Appearance Of Adhesions Research Articles

Effects of Physical Therapy in The Postoperative Period of Plastic Surgery: An Integrative Review

Introduction: The practice of plastic surgery began in the field of reconstructive surgery, in an attempt to recover the functionality of some area of ​​the body or give it a more natural appearance. In this sense, the role of the physical therapist is recommended in various aesthetic surgeries that, through physical therapy resources and techniques, promote tissue healing, reduce the appearance of adhesions, and reduce or eliminate pain, bruises, and edema. Objective: to identify the effects of physical therapy in the postoperative period of plastic surgery. Methodology: This is an integrative literature review, in which there will be a review of articles related to the study of the effects of physical therapy assistance applied to the postoperative period of plastic surgery. Articles related to the proposed theme were included, published between 2011 and 2024, available in full, without language restriction; in addition to theses, dissertations, and monographs. Exclusion criteria were literature review articles, articles or abstracts that had been published in conference proceedings; as well as letters from editors and preprints. Results and discussions: it can show that physiotherapy in the postoperative period of plastic surgery is essential in reducing recovery time, reducing edema, improving the healing process, and preventing the risk of complications in the postoperative period. The main physiotherapeutic resources and techniques were: lymphatic drainage, ultrasound, radiofrequency, laser, and high frequency. Regarding plastic surgeries, the most frequent in the literature were: abdominoplasty, blepharoplasty, rhytidectomy, and liposuction. Final considerations: Dermatofunctional physiotherapy is of paramount importance in the postoperative period of plastic surgery. It is essential in reducing recovery time and reducing the risks arising from surgery.

Analysis of clinical effect of arthroscopic release at different time in treating knee adhesion after arthroscopic surgery

Objective: To explore the efficacy of arthroscopic release in treating postoperative knee adhesion and investigate the influence of release timing on the treatment outcomes. Methods: A total of 50 patients who accepted arthroscopic release in Peking University Third Hospital from February 2017 to December 2021 were included in the retrospective cohort. The study cohort comprised 28 men and 22 women, with a mean age of (30.8±11.9) years. All the primary surgeries were manipulated under arthroscopes. A comparison was made between pre-and postoperative range of motion (ROM), visual analog scale (VAS), International Knee Documentation Committee (IKDC) scores, and Tegner activity scale scores for the patients. According to the interval between the appearance of adhesion and arthroscopic release, the patients were divided into four groups:<3 months group (n=12), 3-6 months group (n=16),>6-12 months group (n=14), and>12 months group (n=8). Inter-group comparisons on postoperative ROM, IKDC scores, and Tegner activity scale scores and improvement values of each outcome were conducted. Results: All the patients were followed up for (36.4±19.7) months. Patients gained significant improvement in flexion, extension, IKDC scores, and Tegner scores (125.0°±20.0° vs 75.7°±27.5°, 2.3°±4.8° vs 7.4°±7.3°, 69.8±17.7 vs 51.4±12.8, 4.1±2.1 vs 2.2±1.1) (all P<0.05), while the VAS scores did not show significant improvement. There were no significant differences among different groups in postoperative extension, IKDC scores or Tegner scores, nor in their improvements. However, patients in the ≤6 months group could gain better postoperative flexion and improvement in flexion than those in the >6 months group (129.9°±20.0° vs 118.8°±17.4°, 58.6°±32.8° vs 37.3°±23.1°) (P<0.05). Conclusions: Arthroscopic release presents a great effect in treating knee adhesion after arthroscopic operation. Once the symptoms of adhesion appear and physical rehabilitation fails to improve the ROM, one should accept early surgical intervention (less than 6 months) for a better outcome.

