Oxidized Cellulose - an overview (2023)

A good example is oxidized cellulose dressing, which, owing to its biodegradable, bactericidal, and haemostatic properties, has been used as a topical haemostatic wound dressing in a variety of surgical procedures, which includes neurosurgery, abdominal surgery, cardiovascular surgery, thoracic surgery, head and neck surgery, pelvic surgery, and skin and subcutaneous tissue procedures.

From: Advanced Textiles for Wound Care, 2009

Related terms:

  • Hemostat
  • Neoplasm
  • Surgicel
  • Blood Stasis
  • Fulguration
  • Fibrin Glue
  • Thrombin
  • Gelatin
  • Cellulose
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Coagulopathy and Hemorrhage

Anton N. Sidawy MD, MPH, in Rutherford's Vascular Surgery and Endovascular Therapy, 2019

Oxidized Cellulose

Oxidized regenerated cellulose is branded as Surgicel Fibrillar and Surgicel Nu-Knit (both produced by Ethicon, Inc., Somerville, New Jersey). The material offers handling characteristics superior to those of gelatin foam, and the knitted fabric can be trimmed to fit any size. It does not stick to instruments and can easily be held firmly against bleeding tissue until hemostasis is achieved. Surgicel Fibrillar resembles cotton in consistency and remains pliable when laid into a wound. These products should not be moistened before use because greater hemostatic effect is exerted when they are applied dry.

Oxidized cellulose products result in a decreased local pH. There are theoretical advantages to this effect, including antimicrobial effects and hemostatic effects. Disadvantages of acidity include inactivation of other topical agents, such as thrombin (which should not be used together with cellulose) and potential increases in inflammation resulting in delayed wound healing.110

The observed discoloration of cellulose products following blood contact are attributable to low pH resulting in RBC lysis and hematin generation. Only the minimal necessary amount of product should be applied, with any excess agent removed after hemostasis is achieved.

Separations of Water Pollutants with Nanotechnology

Sunil K. Sharma, ... Benjamin S. Hsiao, in Separation Science and Technology, 2022


CNF extracted from raw jute using the one step nitro-oxidation method were found to be highly effective material for remediation of lead(II) ions from contaminated water. The maximum lead removal capacity of CNF, calculated using the Langmuir model, was found to be higher than the materials reported in the literature so far. The adsorption mechanism at low (≤1000ppm) lead(II) ion concentration is mainly due to electrostatic interactions between lead(II) ions and CNF, while that at high (≥1000ppm) lead(II) ion concentration is dominated by the growth of lead nanocrystals on CNF surface. Now, it is clear that CNF can be used either in the form of coagulants, adsorbents, or flocculants in both dispersion and membrane formats to removal toxic metal ions form drinking water.

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Topical Hemostatic Agents

Grant C. Fowler MD, in Pfenninger and Fowler's Procedures for Primary Care, 2020

Oxidized Cellulose (Surgicel)

Oxidized cellulose consists of absorbable fibers prepared from cellulose. Woven strips or sheets of cellulose can be cut and held with firm pressure on the wound bed. Oxidized cellulose provides a meshwork for coagulation and causes local vasoconstriction. This preparation is moderately priced, easy to handle, and mildly bactericidal.

Foreign-body reaction is possible if excessive amounts of cellulose are left in a wound. Cellulose should not be used under grafts or flaps because it separates the graft from the blood supply. Some experts believe that the removal of oxidized cellulose after obtaining hemostasis frequently produces rebleeding.

(Video) Surgicel Mode of Action


In Mosby's Dental Drug Reference (Eleventh Edition), 2014

Drug Class:

Cellulose hemostatic

Mechanism of Action

Oxidized cellulose is saturated with blood at the bleeding site and swells into a gelatinous mass that aids in clot formation. When used in small amounts, it is absorbed from the sites of implantation with minimal tissue reaction.

Therapeutic Effect: Reduces bleeding.


Hemostasis in surgery, oral surgery, exodontia


Absorption occurs in 7–14 days. Half-life: Unknown.

