Neurosurgical patties look like the simplest line on a craniotomy pick list: a small rectangle of absorbent material with a string sewn in. They are also one of the least standardized items in most ORs. Three or four families share a shelf, the preference card names a size the shelf does not hold, and the count sheet treats every pattie the same even though the materials handle differently on tissue.
This guide covers the four families American Surgical Company makes, how ORs pick among them, what the X-ray line and locator string do in the count, and how the packaging works.
What the material decides
A pattie protects tissue under an instrument or retractor, absorbs fluid, and channels suction without dragging on the surface beneath it. The material sets how each of those goes.
- Rayon is strong, pliable when wet, and comes in the widest size range. It is the default for most craniotomy and spine cases.
- Cotton holds more fluid and dries more slowly, so it stays soft through a long case.
- Ultra-thin rayon fits where a standard pattie will not: skull base, keyhole, and endoscopic corridors.
- A low-adherence outer layer matters when the tissue under the pattie is friable and the surgeon wants it lifted clean.
Every American Surgical family carries an X-ray detectable barium line, and every pattie carries a sewn-in locator string. Material choice is about handling, not detectability.
The four families
| Family | Construction | Where ORs use it | Manufacturer-stated absorbency | Sizes |
|---|---|---|---|---|
| Ray-Cot | Standard-profile rayon, single barium line, precision-cut edges | Everyday craniotomy and spine pattie | Up to 12 percent greater absorption by weight in the manufacturer's testing | 18 pattie sizes with string, 8 strips without |
| Americot | 100 percent U.S.A. cotton, single barium line | Long cases where slow drying keeps the pattie soft | More than 11 times its dry weight | 18 pattie sizes, 3 strips |
| Delicot | Ultra-thin rayon, 0.33 mm profile | Skull base, keyhole, endoscopic and other microsurgery | More than 8 times its dry weight | More than 10 rectangular sizes from 2 mm to 30 mm, plus tapered shapes |
| Telfa | Cotton core inside a perforated Telfa outer layer | Friable tissue where reduced adhesion matters | More than 11 times its dry weight | 9 pattie sizes, 2 strips |
A fifth line, Uniqcot, is a thinner rayon between Ray-Cot and Delicot. It is the pattie Keystone substitutes when a Ray-Cot size goes on allocation, because it handles closest to Ray-Cot at the same footprint. Telfa is a registered trademark of KPR U.S., LLC.
How ORs choose neurosurgical patties
The catalog runs from 1/4 x 1/4 in to 3-1/2 x 6 in. No OR needs all of it. The facilities that keep the shelf under control do five things.
- Start from the preference cards, not the catalog. List every family and size the neuro and spine cards call for and compare it to the shelf. The gap is usually the problem, not the budget.
- Standardize the workhorse first. Pick one standard-profile family, Ray-Cot or Americot, for the bulk of case volume and hold the three or four sizes the cards name most. The 1/4 x 3 in, 1/2 x 3 in, and 1 x 3 in sizes cover most of that demand.
- Add ultra-thin only where the corridor is narrow. Delicot and tapered Delicot belong on the cards of surgeons doing skull base, keyhole, and endoscopic work, not on the whole service's par list.
- Add Telfa by surgeon request. Low adherence is a handling preference. Stock it for the surgeons who ask for it and keep the sizes tight.
- Write the alternate down before you need it. Name the substitute family and size on the card and get the surgeon's sign-off before an allocation notice forces the call.
These are sterile, single-use devices sold to licensed healthcare facilities and their purchasing agents.
X-ray detectable lines, strings, and the count
The AHRQ Patient Safety Network primer on retained surgical items, updated February 2025, describes the standard count as two people viewing the items together, one separating each item by hand, both counting aloud. It reports that in 40 of 46 confirmed retained-sponge cases reviewed, the final count had been called correct. Every surgical sponge must carry a radiopaque barium marker, and radiologists have misread those markers as monitoring leads. Barcode, radiofrequency, and RFID systems are adjuncts to the manual count, not replacements.
What that means at the back table:
- The string is the count tool. It stays outside the field so the scrub can find and lift each pattie and confirm the number against the sheet. American Surgical color-codes it by part number: blue on most patties, gold, grey, or neon green on select Delicot sizes, white or silver on the strips that carry one.
- Most strips ship without a string. They carry the barium line; the count relies on the sheet.
- The barium line is the backup, not the plan. The product pages list X-ray detectability and a string; there is no RF tag. An RF wand sweep does not replace the pattie count.
None of this is clinical guidance. It is the reason purchasing should keep one family per size on the shelf and put string colors on the count sheet.
Sizes, pouch counts, and case quantities
Packaging is consistent across the line, so the par math is simple.
- 10 patties per sterile pouch, 20 pouches per box, 200 per box. The one exception the manufacturer lists is the 2 x 20 mm Delicot (63x00), which packs 100 per box in 10 pouches of 10.
- Part-number logic. Ray-Cot patties are 60-series and strips 61-series. Delicot is 63-series, with a T suffix on tapered shapes. Telfa patties are 80-series, strips 81-series. Americot patties are 20-series with an S suffix, strips 21-series. Examples Keystone stocks: Ray-Cot 60-04 (1/4 x 3 in), Delicot 63-06 (1/4 x 2 in), Telfa 80-09 (1/2 x 3 in), Americot 20-10S (1 x 3 in).
- Par by pouch, not by box. Count pouches opened per case, multiply by weekly case volume, and hold four weeks on the two highest-volume sizes. A box of 200 covers 20 single-pouch cases. Receive by lot and rotate on dating.
Confirm current codes against the manufacturer's 2026 listing before writing a standing order, and order by part number so a 1/2 x 3 in Telfa does not arrive as a 1/2 x 3 in Ray-Cot.
What Keystone stocks
Keystone Supply Group stocks American Surgical Company patties and strips in Edina, Minnesota: Ray-Cot, Uniqcot, Delicot, Telfa, and Americot in the sizes ORs order most, with the rest of the catalog order-in at 2 to 3 weeks. Every quote lists the manufacturer, part number, pack, and stated lead time, and names the Uniqcot alternate when a Ray-Cot size is tight. Orders ship from Edina or direct from the manufacturer in Salem, Massachusetts. Same-day quotes during business hours, Net 30 for approved accounts.
Browse surgical specialty and OR consumables or send your pattie preference list for a quote. The sales department is at Orders@KeystoneSupplyGroup.com and (507) 237-6036.
Sources
- American Surgical Company, Surgical Patties and Strips: https://www.americansurgical.com/surgical-patties/
- American Surgical Company, Ray-Cot Neurosurgical Pattie: https://www.americansurgical.com/ray-cot-neuro-pattie/
- American Surgical Company, Delicot Neurosurgical Pattie: https://www.americansurgical.com/delicot-neurosurgical-pattie/
- American Surgical Company, Telfa Neurosurgical Pattie: https://www.americansurgical.com/telfa-neurosurgical-pattie/
- American Surgical Company, Americot 100% Cotton Pattie: https://www.americansurgical.com/americot-cotton-neurosurgical-pattie/
- AHRQ Patient Safety Network, Retained Surgical Items: Causation and Prevention: https://psnet.ahrq.gov/primer/retained-surgical-items-causation-and-prevention
