Differences In Adhesion Formation Research Articles

Application of infrared thermography in assessing presence and severity of intra-abdominal adhesions

Abdominal surgeries can sometimes lead to the formation of intra-abdominal adhesions, which may result in severe complications. Despite the availability of several diagnostic procedures, thermography has not been used for identifying intra-abdominal adhesions. Therefore, the objective of the current study was to assess abdominal temperature changes in rats with experimentally induced intra-abdominal adhesions. A total of 48 female rats were randomly divided into 4 groups (n = 12 each): Control (Group C), Laparotomy (Group Lap), Peritoneal Button Creation (Group PBC), and Uterus horn (Group UH). Skin temperature of abdominal region was measured before the procedure (T0) and daily thereafter until day 7 (T7). On day 7, all rats were euthanized for macroscopic evaluation, adhesion scoring, histopathological, immunohistochemical and immunofluorescence analyses. Significant differences were observed between Group C and Group PBC and Group UH at T5, while at T6 and T7, there was a difference between Group C and Group Lap, Group PBC, and Group UH in abdominal skin temperature (P < 0.05). The highest level of inflammation, angiogenesis, IL-1β, and VEGF were observed in Group PBC followed by Group UH, Group Lap, and Group C (P < 0.05). There was a significant difference in adhesion formation between Group C and Groups Lap, PBC, and UH (P = 0.02). However, no significant difference was found in adhesion scores between Groups Lap, PBC, and UH (P = 0.25). A significant difference was found in mean abdominal skin temperature between adhesion scores 4 and 0, 1, and 2 (P < 0.05), while no significant difference was observed between adhesion scores 3 and 4 (P > 0.05). In conclusion, the current study suggests that the presence of intra-abdominal adhesions is associated with an increase in abdominal temperature, and this increase is correlates with the severity of adhesion.

Outcomes of Septal Surgery with Nasal Packing Versus Quilting Sutures

Background: Septoplasty is a common surgical procedure used to correct a deviated nasal septum, which can cause nasal obstruction and impact respiratory function. Postoperative management traditionally includes nasal packing to prevent complications such as bleeding and hematoma, although it can be associated with discomfort and other complications. Quilting sutures have been proposed as an alternative technique to reduce these issues. Objective: To compare the postoperative outcomes of nasal packing versus quilting sutures in patients undergoing septoplasty. Methods: This prospective comparative cross-sectional study was conducted at the ENT unit of Combined Military Hospital Rawalpindi, Pakistan, after obtaining ethical approval. The sample size comprised 384 patients, with 192 in the nasal packing group and 192 in the quilting sutures group. Inclusion criteria included patients aged 18 to 70 years undergoing elective nasal septoplasty. Exclusion criteria were patients with nasal polyps, allergic rhinitis, diabetes, coagulation disorders, septal flap tears, those unfit for surgery, and those undergoing combined septoplasty and turbinate intervention. Patients were randomly assigned to either nasal packing or quilting sutures groups. Baseline characteristics, including age, gender, and BMI, were documented. Postoperative assessments were conducted at 48 hours, 1 week, and 3 months, evaluating pain using a visual analogue scale (VAS), bleeding, epiphora, dyspnea, hematoma, and adhesions. Data analysis was performed using SPSS version 26.0, with quantitative data represented as mean ± standard deviation and qualitative data as percentages and frequencies. Statistical significance was determined using chi-square and unpaired two-tailed Student’s t-tests, with p &lt; 0.05 considered significant. Results: The mean age of participants was 34.37 ± 6.95 years. Gender distribution included 256 males (66.7%) and 128 females (33.3%). At 48 hours postoperatively, the nasal packing group had a higher mean pain score (5.96 ± 1.39) compared to the quilting sutures group (2.03 ± 1.05) (p &lt; 0.001). Bleeding was more significant in the quilting sutures group (1.82 ± 0.60) than in the nasal packing group (1.27 ± 0.45) (p &lt; 0.001). Epiphora and dyspnea were more common in the nasal packing group, with 48 patients (25%) and 81 patients (42.2%), respectively, compared to 8 patients (4.2%) and 6 patients (3.1%) in the quilting sutures group (p &lt; 0.001). Hematoma occurrence was low and not significantly different between the groups. After 1 week, pain scores remained higher in the nasal packing group (1.45 ± 1.12) compared to the quilting sutures group (0.58 ± 0.79) (p &lt; 0.001). At 3 months, pain scores were still higher in the nasal packing group (1.45 ± 1.12) compared to the quilting sutures group (0.58 ± 0.80) (p &lt; 0.001), with no significant difference in adhesion formation. Conclusion: Quilting sutures resulted in lower postoperative pain and fewer complications compared to nasal packing in patients undergoing septoplasty, despite a slightly higher risk of bleeding. These findings suggest that quilting sutures may be a preferable alternative to nasal packing for postoperative management in septoplasty.