Safety of mesh with fluoropolymer coating during intra-abdominal placement in large animals: results of the pilot study

When performing laparoscopic intraperitoneal hernioplasty (IPOM), endoprostheses made of fluoropolymers are often used. However, there is no data in the literature on the intra-abdominal use of inexpensive polyester prostheses with a fluoropolymer coating compared to composite implants. Thus, the aim of the pilot study was a preliminary assessment of the safety profile of FTOREX mesh endoprostheses during intra-abdominal placement in large animals. 6 endoprostheses were installed laparoscopically intraperitoneally in each of the 3 pigs: 1) FTOREX; 2) FTOREX with a layer of carboxymethylcellulose; 3) REPEREN-16-2; 4) SYMBOTEX; 5) VENTRALIGHT ST; 6) decellularized pork peritoneum. Fixation was performed with a herniator, transfascial sutures were not used. Relaparoscopy was performed after 45 days, and withdrawal from the experiment was performed after 90 days. Performance characteristics, signs of deformation and retraction, parameters of spike formation were evaluated. All the animals survived, no complications were observed. There were no clinical manifestations or behavioral reactions indicating the presence of adhesions. The most convenient to use were the SYMBOTEX and FTOREX implants (5.0 points each). By the end of the experiment, deformation and retraction were noted in both variants of the FTOREX implants and the REPEREN prosthesis. These changes were completely absent only when using the SYMBOTEX endoprosthesis. According to the number of implants with adhesions, by the end of the observation, both variants of FTOREX prostheses occupied an intermediate position between the Reference (the worst indicator) and VENTRALIGHT ST (the best indicator). However, both FTOREX endoprostheses showed the best performance among all implants in the integral assessment of adhesions, as well as in terms of parameters such as the area and appearance of adhesions, and in terms of the strength of the joints, they were second only to the VENTRALIGHT ST endoprosthesis (0.67 vs. 0.5 points). During the study, there was no reliable dependence of deformation, retraction and adhesion formation indicators on the type of implant. The results of the pilot study showed that all the implants used did not cause any clinically significant adverse reactions or complications. FTOREX endoprostheses with their intraperitoneal installation have anti-adhesive properties that are not inferior to VENTRALIGHT ST or SYMBOTEX composite implants. However, having less rigidity, they are more often deformed and subjected to retraction.

Mesenchymal stem cells under hypoxia condition inhibit peritoneal adhesion by suppressing the prolonged release of interleukin-6.

Aim To investigate the role of hypoxia-preconditioned mesenchymal stem cells (H-MSCs) in preventing peritoneal adhesion by regulating IL-6 at days 6 and 12. Methods Twenty-four PAs rat model weighing 250 g to 300 g were randomly allocated into 4 groups: sham (Sh), control (C), H-MSCs treatment group at dose 1.5 x 106(T1) and 3 x 106(T2). To induce H-MSCs, all MSCs population were incubated under hypoxia state (5% O2 ), 5% CO2, and 37oC for 24 hours. Expression level of IL-6 was performed using ELISA. Morphological appearance of adhesion was observed by visualizing the existence of adhesion formation in intestinal. Results In this study we found that there was a trend of decrease of IL-6 level on day 6 following MSCs treatments. Interestingly, there was a significant decrease of IL-6 level on day 12 in all treatment groups. Also, no adhesion occurred in T2 group. Conclusions H-MSCs prevent PA development by suppressing the prolonged release of IL-6 at proliferation phase.

Totally Endoscopic Suprapubic Approach to Ventral Hernia Repair: Advantages of a New Minimally Invasive Procedure

Laparoscopic ventral hernia repair is in full development with the appearance of surgical techniques that try to diminish the disadvantages associated with this procedure. Totally endoscopic subcutaneous ventral hernia surgery with suprapubic access is a new minimally invasive surgical technique that surgically corrects the hernia defect associated or not with diastasis recti, with the advantages of not penetrating the intra-abdominal space and avoiding the prosthesis placement in contact with the viscera, with the consequent complications derived from it (appearance of adhesions or fistulas).

Abordaje totalmente endoscópico suprapúbico de la hernia ventral. Ventajas de un nuevo procedimiento mínimamente invasivo

Laparoscopic ventral hernia repair is in full development with the appearance of surgical techniques that try to diminish the disadvantages associated with this procedure. Totally endoscopic subcutaneous ventral hernia surgery with suprapubic access is a new minimally invasive surgical technique that surgically corrects the hernia defect associated or not with diastasis recti with the advantages of not penetrating the intra-abdominal space, thereby avoiding placement of the prosthesis in contact with the viscera and consequent complications (appearance of adhesions or fistulae).

