Gelfoam and Surgiflo — Gelatin-Based Hemostatic Matrices
Gelatin-based hemostatic matrices are absorbable porcine-gelatin products that control bleeding through mechanical tamponade, platelet activation on the gelatin surface, and physical absorption of blood (up to 45× their weight). Available as sponges (Gelfoam) for sheet application and as flowable gel (Surgiflo) for irregular cavities and minimally invasive delivery.[1]
Gelatin matrices are frequently combined with topical thrombin to convert a passive matrix into an active hemostatic agent.
Mechanism
- Porcine-gelatin foam provides a physical scaffold that absorbs ~45× its weight in fluid
- Contact activation of platelets on the gelatin surface promotes local clot formation
- Mechanical tamponade of the bleeding surface
- Absorbed in 4–6 weeks by phagocytosis and enzymatic degradation
- Can be saturated with topical thrombin before application to add direct coagulation-cascade activation
Product Forms
| Product | Form | Manufacturer | Best for |
|---|---|---|---|
| Gelfoam | Pre-cut sponge (various sizes) | Pfizer | Sheet application to broad surfaces |
| Gelfoam Powder | Powder | Pfizer | Combined with thrombin → slurry for cavities |
| Surgiflo | Flowable gel | Ethicon | Irregular cavities; syringe delivery |
| Spongostan | Sponge (EU equivalent) | Ethicon | Sheet application |
GU Applications
Gelfoam sponge
- Bone bleeding — pubic bone (pubectomy for UPF), iliac bone, sacrum — packed into the bleeding surface
- Deep pelvic dissection — pelvic sidewall, presacral venous plexus
- Retroperitoneal / renal bed — after partial nephrectomy
- Donor bed after flap harvest (gracilis, ALT)
Gelfoam + topical thrombin (slurry)
- Gelfoam sponge or powder saturated with reconstituted topical thrombin produces an active hemostatic matrix
- Particularly useful for bleeding in heparinized or coagulopathic patients where passive matrices alone underperform
- Classic combination for neurovascular bundle protection during RARP where cautery is contraindicated
Surgiflo (flowable)
- Irregular cavity bleeding — a syringe delivers flowable gel into spaces not accessible to sponge application
- Laparoscopic / robotic application — delivered through trocar-compatible applicator
- Partial nephrectomy — filling the renal parenchymal defect after tumor excision
Technique Pearls
- Dry the field before application — the gelatin must contact blood rather than standing fluid
- Pre-soak with thrombin (if using) — 1000 units/mL reconstituted thrombin saturated into the sponge
- Hold with dry gauze pressure for 3–5 minutes
- Do not over-pack — the matrix swells and can compress adjacent nerves or tissues
- Avoid placing in infected fields — gelatin matrices can harbor bacteria; consider Arista (rapid resorption) or avoid hemostatic matrices in frank infection
Limitations
- Persistent foreign body 4–6 weeks — can produce granuloma on follow-up imaging
- Urinary-tract stone nidus risk — avoid contact with collecting system
- Swelling — can cause compression of adjacent structures, especially in confined spaces (pelvic sidewall, spinal canal)
- Not effective against arterial bleeding — control source first
- Porcine origin — not suitable for patients with strict dietary or religious objections to porcine products
Gelfoam vs. Surgicel vs. Arista vs. FloSeal
| Feature | Gelfoam | Surgicel | Arista AH | FloSeal |
|---|---|---|---|---|
| Source | Porcine gelatin | Plant cellulose | Plant starch | Bovine gelatin + human thrombin |
| Mechanism | Passive + platelet contact | Passive + acidic pH | Passive + water absorption | Active (thrombin) |
| Form | Sponge / powder / flowable | Fabric / fibril / powder | Powder | Flowable gel |
| Resorption | 4–6 weeks | 7–14 days | 24–48 hours | 6–8 weeks |
| Coagulopathy effectiveness | Low alone; moderate with thrombin | Low | Low | High |
| Cost | Low | Low–moderate | Moderate | High |
See Also
- Hemostatic agents overview
- Topical thrombin — often combined with Gelfoam
- FloSeal — pre-combined thrombin + gelatin flowable
References
1. Seyednejad H, Imani M, Jamieson T, Seifalian AM. Topical haemostatic agents. Br J Surg. 2008;95(10):1197–225. doi:10.1002/bjs.6357