2019 SCIENCELINE

Journal of Life Science and Biomedicine

J Life Sci Biomed, 9 (2): 42-44, 2019

License: CC BY 4.0

ISSN 2251-9939

The use of a new hemostatic preparation

made of the cellulose derivatives in

surgery: “warning” for postoperative

complications!

Gianluca Franceschini (MD)^, Alba Di Leone (MD), Giuseppe Visconti (MD), Riccardo Masetti (MD)

Division of Breast Surgery, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS;

Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8 - 00168, Rome, Italy.

Corresponding author: Prof. Dr. Gianluca Franceschini; Email: gianlucafranceschini70@gmail.com

INTRODUCTION

Letter to Editor

Introduction. We have read with interest the article by Rustam Abrarovich Sadykov et al.

(2019) on “New hemostatic preparation made of the cellulose derivatives” [1 ]. The Authors

present their early experience on new samples of pellicle hemostatic coverage on the basis of

the cellulose derivatives. They conclude: “Rapid enough biodegradation of polymer along

with the unexpressed inflammatory reaction allows preventing the infecting related to the

presence of foreign body. The rapid forming of fibrotic tissue in a zone of lesion makes it

possible to obtain a durable hemostasis”.

PII: S225199391900007-9

Rec. 18 February 2019

Rev. 23 March 2019

Pub. 25 March 2019

Results. In our series we noted a 10% rate of allergic skin reactions with irritation, redness,

itching, swelling, rash and hives in the mammary region, successfully managed with

steroids and antihistamine medications. In addition, we experienced a significant seroma in

the site of oxidized regenerated cellulose (ORC) placement in 45% of our patients.

Keywords

Hemostasis,

Oxidized Cellulose,

Polymer

Conclusion and Recommendation. When using a new preparation made of the cellulose

derivatives, as a possible aid to reduce the risk of postoperative haematoma and infections it

is important to discuss with the patient also about possible postoperative complications. It

is also important that surgeons specify clearly the use of this biomaterial in the report of the

surgical procedure so that radiologists can properly interpret the sonographic findings due

to this biomaterial and avoid misdiagnosis and undue alarmism during the follow-up of

these patients.

DISCUSSION

We have previously reported our experience with the use of oxidized regenerated cellulose (ORC), at the

Catholic Breast Unit of Rome, as a possible aid to reduce the risk of postoperative haematoma and infections

and to improve the aesthetic outcomes in patients undergoing an oncoplastic procedures for breast cancer [2, 3 ].

However, as new hemostatic preparations made of the cellulose derivatives is being increasingly utilized

in surgery [1-6 ], we think that it is important to properly inform the patients not only about the potential

advantages but also about possible postoperative complications of these materials. Tanaka et al. [4] report a 18%

rate of allergic reaction with the use of ORC, mainly presenting as acute dermatitis and eczema, and one case of

exudation followed by wound dehiscence [4 ].

In our series we noted a 10% rate of allergic skin reactions with irritation, redness, itching, swelling, rash

and hives in the mammary region, successfully managed with steroids and antihistamine medications. In

addition, we experienced a significant seroma in the site of ORC placement in 45% of our patients [3 ]. This

seroma, that appears in the early postoperative period as consequence of redundant ORC digestion, normally

resolved within few weeks with repeated percutaneous aspirations but in two cases it was followed by the

To cite this paper: Franceschini G, Di Leone A, Visconti G, Masetti R 2019. The use of a new hemostatic preparation made of the cellulose derivatives in surgery:

“warning” for postoperative complications! J. Life Sci. Biomed. 9(2): 42-44; www.jlsb.science-line.com

formation of an abscess in the residual cavity that required surgical drainage. We also had a case of a foreign

body reaction that required surgical excision to solve the complication (Figure 1).

Besides, we think it is important to call the attention of radiologists on the peculiar findings that

preparation made of the cellulose derivatives as ORC may determine on postoperative ultrasound (US)

examination, that often lead to undue alarmism.

In our series, peculiar fluid anaechoic accumulation containing small hyperechoic, round components

were documented on breast US examination (performed six months after surgery) in all cases. This typical

round image (that we named “ile-flottante”) (Figure 2), is consequence of the fibrogenetic action induced by

ORC and of the partial reabsorption of this biomaterial. It appears non-mobile, avascular, and adherent to the

parenchymal tissue planes and is often misinterpreted in an alarming way by the radiologists. The diagnostic

interpretations in our patients varied from possible residual disease to haematoma sequaele, local abscess or

area of fat necrosis.

Figure 1. A foreign body reaction that required surgical excision after six-month follow-up in a patient treated

by breast oncoplastic conservative surgery with ORC.

Figure 2. Ultrasound images (Siemens Antares sonography unit, Siemens Medical Solutions, Sweden) at six-

month follow-up in three patients treated by breast oncoplastic conservative surgery with ORC. With the use of

a high-frequency 10–13 MHz linear array transducer, a free anaechoic collection without wall with the presence

of typical small hyperechoic round masses (yellow arrow) in continuity with the breast parenchyma is showed.

To cite this paper: Franceschini G, Di Leone A, Visconti G, Masetti R 2019. The use of a new hemostatic preparation made of the cellulose derivatives in surgery:

“warning” for postoperative complications! J. Life Sci. Biomed. 9(2): 42-44; www.jlsb.science-line.com

CONCLUSION

In conclusion, when using a new preparation made of the cellulose derivatives, as a possible aid to reduce the

risk of postoperative haematoma and infections it is important to discuss with the patient also about possible

postoperative complications. It is also important that surgeons specify clearly the use of this biomaterial in the

report of the surgical procedure so that radiologists can properly interpret the sonographic findings due to this

biomaterial and avoid misdiagnosis and undue alarmism during the follow-up of these patients.

REFERENCES

1. Sadykov RA, Ismailov BA, and Valerevna KO. New hemostatic preparation made of the cellulose

derivatives. J Life Sci Biomed, 2019; 9 (1): 19-25.

2. Franceschini G, Visconti G, Sanchez AM, Di Leone A, Salgarello M, Masetti R. Oxidized regenerated

cellulose in breast surgery: experimental model. J Surg Res, 2015 Sep; 198(1): 237-44.

3. Franceschini G, Visconti G, Terribile D, Fabbri C, Magno S, Di Leone A, Salgarello M, Masetti R. The role of

oxidized regenerate cellulose to prevent cosmetic defects in oncoplastic breast surgery. Eur Rev Med

Pharmacol Sci, 2012 Jul; 16(7):966-71.

4. Tanaka S, Sato N, Fujioka H, Takahashi Y, Kimura K, Iwamoto M, Uchiyama K. Breast conserving surgery

using volume replacement with oxidized regenerated cellulose: a cosmetic outcome analysis. Breast J, 2014

Mar-Apr; 20(2): 154-8.

5. Rassu PC. Observed outcomes on the use of oxidized and regenerated cellulose polymer for breast

conserving surgery - A case series. Ann Med Surg (Lond), 2015 Dec 22; 5:57-66.

6. Gottrup F, Cullen BM, Karlsmark T, Bischoff-Mikkelsen M, Nisbet L, Gibson MC. 2013. Randomized

controlled trial on collagen/oxidized regenerated cellulose/silver treatment. Wound Repair Regen, 21: 216.

doi: 10.111/wrr.12020

To cite this paper: Franceschini G, Di Leone A, Visconti G, Masetti R 2019. The use of a new hemostatic preparation made of the cellulose derivatives in surgery:

“warning” for postoperative complications! J. Life Sci. Biomed. 9(2): 42-44; www.jlsb.science-line.com