Imaging appearance and distribution of intra-articular adhesions following open FAI surgery

ObjectivesTo evaluate the appearance and distribution of intra-articular adhesions on direct MR arthrograms (MRA) in symptomatic patients after surgical hip dislocation (SHD) for the treatment of femoroacetabular impingement (FAI). MethodsAll 18 patients (19 hips) who underwent arthroscopic debridement for treatment of symptomatic adhesions after open surgery of FAI between 2003 and 2012 and that had a complete set of pre- and postoperative direct MRA were evaluated. On radial PD-w images, pre- and postoperative osseous alpha angles were measured. Signal intensity and degree of obliteration of the peripheral compartment of the hip joint were assessed circumferentially at each ‘half-hour’ position and quantified with the adhesion alpha angle (measured between a line connecting the most proximal appearance of adhesions on the femoral neck with the femoral head center and the femoral neck axis). Linear regression analysis was performed between the site of correction and adhesions. As a control group, all patients (9; 9 hips) that underwent revision surgery during the same time period in which adhesions were not the primary cause for revision were evaluated. ResultsFemoral adhesions primarily (47%) appeared as intermediate, complete obliterations correlating with the site of offset correction (R = 0.883, p < 0.001). Adhesion alpha angles were comparable to the pre-operative osseous alpha angles (21/24 positions, p > 0.05) and were greater than the postoperative osseous alpha angles (11/24 positions, p < 0.05). Most labral adhesions (83.2%) appeared as adjacent and correlated with the site of rim trimming (R = 0.777, p < 0.001). In the control group, the most common reason for revision surgery was persisting cam deformity (67%). The radiographic findings were confirmed intra-operatively. ConclusionIntra-articular adhesions most commonly appear at the site of primary offset correction. Recurrent impingement due to scar tissue may be quantified with the adhesion alpha angle. MRA of the hip are suitable to distinguish between postoperative adhesions and other known causes for persisting symptoms.

Effects of BMP-12-releasing sutures on Achilles tendon healing.

Tendon healing is a complex coordinated event orchestrated by numerous biologically active proteins. Unfortunately, tendons have limited regenerative potential and as a result, repair may be protracted months to years. Current treatment strategies do not offer localized delivery of biologically active proteins, which may result in reduced therapeutic efficacy. Surgical sutures coated with nanostructured minerals may provide a potentially universal tool to efficiently incorporate and deliver biologically active proteins directly to the wound. Additionally, previous reports indicated that treatment with bone morphogenetic protein-12 (BMP-12) improved tendon healing. Based on this information, we hypothesized that mineral-coated surgical sutures may be an effective platform for localized BMP-12 delivery to an injured tendon. The objective of this study was, therefore, to elucidate the healing effects of mineral-coated sutures releasing BMP-12 using a rat Achilles healing model. The effects of BMP-12-releasing sutures were also compared with standard BMP-12 delivery methods, including delivery of BMP-12 through collagen sponge or direct injection. Rat Achilles tendons were unilaterally transected and repaired using BMP-12-releasing suture (0, 0.15, 1.5, or 3.0 μg), collagen sponge (0 or 1.5 μg BMP-12), or direct injection (0 or 1.5 μg). By 14 days postinjury, repair with BMP-12-releasing sutures reduced the appearance of adhesions to the tendon and decreased total cell numbers. BMP-12 released from sutures and collagen sponge also tended to improve collagen organization when compared with BMP-12 delivered through injection. Based on these results, the release of a protein from sutures was able to elicit a biological response. Furthermore, BMP-12-releasing sutures modulated tendon healing, and the delivery method dictated the response of the healing tissue to BMP-12.

Prevention of Pleural Adhesions by Bioactive Polypeptides - A Pilot Study

Objective: Postoperative pleural adhesions lead to major problems in repeated thoracic surgery. To date, no antiadhesive product has been proven clinically effective. Previous studies of differently charged polypeptides, poly-L-lysine (PL) and poly-L-glutamate (PG) have shown promising results reducing postoperative abdominal adhesions in experimental settings. This pilot study examined the possible pleural adhesion prevention by using the PL+PG concept after pleural surgery and its possible effect on key parameters; plasmin activator inhibitor-1 (PAI-1) and tissue growth factor beta 1 (TGFb) in the fibrinolytic process.Methods: A total of 22 male rats were used in the study, one control group (n=10) and one experimental group (n=12). All animals underwent primary pleural surgery, the controls receiving saline in the pleural cavity and the experimental group the PL+PG solution administered by spray. The animals were evaluated on day 7. Macroscopic appearance of adhesions was evaluated by a scoring system. Histology slides of the adhesions and pleural biopsies for evaluation of PAI-1 and TGFb1 were taken on day 7.Results: A significant reduction of adhesions in the PL+PG group (p<0.05) was noted at day 7 both regarding the length and severity of adhesions. There were no significant differences in the concentration of PAI-1 and TGFb1 when comparing the two groups.Conclusions: PL+PG may be used to prevent pleural adhesions. The process of fibrinolysis, and fibrosis was though not affected after PLPG administration.