Contact Guidance of Connective Tissue Fibroblasts on Submicrometer Anisotropic Topographical Cues Is Dependent on Tissue of Origin, β1 Integrins, and Tensin-1 Recruitment.

The substratum topography of both natural and synthetic materials is a prominent regulator of cell behaviors including adhesion, migration, matrix fibrillogenesis, and cell phenotype. Connective tissue fibroblasts are known to respond to repeating groove topographical modifications by aligning and exhibiting directed migration, a phenomenon termed contact guidance. Although both reside in collagen rich connective tissues, dermal and gingival fibroblasts are known to exhibit differences in phenotype during wound healing, with gingival tissue showing a fetal-like scarless response. Differences in adhesion formation and maturation are known to underlie both a scarring phenotype and cell response to topographical features. Utilizing repeating groove substrates with periodicities of 600, 900, and 1200 nm (depth, 100 nm), we investigated the roles of integrins αvβ3 and β1 associated adhesions on contact guidance of human gingival (HGFs) and dermal fibroblasts (HDFs). HGFs showed a higher degree of orientation with the groove long axis than HDFs, with alignment of both vinculin and tensin-1 evident on 600 and 900 nm periodicities in both cell types. Orientation with grooves of any periodicity in HGFs and HDFs did not alter the adhesion number or area compared to smooth control surfaces. Growth of both cell types on all periodicities reduced fibronectin fibrillogenesis compared to control surfaces. Independent inhibition of integrin αvβ3 and β1 in both cell types induced changes in spreading up to 6 h and reduced alignment with the groove long axis. At 24 h post-seeding with blocking antibodies, HGFs recovered orientation, but in HDFs, blocking of β1, but not αvβ3 integrins, inhibited alignment. Blocking of β1 and αvβ3 in HDFs, but not HGFs, inhibited tensin-1-associated fibrillar adhesion formation. Furthermore, inhibition of β1 integrins in HDFs, but not HGFs, resulted in recruitment of tensin-1 to αvβ3 focal adhesions, preventing HDFs from aligning with the groove long axis. Our work demonstrates that tensin-1 localization with specific integrins in adhesion sites is an important determinant of contact guidance. This work emphasizes further the need for tissue-specific biomaterials, when integration into host tissues is required.

Comparing Five New Polymer Barriers for the Prevention of Intra-abdominal Adhesions in a Rat Model

BackgroundIntra-abdominal adhesions affect up to 93% of the patients after abdominal surgery, causing small-bowel obstruction, infertility, chronic abdominal pain, and iatrogenic bowel injury at reoperation. The efficacy of five new polymer antiadhesive barriers to avoid adhesion formation is evaluated in an ischemic button model in rats. Materials and methodsFive new, biodegradable polyurethane and copolyester-based, antiadhesive barriers (A1, A2, A3, B1, and B2) were evaluated in separate experimental groups and compared with two control groups (hyaluronate carboxymethylcellulose barrier and no antiadhesive barrier) in an ischemic button model (n = 11 per group operated). After 14 d, the quantity and quality of the adhesions were scored macroscopically. The Kruskal–Wallis with Mann–Whitney U post hoc and the Fisher's exact tests were used for data analysis. The Bonferroni correction method was applied, and a P-value <0.007 was considered significant. ResultsTwo animals died during surgery and follow-up. A significant reduction of adhesions to ischemic buttons was found in the A2 group (median, 3.5; interquartile range, 2.25) compared with no adhesive barrier (median, 8.0; interquartile range, 2.0) (P = 0.001). The remaining groups did not differ significantly regarding adhesion quantity or quality. Adverse events were observed in the A2, A3, and B2 groups. ConclusionsThe A2 antiadhesive barrier reduced the adhesion formation significantly compared with no anti-adhesive barrier, but applicability is questionable because of extensive adverse events observed due to implantation of the anti-adhesive barrier. The Nair score appears not to be sensitive enough to detect differences in adhesion formation in this model. Future research should focus on anti-adhesive barriers that are self-adhering.

