Surgicel Use After Fasciotomy
Surgicel (oxidized regenerated cellulose) should NOT be used in fasciotomy wounds and must be completely removed if inadvertently placed, as it can cause foreign body reactions, abscess formation, and impair wound healing in contaminated or open wounds.
Why Surgicel is Contraindicated in Fasciotomy Wounds
Primary Wound Management After Fasciotomy
Fasciotomy wounds must be left open initially and managed with negative pressure wound therapy (NPWT) rather than hemostatic agents like Surgicel 1, 2.
The standard approach involves leaving fasciotomy incisions open for delayed primary closure at a median of 5 days, or preparation for skin grafting if direct closure is not possible 1, 2.
NPWT is the first-line therapy for open fasciotomy wounds because it actively drains fluid, prevents loss of tissue domain, and facilitates eventual wound closure 3.
Specific Risks of Surgicel in Open Wounds
Surgicel can mimic abscess formation on imaging, appearing as echogenic masses with posterior reverberation artifact on ultrasound and complex fluid/gas collections on CT scan 4.
When retained in surgical sites, Surgicel can cause delayed complications including cyst formation, foreign body reactions, and inflammatory masses that may require surgical drainage even 25 months after initial placement 5.
Surgicel should be removed when used in areas of bony confine or where swelling could cause pressure, as it absorbs fluid and expands, potentially causing compartment-like pressure effects 6.
Appropriate Hemostasis in Fasciotomy Context
Direct pressure, ligature, and diathermocoagulation are the primary hemostatic methods during fasciotomy 3.
If hemostatic agents are absolutely necessary during the initial procedure, they must be completely removed before wound closure to prevent foreign body complications 5.
The focus after fasciotomy is on monitoring for compartment syndrome recurrence and managing the open wound with NPWT, not on achieving immediate hemostasis with topical agents 3, 1.
Critical Pitfalls to Avoid
Never leave Surgicel in contaminated or potentially contaminated wounds, as fasciotomy wounds are considered contaminated due to the ischemic tissue and potential for infection 3.
Do not use Surgicel as a wound filler in open fasciotomy sites—NPWT with non-adherent interface layers is the appropriate wound management strategy 3.
If Surgicel was inadvertently used, it should be actively sought and removed at the first dressing change to prevent delayed complications requiring reoperation 5.
Recognize that Surgicel's bactericidal properties, while beneficial in closed surgical sites, do not justify its use in open wounds where mechanical debridement and drainage are more important 6.