Indications and Dosages

▸ Surgical Procedures to Assist in the Control of Capillary, Venous, and Small Arterial Hemorrhage When Ligation or Other Conventional Methods of Control Are Impractical or Ineffective

Minimal amounts of an appropriate size are laid on the bleeding site or held firmly against the tissues until hemostasis is obtained.

Side Effects/Adverse Reactions

Frequency Not Defined

Headache, nasal burning or stinging, sneezing, encapsulation of fluid

Precautions and Contraindications

Use for packing or implantation in fractures or laminectomies, hemorrhage from large arteries, and nonhemorrhagic oozing surfaces; use as a wrap; use around the optic nerve and chiasm; applied as wadding or packing as a hemostatic agent; hypersensitivity to oxidized cellulose or any component of the formulation


Do not autoclave; inactivation of topical thrombin

Serious Reactions


Pain, numbness, and paralysis have been reported.

Dental Considerations


Apply dry; use only amount needed to control bleeding.

Place loosely and avoid packing; remove excess before closure in surgery; irrigate first, then remove using sterile technique.

Ensure therapeutic response: decreased bleeding in surgery.

Can be left in situ when necessary but should be removed once bleeding is controlled.

Application of topical thrombin solution to the cellulose gauze will inactivate thrombin because of acidity.

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(Video) Surgicel SNoW -

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Fundamentals of Laparoscopic and Robotic Urologic Surgery

Alan W. Partin MD, PhD, in Campbell-Walsh-Wein Urology, 2021

Non–Fibrin-Based Surgical Hemostats

In contrast to the fibrin-based agents, other hemostatic agents such as thrombin-soaked oxidized cellulose particles (Floseal [Baxter, Glendale, CA]; Surgiflo [Johnson & Johnson, New Brunswick, NJ]) have no adhesive capability but are excellent hemostatic agents in the presence of active bleeding from parenchymal surfaces such as a partial nephrectomy bed, a liver or spleen laceration, or an oozing adrenal bed. These agents are composed of human-derived thrombin and bovine- or porcine-derived gelatin matrix. The gelatin granules swell 10% to 20% to produce a tamponade effect, whereas the high concentration of thrombin promotes conversion of fibrinogen to fibrin, as well as activating platelets and several coagulation factors. This agent is also prepared by the scrub assistant; it takes 2 minutes to prepare and is usable for 2 hours. It is applied through a tube applicator with a syringe. It is most effective when pressure is applied after its delivery; this can be done either with an instrument (e.g., 10-mm gauze-tipped dissector) or with a bolster.

The Avitene microfibrillar collagen hemostat (Davol, Cranston, RI) is an active collagen hemostat that accelerates clot formation by enhancing platelet aggregation and the release of fibrin. Similar to Floseal, it has no tissue sealing capability but is useful for counteracting parenchymal bleeding. EndoAvitene is available for use in endoscopic procedures. EndoAvitene comes prepared in a preloaded endoscopic delivery system developed to easily pass through standard trocars and cannulae. It is available in 5- and 10-mm diameters.

Intraoperative Complications

Randolph R. Resnik, in Misch's Avoiding Complications in Oral Implantology, 2018


The most common cellulose-based hemostatic agent is regenerated oxidized cellulose that initiates clotting via contact activation. Oxidized cellulose has been shown to be poorly absorbed and may cause healing complications postoperatively.

Resorbable Oxidized Cellulose/Fabric Meshwork (Surgicel [Ethicon US]).

Surgicel is a resorbable oxidized cellulose material in a sterile fabric meshwork. When Surgicel is applied to the bleeding area, it swells into a brownish/black gelatinous mass that aids in the clotting process. Because this agent lowers the pH of the surrounding tissue, red cell lysis occurs, accounting for the dark discoloration. This caustic material should ideally be removed because it may delay healing and interfere with osteogenesis (Fig. 7.13A).

Cellulose Fabric Meshwork (ActCel [Coreva Health Science, LLC]).

