TOPICAL ABSORBABLE HEMOSTATSTHE SURGICEL FAMILY

Understanding the haemostatic

Coagulation
cascade
Cascade

Surgery and blood loss management

Optimal surgical technique = effective blood loss management

Effectively control blood loss and avoid

Impaired intra-operative visualisation

Prolonged operative time
Conversion of laparoscopic procedures
Unnecessary post-operative haematomas
Infection and increased morbidity
Increased length of hospitalisation
Increased re-operation rates
Haemodynamic deterioration, hypovolaemia, anaemia
Increased exposure to blood component transfusion

Surgery and blood loss management

Negative outcomes of blood transfusion can include:

1.
2.
3.
4.

Increased post-operative infection

Allergic and haemolytic transfusion reactions
Viral transmission
Increased mortality in CABG

The economic burden of blood loss

There can be severe financial costs
associated with ineffective blood loss
management
Longer operative time
Longer hospital stays
The cost of increased morbidity
Increased re-operation rates
The cost of blood transfusion

Fixed and variable

WHAT RISKS ARE THERE IN

TRANSFUSING BLOOD??

Blood transfusion transmitted infections

Virus

Bacteria
(Yersinia enterocolitica)

Prions

TRIM
Transfusion Related Immuno-Modulation

TRIM
Transfusion Related Immuno-Modulation

TA-GVHD
Transfusion Associated - Graft Versus Host Disease

Rare
90% fatal

T.R.A.L.I.
Transfusion Related Acute Lung Injury

Paling Risk Scale for Major Transfusion Hazards

108

107

106

105

HIV

104

103

102

101

100

General
anesthesia

HCV
HBV

Bacteria
Mis-Transfusion
TRALI
TA-GVHD
Cardiac
Under
transfusion
Sunny Dzik, MD

Traditional methods of haemostasis

Mechanical
Haemostatic clamps
Ligating clips
Clips
Staples
Sutures
Bone wax
Digital pressure
External bandages
Tourniquets

Pharmacological
Systemic
Fibrinolysis inhibitors
Aprotinin
Tranexamic acid
Epsilon aminocaproic acid
Recombinant FVII
Local
Epinephrine/adrenaline
Prophylactic
Erythropoietin

Blood transfusion/blood
salvage
Transfusion (autologous or
allogenic)
Cell saver
Haemodilution
Hypotensive epidural
anaesthesia

Surgical cauterisation
Electrocautery
Electrosurgery
Ultrasound
Laser
Cryogenic cautery

Mechanical Methods:
Example
Clamps, ligating
clips,
vascular staplers

Vascular clamping
(Liver)

Digital Pressure
(Liver)

Thermal agents
Electrocautery/ Monopolar & Bipolar
High Temperatures up to 350c; dry tissue can stick
to the electrode; traumatic system for the tissue

Gas coagulation (argon beam)

Less traumatic, expensive

Ultrasound dissection or harmonic scalpel

Allows both cutting and coagulation at the
point of impact

Situations where traditional

haemostasis may not be
effective
Diffuse bleeding from a
broad surface area
Bleeding from an isolated
source
Isolated or diffuse bleeding
from a poorly visualised
source
Isolated or diffuse bleeding
from an anatomical
location that is difficult to

To control bleeding effectively the best

choice needs to be made in each situation
Many factors affect which method is
chosen

The severity of bleeding

Anatomic location of the source of bleeding

Visibility and identification of the source
Access to the source
Proximity of adjacent critical structures
The source of bleeding
Tissue type and fragility/friability
Coagulation system status
Surgical technique

Good use of appropriate haemostats

can improve surgical technique and

Minimise blood loss

outcomes

Improve visualization
Save operative time
Reduce or avoid transfusion
Manage anticoagulated patients
Avoid conversion of laparoscopic procedures
Prevent leakage