Peritoneal adhesion index (PAI): proposal of a score for the “ignored iceberg” of medicine and surgery

Peritoneal adhesions describe a condition in which pathological bonds form between the omentum, the small and large bowels, the abdominal wall, and other intra-abdominal organs. Different classification systems have been proposed, but they do not resolve the underlying problem of ambiguity in the quantification and definition of adhesions. We therefore propose a standardized classification system of adhesions to universalize their definition based on the macroscopic appearance of adhesions and their diffusion to different regions of the abdomen. By scoring with these criteria, the peritoneal adhesion index (PAI) can range from 0 to 30, unambiguously specifying precise adhesion scenarios. The standardized classification and quantification of adhesions would enable different studies to more meaningfully integrate their results, thereby facilitating a more comprehensive approach to the treatment and management of this pathology.

Surface Treatment with 5-Fluorouracil After Flexor Tendon Repair in a Canine in Vivo Model

Topical 5-fluorouracil has been reported to reduce adhesions in animal models of tenolysis. The purpose of this study was to investigate the effects of topical 5-fluorouracil on adhesion formation after tendon repairs were subjected to immediate postoperative rehabilitation in a canine model in vivo. Sixty dogs were randomly assigned to either a 5-fluorouracil treatment (thirty dogs) or a control group (thirty dogs). Each treatment group was then divided into three survival time points: ten days, twenty-one days, and forty-two days. The second and fifth flexor digitorum profundus tendons from each dog were fully lacerated at the zone-II area and then were repaired. Passive motion therapy started at day 5 postoperatively and continued until the dogs were killed. The repaired tendons were evaluated for normalized work of flexion, gliding resistance, repair strength, gene expression for type-I and type-III collagen and transforming growth factor-beta1, and histological appearance. The normalized work of flexion of the repaired tendons treated with 5-fluorouracil was significantly lower than that of the repaired tendons without 5-fluorouracil treatment at ten days. However, there was no significant difference between treated and untreated tendons at twenty-one and forty-two days. There was also no significant difference in gliding resistance, repair failure strength, or stiffness between treated and untreated tendons at any time point, or in the gross or histological appearance of adhesions at the time of killing. The expression of types-I and III collagen and transforming growth factor-beta1 of the repaired tendon with 5-fluorouracil treatment was significantly lower than that of the tendons without treatment at ten days postoperatively, but not at twenty-one or forty-two days. Although 5-fluorouracil treatment can reduce adhesions in in vivo models of tenolysis, this treatment had only a transient effect in an in vivo model of tendon repair that included passive motion.

106: Thermal Damage and Coagulations—What Do We Need To Know?

Adhesions still account for great numbers of postoperative complications in pelvic surgery, leading to intestinal obstruction, chronic pelvic pain, female infertility plus complicated following surgeries and increasing hospitalization costs. The objective was to determine the benefit and efficacy of novel barriers agents in adhesion prophylaxis in an established rat uterine horn model. All “barriers” were evaluated in a prospective, randomized study with six study groups (each n = 18) and a control group (lRS, n = 18) in comparison to clinical routine (RL). Synthetic peritoneum (XA-1-2002 membrane and foil (Supraseal, PDLA-Copolymer, PDLA 1-3); Interceed (oxidized, regenerated cellulose, ORC) and innovative barrier solutions (Adept 4% Icodextrin, ICT); Hyalobarrier Gel (Hyaluronic acid) were compared to simulated Aszites (lactated Ringer’s solution, RL) and histomorphological results were captured applying the Masson trichrome staining. Both the visceral and parietal peritoneum and the uterine horn were traumatized (Perlon brushing) and treated with alloplastic agents and evaluated four weeks postoperatively at 2nd-look Laparatomy. Groups treated with Adept, Hyalobarrier Gel, Interceed and SupraSeal showed significantly less and only moderate adhesions when compared to RL. Among these groups, no significant varieties in the protective impact could be ascertained. Fibroblast rich tissue with acute inflammatory reaction could be demonstrated for ORC and PDLA 2. Solid barriers carry the risk of material residua and lead to an accumulation of adhesion appearance at the suture sites. Hydroflotation formulas like Adept, spread intra-abdominally and develop their protective impact evenly. The present study emphasizes the need to apply innovative anti-adhesion agents in surgery known to carry a high risk of adhesions.

