Physical and mechanical properties of cellulose based hemostatic agents: an in vitro comparison

Cellulose based hemostatic agents have been widely applied in various surgical specialties and play an important role on arresting bleeding during surgical procedures. Oxidized regenerated and non-regenerated cellulose hemostatic agents have evolved little since their introduction, but are still effective and probably the most commonly used hemostatic agents to stop bleeding during surgical procedures. To date there has been no comprehensive study comparing the various commercially available oxidized cellulose based hemostatic agents.

We compared the physical, chemical and mechanical properties of seven different currently available ORC and OC hemostatic agents [Cellistypt (Synthesia A.S.), Curacel (Cura Medical), Emoxicel (Bioster A.S.), Equitamp (Equimedical B.V.), Gelitacel (Gelita Medical B.V.), Pahacel (Altaylar Medical), Surgicel (Ethicon, Johnson&Johnson)] and performed an evaluation of expert opinions regarding intraoperative handling of the agents during surgical procedures. Weft knitted material had better handling qualities than woven fabric, conforming more readily to irregular shaped surgical cavities. Surgicel and Curacel showed a higher flexibility and drapability, and conformed easily to the site of application, while Emoxicel resulted in more rigidity. The degree of swelling after contact with fluids was 25% in Surgicel, while Equitamp and Emoxicel increased up to 90% and 120% of their dry volume, showing a statistically significant difference. Of the seven products tested, Emoxicel was the slowest hemostatic agent in liquid absorption. Conclusions: Surgeons should carefully select cellulose-based hemostatic agent upon considering its mechanism, advantages, disadvantages and dissolution properties.