Gelfoam and Surgiflo — Gelatin-Based Hemostatic Matrices
Gelatin-based hemostatic matrices are absorbable porcine-gelatin products that provide a physical scaffold and absorb blood (the Gelfoam sponge absorbs up to 45× its weight of whole blood). Platelet-mediated clotting has been proposed for Gelfoam, but its mode of action is not fully understood. Available as sponges (Gelfoam) for sheet application and as flowable gel (Surgiflo) for irregular cavities and minimally invasive delivery.[1][2]
Gelatin matrices are frequently combined with topical thrombin to convert a passive matrix into an active hemostatic agent.
Mechanism
- Porcine-gelatin foam provides a physical scaffold; the Gelfoam sponge absorbs up to 45× its weight of whole blood, and its capacity rises with sponge size[2]
- Platelet contribution has been proposed: platelets contacting the sponge’s interstices may release thromboplastin; the label says the effect appears more physical than an alteration of coagulation[2]
- Mechanical matrix: Gelfoam sponge slows surface blood flow and supports clot formation through its bulk.[2]
- Absorbed in 4–6 weeks when placed in soft tissue (amount, blood saturation and site all affect this); on nasal, rectal or vaginal mucosa it liquefies within 2–5 days[2]. Spongostan (sponge and powder) and Surgiflo are both labeled as absorbed in about 4–6 weeks[3][4]
- Can be saturated with topical thrombin before application to add direct coagulation-cascade activation
Product Forms
| Product | Form | Manufacturer | Best for |
|---|---|---|---|
| Gelfoam | Compressed sponge; the current Pfizer label lists Size 100 (100 cm², 8 × 12.5 cm), cut to size | Pfizer | Sheet application to broad surfaces[2] |
| Gelfoam Powder | 1 g powder; prepare with approximately 3–4 mL sterile saline or thrombin for paste (7–10 mL for a thinner mix) | Pfizer | Apply to a visible bleeding surface in an irregular cavity or on cancellous bone; remove excess after hemostasis[5] |
| Surgiflo | 8 mL flowable porcine gelatin; standalone 2991 is mixed with saline or thrombin, while SF2995/2994 kits include human thrombin (the cited 2994 IFU specifies 2 mL and 2,000 IU) | Ethicon | Visible bleeding surfaces in irregular spaces; a dedicated applicator permits delivery through a 5 mm or larger trocar[4][6] |
| Spongostan | Sponge (7 × 5 × 1 cm; 1 cm cube) and powder (1 g); ready out of package, used dry or saline-soaked | Ethicon | Sheet application; powder for surfaces and cavities[3] |
GU Applications
Gelfoam sponge
- Exposed bone bleeding. Apply a minimal piece to the pubic bone (including after pubectomy for UPF), iliac bone, or sacrum; avoid packing bony cavities or foramina, and remove excess after hemostasis.[2]
- Deep pelvic dissection. For pelvic sidewall or presacral venous-plexus bleeding, apply the sponge to the visualized bleeding surface when feasible; do not place it inside a vessel, and avoid positioning that creates negative peripheral venous pressure.[2] In gynecologic operations, ACOG advises sutures, clips, or electrosurgery first when feasible and advises against using topical hemostatic agents for routine prophylaxis of postoperative bleeding.[9]
- Retroperitoneal or renal bed. After partial nephrectomy, place a minimal Gelfoam sponge on a visualized capillary, venous, or arteriolar bleeding surface when pressure, ligature, or other conventional control is ineffective or impractical; remove excess after hemostasis.[2]
- Donor bed after flap harvest (gracilis, ALT)
Gelfoam + topical thrombin (slurry)
- Gelfoam sponge or powder saturated with reconstituted topical thrombin produces an active hemostatic matrix
- Often chosen when a passive matrix alone is unlikely to be enough, such as diffuse oozing in an anticoagulated patient. Assess and treat clinically important systemic coagulopathy as indicated: the label does not recommend gelatin sponge as primary treatment of a coagulation disorder, and combined use with thrombin has not been tested in controlled trials[2]
- Ahlering et al. described a cautery-free RARP technique in 17 men in which FloSeal was applied along the dissected neurovascular bundle and covered with a dry Gelfoam sheet.[8]
Surgiflo (flowable)
- Irregular cavity bleeding. A syringe delivers flowable Surgiflo to a visible bleeding surface in spaces not accessible to sponge application. For open tissue defects, begin at the deepest point and withdraw the tip while applying; hold saline-moistened gauze over the matrix, inspect after 1–2 minutes, and gently irrigate excess once bleeding stops.[4]
- Laparoscopic or robotic application. Delivered through trocar-compatible applicator
- Not for pumping arterial bleeding, where blood has pooled, or where the bleeding point is submerged; it does not act as a tampon or plug[4]
- Partial nephrectomy. Apply to residual bleeding in the renal parenchymal defect after tumor excision when conventional control is ineffective or impractical; do not leave the matrix in the renal pelvis or ureters.[4] A 2026 review of two randomized trials and 13 observational studies (3,408 adults undergoing partial nephrectomy) found no statistically significant difference in transfusion, hemorrhagic complications, or urinary leakage for mixed topical agents plus renorrhaphy versus renorrhaphy alone; none evaluated selective rescue use.[7]
Technique Pearls
- Visualize the bleeding site, then use the minimum amount needed. The sponge may be applied dry or wet; a first piece usually controls bleeding, and if not, repeat with a fresh piece[2]
