Comparison of regenerated and non-regenerated oxidized cellulose hemostatic agents

Abstract

SummaryBackgroundOxidized 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.ObjectiveThis 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).MethodsIn 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.ResultsUltrastructure 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.ConclusionONRC provides superior hemostasis and equivalent bactericidal effectiveness relative to ORC, which is likely due to its fiber structure than acidity.

Oxidized (non)-regenerated cellulose affects fundamental cellular processes of wound healing

“…describe superior hemostasis for ONRC, with equivalent bactericidal effectiveness when compared to ORC13. Both materials have already proven beneficial antibacterial effects even against antibiotic resistant microorganisms such as VRE, MRSA1318. Little is known regarding how ORC and ONRC influence DIWH.…”

Magnetic Resonance Imaging Appearance and Mechanism of Action of Five Hemostatic Agents Used in Neurosurgery

“…This acidification will remain until the cellulose is fully absorbed usually in 7–14 days. The resultant low pH causes local vasoconstriction and may also be bactericidal . The cellulose base of Surgicel can act as a scaffold for platelet aggregation .…”

Induction of Low-Level Hydrogen Peroxide Generation by Unbleached Cotton Nonwovens as Potential Wound Dressing Materials

“…For example, honey, which is a complex mixture of polysaccharides, was used in ancient cultures, but has recently been developed in chronic wound dressing applications [5]. In addition, oxidized regenerated cellulose, carboxymethylcellulose, and chitosan, N -acetyl-glucosamine, are incorporated into materials that constitute structurally- or process-modified polysaccharide fibers used in wound dressings [6,7,8]. However, cotton in its many forms remains the most widely used material that forms the basis of wound dressings.…”