Biomaterial-Based Hemostasis: A Review of the Clinical and Functional Versatility of Oxidized Regenerated Cellulose

Oxidized Regenerated Cellulose (ORC) is a widely used polysaccharide-based hemostatic agent known for its biocompatibility, absorbability, antibacterial properties, and ease of application. It has been employed across a broad range of surgical specialties as an adjunctive tool for controlling mild to moderate bleeding, reducing postoperative adhesions, and minimizing infection risks. This scoping review aimed to evaluate the clinical efficacy, safety, functional versatility, and future potential of ORC across diverse surgical applications, with a focus on its comparative performance against other topical hemostatic agents. A systematic search of PubMed Central and clinicaltrials.gov database was conducted, including filters for only clinical trials, controlled trials, and randomized controlled trials involving human subjects. A total of 31 studies (28 from PubMed Central and three from clinicaltrials.gov) met the inclusion criteria, encompassing various surgical disciplines. Data were extracted on clinical indication, comparator agents, outcomes, and adverse events. ORC demonstrated consistent efficacy in controlling intraoperative bleeding, particularly in orthopedic, general, and gynecologic surgeries. It reduced total blood loss and postoperative drainage in specific contexts, though its hemostatic effect was less pronounced than fibrin-based sealants in high-pressure bleeding scenarios. It also contributed to adhesion prevention, particularly in pelvic and abdominal surgeries, and showed antibacterial activity against multidrug-resistant organisms. Adverse events were rare and typically unrelated to the material itself. In conclusion, ORC is a versatile, cost-effective hemostatic agent valued for its ease of use, rapid absorption, and intrinsic bactericidal properties. While newer, specialized agents may excel in specific high-risk scenarios, it remains a clinically indispensable option due to its balanced efficacy and safety profile, particularly in resource-limited settings. Further high-quality studies are warranted to solidify its evidence base across diverse surgical applications.