Air, faeces, urine, CSF, bile, lymph

Decrease post-op drainage and infection

Reduce haematoma related complications
Decrease length of hospital stay

Biosurgicals-The range
Biosurgicals
Biosurgicals

TAH
TAH

Biologics
Biologics

Synthetic
Synthetic
Sealants
Sealants

SURGICEL

EVICEL / QUIXIL

OMNEX CV

SPONGOSTAN

SURGIFLO +
EVITHROM

Pulmonary
Sealant

SURGIFLO plus
flextip

Fibrin Patch
EVITHROM

(Internal expertise
& Ferrosan
partnership)

(Omrix
BioPharmaceuticals
partnership)

(Closure/Interna
l Medicalacquisition)

TAHs Classification
T O P IC A L H E M O S T A T S
PLANT BASE D

A N IM A L

O X ID IZ E D R E G E N E R A T E D
CELLULO SE

P O R C IN E
g e la t in
E Q U IN E
c o lla g e n
B O V IN E & O T H E R S
c o lla g e n
f ib r in g lu e
t h r o m b in

TAHs Absorption
T O P IC A L H E M O S T A T S

HYDROLYTIC
ABSORPTION
1-2 WEEKS

PLANT BASE D

A N IM A L

ENZYMATIC
ABSORPTION

O X ID IZ E D R E G E N E R A T E D
CELLULO SE

P O R C IN E
g e la t in

4-6 WEEKS

Readily degradable through

fluid absorption and gelling

E Q U IN E
c o lla g e n
B O V IN E & O T H E R S
c o lla g e n
f ib r in g lu e
t h r o m b in

6-10 WEEKS

Th
e

SURGICEL
*

famil
y

History of the SURGICEL Family

Ethicon introduces
SURGICEL (1959)

1940

1950

First gelatine
Haemostat
is launched

1960

NU-KNIT is
launched (1986)

1970 1995 1980

1990

2002
2000

FIBRILLAR
is launched (1996)

MORE THAN 45 YEARS OF EXPERIENCE AND

PROVED TRACK RECORD !!!

The TAH most used by

surgeons

Plant based - ORC

Flexible & homogenous sheer weave
Wide variety of surgical procedures
Only hemostat with anti-bacterial
claims
Absorbable in 7-14 days

SURGICEL* under the

microscope
A microscopic view of
a SURGICEL* showing
its homogenous
nature

A microscopic view of other

products showing loose
fibres with irregularly
knitted structures leading
to poor handling
properties and reduced
safety and efficacy

Strength and Coverage

Heavy flexible weave

Blanket protection
against heavier bleeding
Excellent for wrapping
(sternum, liver,spleen)
Can be passed down
trocar (laparoscopic
procedures)
Holds suture
3X density of SURGICEL
Original

Optimal versatility, adherence, and conformability

Extensive surface area for

platelet adhesion and more rapid
haemostasis
Faster haemostat
Conforms to irregular surfaces
Sticks/Adheres to tissue
Soft layered (7) format
Can be applied in layers, tufts,
peanuts, rolls, etc.
Specially for Neuro, CV, Vascular,
General

SURGICEL* bactericidal
properties

Awareness of the importance of SSIs is

constantly increasing throughout EMEA

Haemostats/sealants and the

cascade

Low pH causes vasoconstriction

Provides a matrix for platelet
adhesion and aggregation

ORC
ORC

Aids in fibrin clot formation

THROMBIN
THROMBIN // GELATINE
GELATINE
COMBINATIONS
COMBINATIONS

Provides a matrix for

platelet adhesion and
aggregation

GELATINE
GELATINE or
or
COLLAGEN
COLLAGEN
FLOWABLE
FLOWABLE GELATINE
GELATINE
Provides a matrix for platelet
adhesion and aggregation
Aids in fibrin clot formation when
used with thrombin

SYNTHETIC
SYNTHETIC SEALANTS
SEALANTS

FIBRIN
FIBRIN SEALANT
SEALANT
Provides all the components
necessary for fibrin clot formation

THANK YOU