclusion, while Surgicel does possess antimicrobial properties that can help reduce the risk of infection in surgical settings, its primary clinical purpose remains hemostasis. Its antimicrobial effect should be considered a beneficial secondary property rather than its primary indication.