ActCel is a cellulose fabric meshwork similar to Surgicel. When the meshwork comes into contact with blood, it expands to 3 to 4 times its original size and is almost immediately converted to a gel. It will undergo complete dissolution within 1 to 2 weeks.30 This material has the advantage over Surgicel that it degrades rapidly into biocompatible end products (glucose, water) and thus does not adversely affect wound healing or bone formation. The mechanisms of action will enhance the coagulation process biochemically by increasing platelet aggregation and physically by initiating clot stabilization.

Regenerated Cotton Cellulose (BloodSTOP [LifeScience PLUS Inc.]).

BloodSTOP is a biocompatible, nonirritating, water-soluble, regenerated cotton cellulose hemostatic agent that resembles traditional gauze. When applied to a bleeding surgical site, BloodSTOP quickly absorbs blood and transforms into a gel to seal the wound with a protective transparent layer, actively aids in blood coagulation, and creates a positive environment for wound healing. Because BloodSTOP is 100% natural cellulose and is water soluble, it is easliy removed without disruption of the wound surfaces after hemostasis. It is manufactured in a single-use, sterile package with a 0.5- × 2-in size (Fig. 7.13).

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Bone Grafts

Marco Rinaldi, ... Luca Boriani, in Computer-Guided Applications for Dental Implants, Bone Grafting, and Reconstructive Surgery (Adapted Translation), 2016

Treatment of Donor Site and Suture

After bone harvesting, the topical use of an oxidized cellulose gauze is usually sufficient to control the bleeding; rarely, it is necessary to use the monopolar or bipolar coagulator. Filling the void left at the donor site with ancillary biomaterials and/or using membranes to promote bone regeneration is optional. The access wound is closed with a two-layer suture technique. The first layer is performed with an absorbable suture wire, which stabilizes the mental muscle to the periosteum; the second layer then closes the mucosal plane. The wire goes deep at the base of the flap, anchoring into muscle, and then returns higher to allow for fixation to the periosteum, or if for some reason this is difficult, the bone itself. The bone suture technique that we advocate is performed after drilling a couple of small holes in the thickness of cortical bone at the more cranial level of the osteotomy within, through which the wires pass (Rinaldi 2001). When tightening the knot, the adhesion of the mental muscles to the bone is immediately observable (Figs. 2.46 and 2.47). Compared to the periosteal suture, bone suture offers greater resistance, allowing support for the heaviest loads needed in this area. The chin wound is constantly stimulated by speaking and varied facial expressions and thus is rarely at rest. Using this technique may prevent the frequent complication of flap dehiscence. Some authors recommend a pressure bandage on the symphysis in the immediate postoperative period to control swelling (Figs. 2.48 to 2.50).

(Video) Lab production of TEMPO-oxidised cellulose nanofibre (CNF) hydrogels

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Insulin-producing Cells Derived from Stem Cells

Susan Bonner-Weir, Gordon C. Weir, in Essentials of Stem Cell Biology (Second Edition), 2009

Generation of Insulin-producing Cells from Mouse and Human Embryonic Stem Cells

The earliest efforts to direct ESC differentiation were mostly done with murine ESCs. Different groups used elaborate multi-stage protocols, which resulted in the production of cells that had some β-cell characteristics, but fell short of being true fully-developed cells. The first work with hESCs provided evidence for some insulin production, but there was little characterization of the cells.

Employing knowledge of pancreatic development and lessons from work on mouse ESC, Novocell Inc. applied a systematic approach to human ESC, and has had striking success. Each of five stages employed particular culture conditions and added differentiation factors. These stages and their differentiation factors included the following:

Stage 1 Definitive Endoderm (activin and Wnt signaling);

Stage 2 Primitive Foregut (epidermal growth factor and fibroblast growth factor 10 (FGF 10);

Stage 3 Posterior Foregut (retinoic acid, cyclopamine);

Stage 4 Pancreatic Endoderm and Endocrine Precursors (γ-secretase inhibitor, exendin 4); and

Stage 5 Hormone Expressing Endocrine Cells (exendin-4, IGF-1, hepatocyte growth factor).

