Eur J Cardiothorac Surg 2002;22:490
© 2002 Elsevier Science NL
Reply to Ibrahim et al.
Francesco Patanè*,
Alessandro Verzini,
Edoardo Zingarelli,
Michele di Summa
Divisione di Cardiochirurgia, Ospedale San Giovanni Battista, C.so Bramante 88, 10126 Turin, Italy
Received 20 May 2002;
accepted 23 May 2002.
* Corresponding author. Tel.: +39-11-633-5511; fax: +39-11-633-6130
e-mail: f_patane{at}hotmail.com
I read with great interest your letter that reports a case of excess Surgicel mimicking an abscess. Surgicel is a local haemostatic gauze. This consists of oxidized regenerated cellulose; it is very useful and used in every kind of surgery. Our experience teaches its great usefulness especially in aortic dissection and in re-do surgery. Nevertheless it has to be used only in single layer in the last phases of haemostasis when you are sure that there are no surgical points of bleeding. We use it only in venous bleeding; we avoid using it for the haemostasis of the grafts’ anastomosis. When you employ Surgicel to adjust the shape and position of aorto-coronary bypass grafts you use it in a single layer. Thus, we think there are no related problems. You should not use Surgicel to tamponade a bleed in the posterior part of an aorta's anastomosis; if it is not possible, you have to wait until there is an optimal coagulation and then remove it, otherwise use biological glue. We recommend avoiding Surgicel between the aorta and pulmonary artery and also between the aorta and vena cava because in this position the formation of pseudoaneurysms and pseudoabscess due to chronic inflammatory reaction is most common. In fact, in all cases, as reported in the literature, the problem related with Surgicel is the use in excess. Actually it is not possible to distinguish a Surgicel accumulation from a tumor or an abscess or an intramural haematoma using X-rays, sonograms and computed tomography scans. For this the reason the Surgicel has to be used as little as possible. We recommend further reports on the utilization of Surgicel during surgical proceedings so as to be able to do a differential diagnosis.
