Oxidized Regenerated Cellulose Gauze: The Haemostatic Solution for Orthopaedic Surgeons

Oxidized Regenerated Cellulose Gauze

 Introduction

Orthopaedic surgeries involve procedures on the musculoskeletal system, including bones, joints, ligaments, tendons, and muscles. These surgeries are often complex and may involve significant blood loss due to the highly vascular nature of bone and soft tissue. Uncontrolled bleeding can lead to complications such as wound issues, infections, delayed rehabilitation, prolonged hospital stays, and increased healthcare cost. Thus, achieving effective haemostasis is a critical component of orthopaedic surgical practice [1].

To address these challenges, various haemostatic agents have been developed to aid surgeons in controlling bleeding efficiently. One of the most commonly used haemostatic agents in orthopaedic and other surgical procedures is oxidized regenerated cellulose gauze (ORCG). ORCG promotes haemostasis by activating the body’s natural coagulation pathways. Upon contact with blood, it forms a gelatinous mass that acts as a matrix for platelet adherence, rapidly facilitating clot formation. Additionally, the low pH environment it creates induces vasoconstriction, further reducing bleeding, while also offering antimicrobial properties [2, 3].

Surgi-ORC® product line includes multiple variants in gauze form, each designed to meet different surgical needs. These variants include Original/Standard, Knit, Fibril and Non-Woven/Snow. Although they share the same chemical composition, their distinct structural properties influence their performance, handling, and suitability for different types of bleeding. Understanding these differences is crucial for selecting the most appropriate variant for specific surgical situations.

Surgi-ORC® Variants: A Comprehensive Comparative Analysis

Selecting the right haemostatic agent is crucial for optimizing surgical outcomes. Below is a comparative analysis of the Surgi-ORC® variants:

FeatureSurgi-ORC® Original/StandardSurgi-ORC® KnitSurgi-ORC® FibrilSurgi-ORC® Non-Woven/SnowStructureFine weave of ORCDenser weave of ORCTufts of soft, light weight ORCStructured non-woven ORC matrixIdeal ForModerate to heavy bleedingHeavy bleedingHard-to-reach site or irregularly shaped bleeding siteOpen and minimally invasive proceduresTime to Haemostasis (TTH)2–5 mins2–5 mins2–5 mins2–5 minsComplete AbsorptionWithin 28 daysWithin 28 daysWithin 28 daysWithin 28 daysPreferred Surgery TypeVarious general surgeries and proceduresDiffuse organ bleeding and transplant procedure, compatible with suturingOrthopaedic, cardiovascular, neuro and vascular surgeriesUrology, gynaecology, cardiovascular, general and peripheral vascular surgeries

Clinical Study: Surgi-ORC® in Orthopaedic Surgeries

A recent multicenter prospective study evaluated the safety and efficacy of Surgi-ORC® in orthopaedic surgeries, providing valuable statistical insights into its performance. The study included 59 patients undergoing upper limb, lower limb, and axial skeleton surgeries, with bleeding classified as mild (35.6%) or moderate (64.4%). The mean blood loss recorded was 60.96 mL, ranging from 15 to 200 mL.

Among the Surgi-ORC® variants used, the average time to haemostasis (TTH) varied:

  • Surgi-ORC® Fibril followed with a TTH of 1.67 minutes.
  • Surgi-ORC® Non-Woven/Snow recorded 1.53 minutes.
  • Surgi-ORC® Original/Standard took 1.95 minutes.
  • Surgi-ORC® Knit required the longest time, averaging 2.28 minutes.

Haemostasis was successfully achieved in 100% of cases within ≤ 5 minutes. Axial skeleton surgeries had the lowest TTH (~1 min), while lower limb surgeries required longer (~2.5 min). Surgeons highly rated the ease of use, and no adverse events or infections were reported. Radiological examinations confirmed complete absorption by day two, reinforcing its safety and effectiveness in surgical bleeding control [4].

Fig.2: Post-surgical X-ray examination shows no traces or residue of Surgi-ORC® on day 2

Choosing the Right Variant for the Right Indication

Each variant of Surgi-ORC® is designed to meet specific surgical challenges. Understanding the strengths of each can help surgeons optimize their choice for better clinical outcomes.

Surgi-ORC® Fibril is highly flexible and conforms well to uneven surfaces, making it particularly useful in orthopaedic surgeries where targeted haemostasis is required. It is effective for stopping localized bleeding in intricate anatomical regions.

Surgi-ORC® Non-Woven/Snow is a lightweight and easily removable variant, best suited for procedures where precise placement and quick handling are necessary. Its pliable nature ensures smooth application without disrupting the surgical field.

Surgi-ORC® Knit offers high tensile strength, making it ideal for controlling heavy bleeding, especially in cases requiring structural support. It provides excellent stability upon application, reducing movement or displacement during surgery.

Surgi-ORC® Original/Standard serves as a versatile option for various general surgical procedures. It provides a balance of easy handling and effective bleeding control, making it a go-to choice for a variety of surgical scenarios.

Conclusion

While all Surgi-ORC® variants share the same fundamental chemical composition, their differences in structural design and application make them uniquely suited to specific surgical scenarios. Choosing the right variant depends on the nature of the bleeding, the complexity of the procedure, and the surgeon’s preference. By leveraging the strengths of each Surgi-ORC® variant, surgeons can enhance haemostatic control, reduce surgical complications, and improve overall patient outcomes in orthopaedic procedures.

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