- Wet application: immerse in sterile saline or thrombin, squeeze out air bubbles between gloved fingers, and confirm it re-expands before use. Reconstitute thrombin as its own label directs[2]
- The sponge may be left in place, and the wound closed over it, when necessary. Left on mucosa, it liquefies on its own[2]
- Hold moderate pressure until hemostasis; moisten an adherent overlying pledget with saline before removal to avoid disrupting the clot.[2]
- Do not over-pack; remove excess. Remove from confined bony or nerve spaces after hemostasis whenever possible because expansion can cause neural injury.[2]
- Avoid placing in infected fields and use caution in contaminated ones: gelatin can form a nidus for infection and abscess. Do not saturate it with antibiotic solution or dust it with antibiotic powder. If infection or abscess develops around it, re-operation may be needed to remove it[2]
Limitations
- Persistent foreign body for 4–6 weeks. Residual material can look like a pseudotumor or pseudoabscess on follow-up imaging and may prompt unnecessary reintervention[2]
- Collecting system: the Surgiflo label states it should not be left in the renal pelvis or ureters, because of potential foci for calculus formation; the Gelfoam sponge label has no equivalent statement, but the same caution is reasonable for any retained gelatin[4]
- Swelling: the sponge re-expands on absorbing fluid and can compress adjacent structures. Avoid packing bony cavities or foramina, and remove excess after hemostasis[2]. Surgiflo incorporated in a clot may swell up to 20% on contact with more fluid[4]
- Bleeding it is meant for: the label covers capillary, venous and arteriolar bleeding when ligature or other conventional control is ineffective or impractical. It does not substitute for ligating or suturing a named vessel[2]
- Gelatin-product contraindications (labels): Gelfoam sponge, Gelfoam powder, and Surgiflo are contraindicated for skin-incision closure (gelatin interposes between skin edges), intravascular placement (embolization risk), and known allergy to their porcine components. Life-threatening anaphylaxis, including death, has been reported with absorbable gelatin; if it occurs, stop use and remove applied product.[2][4][5]
- Surgiflo kits with human thrombin: EVITHROM is contraindicated in patients with a history of anaphylactic or severe systemic reaction to EVITHROM or human blood products; as a human plasma-derived product, it may transmit infectious agents despite risk-reduction measures.[4][6]
- Other label cautions: not for postpartum bleeding or menorrhagia; not with autologous blood salvage circuits; not with methylmethacrylate cement. Avoid patient positioning that produces negative peripheral venous pressure, which has been linked to intravascular migration[2]
- Porcine origin. Not suitable for patients with strict dietary or religious objections to porcine products
Gelfoam vs. Surgicel vs. Arista vs. FloSeal
| Feature | Gelfoam | Surgicel | Arista AH | FloSeal |
|---|---|---|---|---|
| Source | Porcine gelatin | Plant cellulose | Plant starch | Bovine gelatin + thrombin (current US Recothrom formulation available) |
| Mechanism | Passive + platelet contact | Passive + acidic pH | Passive + water absorption | Active (thrombin) |
| Form | Sponge / powder | Fabric / fibril / powder | Powder | Flowable gel |
| Resorption | 4–6 weeks | Not fixed by label (amount, saturation, tissue bed); about 7–14 days commonly quoted | 24–48 hours | 6–8 weeks |
| Coagulopathy considerations | Native clotting needed; thrombin may assist | Native clotting needed | Native clotting needed | Thrombin may assist; not systemic reversal |
| Cost | Low | Low–moderate | Moderate | High |
See Also
- Hemostatic agents overview
- Topical thrombin, often combined with Gelfoam
- FloSeal, pre-combined thrombin plus gelatin flowable
References
1. Seyednejad H, Imani M, Jamieson T, Seifalian AM. Topical haemostatic agents. Br J Surg. 2008;95(10):1197–225. doi:10.1002/bjs.6357
2. Pfizer. GELFOAM compressed sponge prescribing information. Rev. May 2022. Indications, directions for use, contraindications, warnings, absorption, absorptive capacity and how supplied.
3. Ethicon. SPONGOSTAN absorbable gelatin products: device specifications (powder, sponge and haemorrhoidectomy sponge). Manufacturer specification sheet; sizes, absorption time, preparation and shelf life.
4. Ethicon. Hemostasis key-points booklet (Ethicon US, 2022), including SURGIFLO Hemostatic Matrix Kit with Thrombin essential product information (2020 IFU): composition, absorption, swelling, contraindications, warnings and urologic precautions. Manufacturer material.
5. Pfizer. GELFOAM absorbable gelatin powder prescribing information. Rev. May 2022; indications, preparation and precautions.
6. Ethicon. SURGIFLO Hemostatic Matrix family comparison. Codes 2991, SF2995 and 2994; formulation, indication and endoscopic applicator. Accessed October 3, 2026.
7. Shiomi da Cruz JA, De Souza Almeida A, Terada BD, et al. "Adjunctive topical hemostatic agents combined with renorrhaphy versus renorrhaphy alone during partial nephrectomy: a systematic review and meta-analysis." World J Urol. 2026;44(1):592. doi:10.1007/s00345-026-06679-5. PMID: 42627530.
8. Ahlering TE, Eichel L, Chou D, Skarecky DW. "Feasibility study for robotic radical prostatectomy cautery-free neurovascular bundle preservation." Urology. 2005;65(5):994-997. doi:10.1016/j.urology.2004.11.023
9. American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice. "Topical Hemostatic Agents at Time of Obstetric and Gynecologic Surgery: ACOG Committee Opinion, Number 812." Obstet Gynecol. 2020;136(4):e81-e89. doi:10.1097/AOG.0000000000004104