What is Surgifoam (Oxidized Regenerated Cellulose) Used For?
Surgifoam (oxidized regenerated cellulose/Surgicel) is a topical hemostatic agent used as an adjunct to control mild-to-moderate capillary, venous, and small arterial bleeding during surgery when conventional hemostatic methods are impractical or ineffective. 1, 2
Primary Clinical Applications
Hemostatic Control
- Surgicel is specifically indicated for venous or moderate arterial bleeding, particularly in parenchymal injuries where surgical access is difficult 1, 3
- It controls diffuse capillary oozing following bipolar cautery in brain tumor resection beds 2
- It manages epidural oozing during spinal surgery 2
- It achieves hemostasis in 77.7% of cases at 3 minutes, 87.4% at 5 minutes, and 92.2% at 10 minutes across various surgical procedures 4
Surgical Specialties
- Neurosurgery: management of diffuse bleeding in tumor resection beds and spinal procedures 2
- Urological procedures (37.9% of cases in clinical trials) 4
- Abdominal surgery (32.0% of cases) 4
- Head and neck reconstruction with free flap pedicle positioning 5
- Massive hemoptysis control via bronchoscopic-guided topical tamponade (98% immediate arrest rate in 57 patients) 6
Mechanism of Action
- Surgicel works primarily through physical absorption and creation of an artificial clot, rather than direct activation of the coagulation cascade 1
- The oxidized regenerated cellulose causes thrombus formation through its physical properties 7
- It swells upon contact with blood, conforming to the wound surface 1
Application Technique
Pre-Application Requirements
- The bleeding area must be dry and clean before application, as moisture prevents proper adherence and reduces hemostatic effectiveness 1
- Remove debris, blood clots, or necrotic tissue from the wound site 1
- De-epithelialize epithelial surfaces to improve adherence 1
Application Methods
- Apply using a 30-gauge needle, wooden end of a cotton applicator, or micropipette 1
- Use the minimum amount necessary to seal the bleeding site—excessive amounts increase infection risk 1
- Place directly onto the bleeding surface with gentle pressure 1
- Consider applying a non-adherent dressing over the Surgicel for wound protection 1
Additional Benefits
- Surgicel has bactericidal activity against antibiotic-resistant organisms including MRSA, Staphylococcus epidermidis, Streptococcus pneumoniae, and Pseudomonas aeruginosa 2
- It is bioabsorbable and can be left in the surgical bed, unlike traditional surgical sponges 7
Critical Safety Considerations and Contraindications
Absolute Contraindications
- Do NOT use Surgicel when autotransfusion is planned 1
Mandatory Removal Situations
- Surgicel MUST be removed when used around foramina in bone, areas of bony confinement, the spinal cord, optic nerve, or optic chiasm, as it can swell and cause unwanted pressure 2
Application Limitations
- Surgicel is NOT effective for massive bleeding—it should be used for mild-to-moderate bleeding only 8, 4
- Do not apply to wet or actively bleeding surfaces without first achieving some degree of hemostasis through pressure 1
- It should complement, not replace, traditional hemostatic surgical techniques 1
Imaging Considerations
- On postoperative CT scans, retained Surgicel can mimic an abscess, showing focal linear collections of gas within masses with mixed attenuation 7
- No air-fluid levels are typically present, which helps distinguish it from true abscess 7
- Radiologists should obtain surgical history to avoid misdiagnosis when these findings are present 7
Clinical Decision Factors
- Consider the type of surgical procedure, severity of bleeding, patient's coagulation status, and cost when selecting Surgicel 1, 3
- Surgicel should be used in combination with other surgical measures or packing for optimal results 3
- In comparative studies, Surgicel Powder achieved hemostasis in 73.3% of cases with one application versus 3.3% for collagen-based alternatives, with 51% fewer applications required 9