Prevention of peritendinous adhesions using an electrospun DegraPol polymer tube: a histological, ultrasonographic, and biomechanical study in rabbits.

Pietro Giovanoli,Angela Müller,Gion Fessel,Maurizio Calcagni,Johanna Buschmann,Jess G. Snedeker,Eliana Bonavoglia,Gabriella Meier Bürgisser

doi:10.1155/2014/656240

Abstract

Purpose. One of the great challenges in surgical tendon rupture repair is to minimize peritendinous adhesions. In order to reduce adhesion formation, a physical barrier was applied to a sutured rabbit Achilles tendon, with two different immobilization protocols used postoperatively. Methods. Thirty New Zealand white rabbits received a laceration on the Achilles tendon, sutured with a 4-strand Becker suture, and half of the rabbits got a DegraPol tube at the repair site. While fifteen rabbits had their treated hind leg in a 180° stretched position during 6 weeks (adhesion provoking immobilization), the other fifteen rabbits were recasted with a 150° position after 3 weeks (adhesion inhibiting immobilization). Adhesion extent was analysed macroscopically, via ultrasound and histology. Inflammation was determined histologically. Biomechanical properties were analysed. Results. Application of a DegraPol tube reduced adhesion formation by approximately 20%—independently of the immobilization protocol. Biomechanical properties of extracted specimen were not affected by the tube application. There was no serious inflammatory reaction towards the implant material. Conclusions. Implantation of a DegraPol tube tightly set around a sutured tendon acts as a beneficial physical barrier and prevents adhesion formation significantly—without affecting the tendon healing process.

Highlights

Tendon repair is a field in surgery where improvements are still welcome
In order to reduce adhesion formation, a physical barrier was applied to a sutured rabbit Achilles tendon, with two different immobilization protocols used postoperatively
Implantation of a DegraPol tube tightly set around a sutured tendon acts as a beneficial physical barrier and prevents adhesion formation significantly—without affecting the tendon healing process

Summary

Introduction

Tendon repair is a field in surgery where improvements are still welcome. Complications such as scar formation and adhesion in the tendon sheath in the early healing phase up to 6 weeks do occur in 7 to 15% of the cases, which leads to increased work disability and costs [1]. The postoperative treatment has to be optimized with respect to its impact on the adhesion extent as it is well known that for example in Achilles tendon regeneration the ankle angle plays a crucial role [5]. Physical antiadhesion barriers consisting of biomaterials such as fibronectin [6], collagen [3], or silk [7] have been reported to show positive effects with respect to reducing adhesion formation. Antiadhesive agents were beneficially administered such as 5-fluorouracil [8], hyaluronic acid, and ADCON-T/N, being a gelatinepolyglycan ester compound [9] or anti-inflammatory drugs like ibuprofen [10]

Methods

Results

Discussion

Conclusion