With this protocol, cells containing insulin, glucagon, somatostatin, and pancreatic polypeptide were produced. Importantly, the insulin content of these cells was far higher than had been achieved before. However, glucose-stimulated insulin secretion (GSIS) could not be demonstrated, indicating that the insulin-containing cells were immature. Other groups have also had success in directing hESCs towards β-cells.

The next step for Novocell was to make a few changes in the differentiation protocol and transplant the pancreatic precursor cells (Stage 4) into immunocompromised mice. After these cells are placed into an in vivo transplant site, some develop into fully mature functional β-cells. They contained all of the β-cell markers that were examined including MafA by electron microscopy; they contained characteristic β-cell granules with dense cores and halos; they efficiently converted proinsulin to insulin; and they had GSIS. In addition, they could normalize the glucose levels of streptozocin (STZ) diabetes. This experiment was made possible because STZ selectively kills mouse β-cells, but not the human β-cells in a graft site. The site of the grafts did not make much difference; subcutaneous, renal subcapsule, and epididymal fat pad sites were all successful. All of the other pancreatic endocrine cell types were found, but the grafts also contained many presumably immature cells. Importantly, of the 46 grafts examined by pathologists, one contained a teratoma, and six others had teratomatous elements. This raises important concerns about the safety of transplanting precursor cells into humans with diabetes. However, at this stage of the work, no effort was made to eliminate immature cells with teratoma formation potential. Certainly it will be a high priority to find ways to obtain a population of fully-mature cells in vitro, or to obtain a population of transplantable precursor cells that are far enough developed to not form teratomas.

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(Video) [ARTICLE 2006] TEMPO-oxidized Cellulose Nanofiber


Encapsulated Human Islet Allografts: Providing Safety with Efficacy

David W. Scharp M.D., in Cellular Transplantation, 2007


There have been a large number of mouse implants used to develop the PEG conformal coatings at Novocell. The only result discussed in this chapter is the experience of implanting encapsulated mouse islet allografts into spontaneously diabetic NOD mice. Mouse islets from C57 mouse donors have been encapsulated with PEG conformal coatings and implanted into the peritoneal cavity of diabetic NOD mice without using any immunosuppression. The results are shown in Figure 7.8.

Oxidized Cellulose - an overview (1)

Figure 7.8. Novocell results of PEG encapsulated islet allografts implanted into NOD diabetic mice without immunosuppression.

These results clearly show that encapsulated mouse islet allografts can be readily implanted into diabetic NOD recipients without the use of any immunosuppression and achieve > 100 days of relatively normal mouse blood glucose levels. This means that both allograft immune reactivity and autoimmune reactivity are prevented from destroying the encapsulated islets by use of the PEG coating alone.

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William Charles Evans BPharm BSc PhD DSc FIBiol FLS FRPharmS, ... Daphne Evans BA MA, in Trease and Evans' Pharmacognosy (Sixteenth Edition), 2009


The alginate absorbable haemostatic dressings are non-toxic and non-irritant. They have advantages over oxidized cellulose, which include selective rate of absorption, sterilization (and resterilization) by autoclaving or dry heat and compatibility with antibiotics such as penicillin. They may be used internally in neurosurgery, endaural and dental surgery to be subsequently absorbed. Externally, they may be used (e.g. for burns or sites from which skin grafts have been taken) to arrest bleeding and form a protective dressing which may be left or later removed in a manner appropriate to the type of dressing employed (see above). Protective films of calcium alginate may also be used by painting the injured surface with sodium alginate solution and then spraying it with calcium chloride solution.

Calcium alginate wool as a swab for pathological work or bacterial examination of such things as food processing equipment and tableware has the great advantage over cotton wool in that it permits release of all the organisms by disintegration and solution of the swab in, for example, Ringer's solution containing sodium hexametaphosphate.

In fabrics the calcium alginate fibres would disintegrate in alkaline solutions (laundering), but this advantage is turned to a commercial virtue by the use of the yarn as a scaffolding thread to support yarns normally too fine to survive the weaving process. The scaffold is removed by an alkaline bath to leave a lightweight fabric.

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(Video) Surgi-ORC® Absorbable Haemostat (Oxidized Regenerated Cellulose)


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