Rat supraspinatus muscle atrophy after tendon detachment

Rotator cuff tears are one of the most common tendon disorders found in the healthy population. Tendon tears not only affect the biomechanical properties of the tendon, but can also lead to debilitation of the muscles attached to the damaged tendons. The changes that occur in the muscle after tendon detachment are not well understood. A rat rotator cuff model was utilized to determine the time course of changes that occur in the supraspinatus muscle after tendon detachment. It was hypothesized that the lack of load on the supraspinatus muscle would cause a significant decrease in muscle mass and a conversion of muscle fiber properties toward those of fast fiber types. Tendons were detached at the insertion on the humerus without repair. Muscle mass, morphology and fiber properties were measured at one, two, four, eight, and 16 weeks after detachment. Tendon detachment resulted in a rapid loss of muscle mass, an increase in the proportion of fast muscle fibers, and an increase in the fibrotic content of the muscle bed, concomitant with the appearance of adhesions of the tendon to surrounding surfaces. At 16 weeks post-detachment, muscle mass and the fiber properties in the deep muscle layers returned to normal levels. However, the fiber shifts observed in the superficial layers persisted throughout the experiment. These results suggest that load returned to the muscle via adhesions to surrounding surfaces, which may be sufficient to reverse changes in muscle mass.

A scanning electron microscopical study of the two sides of polypropylene mesh (Marlex ®) and PTFE (Gore Tex ®) mesh 2 years after complete abdominal wall reconstruction. A study of 15 cases

The use of biomaterials for the repair of abdominal wall defect is becoming common and safe. It has been 20 years since the senior author developed a method to reconstruct the very large transfixing abdominal wall defect with a combination of two biomaterials (Gore Tex ® PTFE as a neo peritoneum and polypropylene superficial to this in order to give rigidity to the abdominal wall) and a superficial flap. An observation at the electron microscopy level of the two sides of the implants' surfaces was performed. At the time of a late abdominal wall surgical revision on 15 patients, the prosthesis fragments have been analyzed at the electron microscopy level. The aim of our study was to analyze the late evolution of the different sides of these prostheses. Our results showed, for the first time in vivo, that there is an impressive stability of the deep side of PTFE ultra structure after implantation, a significant difference of the two sides of PTFE at the ultrastructural level and the creation of an intermediate tissue between the two meshes. In contrast, the polypropylene invariably gave rise to adhesions and colonisation by the surrounding tissues. Findings confirmed that the structure and porosity of a biomaterial play a key role in the appearance of adhesions and their consistency.

Definition of pertinent parameters for the evaluation of articular cartilage repair tissue with high-resolution magnetic resonance imaging

To evaluate articular cartilage repair tissue after biological cartilage repair, we propose a new technique of non-invasive, high-resolution magnetic resonance imaging (MRI) and define a new classification system. For the definition of pertinent variables the repair tissue of 45 patients treated with three different techniques for cartilage repair (microfracture, autologous osteochondral transplantation, and autologous chondrocyte transplantation) was analyzed 6 and 12 months after the procedure. High-resolution imaging was obtained with a surface phased array coil placed over the knee compartment of interest and adapted sequences were used on a 1 T MRI scanner. The analysis of the repair tissue included the definition and rating of nine pertinent variables: the degree of filling of the defect, the integration to the border zone, the description of the surface and structure, the signal intensity, the status of the subchondral lamina and subchondral bone, the appearance of adhesions and the presence of synovitis. High-resolution MRI, using a surface phased array coil and specific sequences, can be used on every standard 1 or 1.5 T MRI scanner according to the in-house standard protocols for knee imaging in patients who have had cartilage repair procedures without substantially prolonging the total imaging time. The new classification and grading system allows a subtle description and suitable assessment of the articular cartilage repair tissue.

