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Surgicel — Oxidized Regenerated Cellulose

Surgicel is a family of sterile, absorbable hemostats made from oxidized regenerated plant cellulose (ORC), supplied as knitted fabric, coherent Fibrillar fibers, structured nonwoven fabric, or powder. Its products are labeled as adjuncts for capillary, venous, and small-arterial bleeding when ligation or conventional control is impractical or ineffective.[2] It swells into a brownish or black gelatinous mass on contact with blood and aids clot formation through an incompletely understood, apparently physical mechanism; Surgicel is a long-used passive surgical hemostat.[1][2]

Mechanism​

  • Cellulose fibers are chemically oxidized to introduce carboxylic acid groups, producing a low-pH, locally acidic microenvironment when hydrated
  • The acidic pH promotes a gel-like, brown blood-cellulose coagulum as the matrix absorbs blood (the low pH also destroys thrombin; see below)[2]
  • Mechanical tamponade provides a secondary hemostatic effect
  • In a 24-hour in-vitro challenge of Original, Fibrillar and Nu-Knit, low-pH ORC showed bactericidal activity against MRSA and most tested bacteria; one VRE isolate showed less than one-log reduction with Original and Fibrillar. This activity does not replace indicated systemic prophylaxis or treatment of infection.[2][3]
  • The label gives no fixed absorption time: it states absorption depends on the amount used, degree of blood saturation and the tissue bed (and may be prevented in chemically cauterized areas).[2] Ethicon’s family comparison table lists 7–14 days for Original, Fibrillar, SNoW, Nu-Knit and Powder.[5]

Surgicel is a passive matrix. It enhances local clot formation but contains no thrombin or other active coagulation factors, so efficacy depends on the patient's native clotting capacity. It is not for large-artery bleeding, non-hemorrhagic serous oozing, or use as an adhesion barrier.[2]

Product Forms​

FormTextureBest for
Surgicel OriginalKnitted fabric (pad)Sheet placement on bleeding surface
Surgicel FibrillarFluffy cotton-likeConforming to irregular bleeding surfaces; remove material used for temporary packing after hemostasis
Surgicel SNoWStructured non-woven fabricEndoscopic and laparoscopic use; the label says it may be more convenient than other forms
Surgicel Nu-KnitKnitted fabricSheet placement; can be cut to size for endoscopic use
Surgicel PowderFine ORC powder; for laparoscopic or other endoscopic use, replace the supplied tip with the dedicated endoscopic applicator tip and use only that applicator (5 mm or larger trocar); keep its tip in view, do not touch it to a wet surface, and avoid compressing or excessively bending the flexible inner tipDiffuse oozing: apply dry, use minimal amounts, then irrigate and aspirate excess without disturbing the clot. It can scatter or migrate, and dislodged powder can plug the urethra, ureter, catheter or drain. Do not place it in an open vessel, use it intraluminally, or use it with autologous blood-salvage circuits.[2]

The manufacturer lists Original, Fibrillar, Nu-Knit and SNoW as cuttable for endoscopic use.[2] Powder cannot be removed from blood clots, and complete removal may disrupt the clot and increase rebleeding; its IFU requires removal after hemostasis in or near foramina in bone, areas of bony confine, the spinal cord, or the optic nerve and chiasm.[2] Handling and removal instructions differ by form; read the package insert for the form in hand.

GU Applications​

  • Partial nephrectomy renal bed. Placement after sliding-clip renorrhaphy for diffuse capillary oozing; keep it out of the collecting system, where fragments can plug the ureter or a catheter (the label reports a blocked ureter after kidney resection)
  • Pelvic sidewall. After lymphadenectomy for residual oozing
  • Bladder-neck dissection. Controlling diffuse oozing after radical prostatectomy or bladder-neck reconstruction
  • Urethroplasty donor bed. Control of bed bleeding at graft harvest sites (buccal mucosa, penile skin)
  • Retropubic space. For residual capillary or venous bleeding after pelvic dissection when conventional control is ineffective or impractical; remove excess before closure.[2]
  • Athermal RARP technique. In a 105-patient single-surgeon clipless nerve-sparing series, brief pressure with Surgicel gauze was used for periprostatic vessel bleeding, and pulsatile arterial bleeding was sutured.[7]
  • Scrotal or perineal wounds. Avoid closing material into an infected or contaminated wound.[2]

Technique Pearls​

  • Pre-cut the sheet to the size of the bleeding area; oversize increases residual foreign-body volume
  • Apply dry; the hemostatic effect is greater dry, so do not moisten with water or saline; do not pre-treat the site with silver nitrate or other escharotics (they can prevent absorption)[2]
  • Hold fabric forms firmly in place until bleeding stops. After Powder achieves hemostasis, irrigate and aspirate excess without disturbing the clot.[2]
  • Use the minimum and remove excess before closure; retained bulk can encapsulate and mimic artifacts or masses on imaging; in urologic surgery use minimal amounts and avoid plugging the urethra, ureter or catheter[2]
  • Do not apply too tightly as a vascular wrap; stenosis has been reported[2]
  • Control arterial sources first; it is not indicated for large-artery bleeding[2]

Limitations and Cautions​

Do not combine Surgicel with topical thrombin: the low pH destroys thrombin activity and the manufacturer states hemostasis is not enhanced. Do not impregnate it with antibiotics or other agents. Use only the minimum needed; product forms have different handling and removal instructions.[2]

  • Not for packing or wadding unless it will be removed once hemostasis is achieved; not for implantation in bone defects[2]
  • Contaminated or infected fields. Closing it inside a contaminated wound can cause complications; its in-vitro bactericidal effect does not replace drainage or antimicrobials.[2][3]
  • Powder-specific safety. Do not apply Powder prophylactically in a confined surgical bed or near an implant: seroma, swelling, infection and compression of critical structures have been reported in that setting. Postmarket hypersensitivity, including anaphylaxis, has also been reported.[6]
  • Urinary tract. Fragments can plug the urethra, ureter or catheter; the label reports difficulty passing urine after prostatectomy and one blocked ureter after kidney resection that required postoperative catheterization. Avoid placing it within the collecting system. (The stone-nidus warning appears in the gelatin and Arista labels, not in Surgicel's.)[2]
  • Foreign-body reaction and imaging mimicry. A five-patient postoperative CT series described Surgicel appearances mimicking abscess (focal gas in four), while two intracranial meningioma cases described Surgicel granulomata mistaken for tumor recurrence; document placement in the operative note.[2][8][4]
  • Heparinized or coagulopathic patients. As a passive matrix it depends on native clotting; consider an active (thrombin-containing) agent instead, and never add thrombin to Surgicel
  • Remove after hemostasis in bony confines or near structures threatened by swelling; the IFU requires removal near foramina in bone, the spinal cord, optic nerve or chiasm and tubular structures that swelling could constrict. Dislodgement and migration have been reported.[2]
  • Not for non-hemorrhagic serous oozing. Serum and other non-blood fluids do not produce a satisfactory hemostatic effect[2]
  • Not ideal for high-flow bleeding. Control the source first

Surgicel vs. Alternatives​

AgentMechanismBest for vs. Surgicel
SurgicelPassive ORC matrix; appears to aid clot formation physically as it swells into a gelatinous mass when saturated with blood[2]Broad / sheet-like raw surfaces; no coagulopathy
GelfoamPassive matrix, neutral pHBone bleeding; can combine with thrombin
Arista AHPassive, absorbs water → concentrates clotting factorsDiffuse oozing; rapid absorption but excess must still be removed
FloSealActive — contains thrombinAdjunct for local bleeding when conventional control is ineffective or impractical; Baxter cites heparinized-patient efficacy from cardiac surgery.[1][9]
Topical thrombinActive — pure thrombinCombined with Gelfoam for targeted activity

See Also​

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. Ethicon / J&J MedTech. SURGICEL family essential product information and surgical-use instructions. 2022 compilation; form-specific indications, contraindications, warnings, precautions, and adverse reactions for Original, Fibrillar, Nu-Knit, SNoW, and Powder.

3. Spangler D, Rothenburger S, Nguyen K, et al. In vitro antimicrobial activity of oxidized regenerated cellulose against antibiotic-resistant microorganisms. Surg Infect (Larchmt). 2003;4(3):255-62. doi:10.1089/109629603322419599

4. Sandhu GS, Elexpuru-Camiruaga JA, Buckley S. Oxidized cellulose (Surgicel) granulomata mimicking tumour recurrence. Br J Neurosurg. 1996;10(6):617-9. doi:10.1080/02688699646989

5. Ethicon / J&J MedTech. SURGICEL Family Comparison Table. Device specifications, p. 1; absorption time by product form.

6. Ethicon / J&J MedTech. SURGICEL Powder Absorbable Hemostat: US Essential Product Information. Current indications, contraindications, warnings and adverse reactions. Accessed October 8, 2026.

7. Shin TY, Lee YS. "Robot-assisted radical prostatectomy with clipless intrafascial neurovascular bundle-sparing approach: surgical technique and one-year functional and oncologic outcomes." Sci Rep. 2020;10(1):17595. doi:10.1038/s41598-020-74513-y

8. Young ST, Paulson EK, McCann RL, Baker ME. "Appearance of oxidized cellulose (Surgicel) on postoperative CT scans: similarity to postoperative abscess." AJR Am J Roentgenol. 1993;160(2):275–277. doi:10.2214/ajr.160.2.8424333

9. Baxter. FLOSEAL Hemostatic Matrix: US Indications and Important Risk Information. Current indication, heparinized cardiac-surgery evidence and precautions. Accessed October 8, 2026.