Pyoderma Gangrenosum Associated with Acute Megakaryoblastic Leukemia

Pyoderma gangrenosum (PG) is an unusual ulcerating cutaneous process frequently representing a dermatologic manifestation of a systemic disease including myeloproliferative disorders. This article describes the first case of PG associated with acute megakaryoblastic leukemia (AML-M7). This case determined that the morphology of blast forms present within the lesion represented by PG, including elongated cytoplasmic projections, frayed shaggy cytoplasm, and appearance of adhesion of blasts to each other, are suggestive, though not diagnostic, of megakaryoblast. Identification of microthrombi within PG, suggestion of adhesion of circulating megakaryoblasts, and previous reported cases of patients with AML-M7 and patients with PG associated with myeloproliferative disorders exhibiting thrombotic or coagulopathies suggest that a localized microangiopathic consumptive coagulopathy or microthrombotic ischemic process might be considered in the etiology and pathogenesis of PG.

Interface formed between visceral peritoneum and experimental polypropylene or polytetrafluoroethylene abdominal wall implants

The objective of this work was to study the healing process at the interface between biomaterial and visceral peritoneum. Implants of polytetrafluoroethylene (ePTFE) and polypropylene prostheses were introduced into the abdominal wall of New Zealand rabbits. The behaviour of the biomaterials was analysed using light and scanning electron microscopy and immunohistochemistry in which a specific anti-rabbit macrophage monoclonal antibody (RAM 11) was employed. According to macroscopic observation, there was significantly fewer adhesions prosthesis-viscera to ePTFE than to polypropylene implants. After ePTFE implantation, restoration of the peritoneum took place in an orderly fashion. When polypropylene was used, the peritoneum formed was a disorderly tissue in which small areas of haemorrhage and necrosis could be seen to coincide with the appearance of adhesions. The number of labelled macrophages peaked 14 days after ePTFE or polypropylene implantation, after which it decreased gradually. It is concluded that, given the low rate of adhesion provoked by PTFE, this material is ideal for implants contiguous to the peritoneal cavity viscera. The macrophage response does not determine the use of one material or the other. The structure of the newly formed peritoneum and development of adhesions depends on the porosity of the biomaterial.

Structure and properties of molded polyblends containing liquid crystalline polymers

AbstractThe relationship between the microstructure developed during injection molding of liquid crystalline polymers (LCPs) containing blends and their mechanical properties, was studied. A wholly aromatic copolyester LCP was melt blended in various levels with polycarbonate (PC), poly(butylene terephthalate) (PBT), Nylon 6 (N‐6), and amorphous nylon (AN). In all cases the LCP was the minor component. The resulting injection molded structure had a distinct skin core morphology, where elongated fibrous LCP particles comprised the skin layer and spherical and ellipsoidal ones composed the core section. The highest elongation and the finest diameter LCP fibrils were obtained with AN/LCP system, followed by PC/LCP. PBT/LCP blends showed a coarser morphology, while N‐6/LCP system did not correlate with the tensile moduli of the injection molded specimens. AN/LCP blends demonstrated the highest moduli values, consistent with the highest orientations observed using electron microscopy, followed by PC/LCP, PBT/LCP, and N‐6/LCP. Finally, tensile strength levels were correlated with both orientation levels and interfacial adhesion between the polyblend components. AN/LCP that exhibited the highest orientation and good adhesion appearance gave the highest tensile strength values followed by PC/LCP, PBT/LCP, and N‐6/LCP polyblends.

Causes of the appearance of adhesions in the formation of cuprammonium staple fibre

1. It has been shown that the content of ammonia in the spinning solution and the coagulation bath, the content of sodium sulphate in the coagulation bath, and the rate of its feed to the spinning unit affect the adhesivity of cuprammonium staple fibre. 2. To decrease the number of adhesions in the fibre it may be recommended that the ratio of ammonia to cellulose in the solution should be kept between 0.48 and 0.50, the content of ammonia in the coagulation bath should be not more than 0.05 g/litre and that of sodium sulphate 1.2–1.5 g/litre, and the rate of feed of the bath should be 18–20 litres/min.