A prospective randomized experimental study to investigate the peritoneal adhesion formation after waterjet injection and argon plasma coagulation (HybridAPC) in a rat model.

This prospective, randomized, controlled, single-blinded study investigates the peritoneal adhesion formation of HybridAPC (waterjet elevation of the peritoneum with subsequent argon plasma coagulation) versus only waterjet (elevation with the same instrument, but without subsequent argon plasma coagulation) in a rat model (24 female Wistar rats). Bilateral lesions were created on the abdominal wall with HybridAPC on one sidewall and waterjet elevation on the other sidewall of the peritoneum in a standard fashion. After 10days, the rats were euthanized to evaluate the peritoneal trauma sites. Adhesion incidence, quantity, and quality were scored 10days postoperatively and studied histopathologically. Incidence of adhesion formation was 2.3% for HybridAPC; no adhesions occurred for peritoneal elevation with saline (p=1.00). Histologic evaluation revealed no acute inflammation in both groups. An overall moderate degree of granulation tissue formation and myonecrosis was observed in the HybridAPC group, whereas no chronic inflammation and myonecrosis occurred after elevation without thermal ablation (p<0.0001). This study investigates the effect of waterjet elevation of the peritoneum with and without subsequent thermal ablation on adhesion formation in a rat model for the first time. Peritoneal waterjet elevation with saline does not provide any risk of adhesion formation. Thermal coagulation with APC after waterjet elevation of the peritoneum creates advantageous peritoneal conditions due to a permanent moist tissue surface and the cooling effect of the injected solution, resulting in no significant difference in adhesion formation compared to peritoneal elevation without thermal ablation. HybridAPC can thus be regarded as a beneficial coagulation method with only minor adhesion formation due to positive tissue effects of the combined waterjet.

Dexamethasone and sodium carboxymethyl cellulose prevent postoperative intraperitoneal adhesions in rats.

We aimed to evaluate the effects of the barrier agent sodium carboxymethyl cellulose (SCMC) with and without dexamethasone for the prevention of postoperative adhesion formation in a rat model of postoperative peritoneal adhesion. A total of 160 three-month old male and female Wistar rats underwent a laparotomy, and adhesions were induced by ileocecal abrasion. Rats were randomly assigned to 4 groups (n=40 each): group A, untreated; group B, treated with SCMC only; group C1, treated with SCMC + 3 mg dexamethasone, and group C2, treated with SCMC + 8 mg dexamethasone. After 12 days, adhesion formation and histopathological changes were compared. In groups A, B, C1, and C2, the mortality rates were 10, 5, 5, and 5%, respectively. In groups C1 and C2, the adhesions were filmy and easy to dissect and were milder compared with those in groups A and B. The total adhesion score in group C1 (3.38±0.49) was significantly lower than that of group B (6.01±0.57; P<0.01) or group A (8.01±0.67; P<0.05). There was no significant difference in adhesion formation between groups C1 and C2. Compared with groups A and B, groups C1 and C2 exhibited milder histopathological changes. SCMC in combination with dexamethasone can prevent adhesion formation and is a better barrier agent than SCMC alone. The safety and feasibility of SCMC in combination with dexamethasone to prevent adhesion formation after abdominal surgery warrants further clinical study.

Colorectal anastomosis facilitated by the use of the LigaSure® sealing device: comparative study in an animal model

Recently, there has been speculation about the possibility of fusing intestinal tissue using bipolar sealing devices. In this study we compare in a porcine model the anastomoses created using the LigaSure(®) device with those created with a stapler after section and closure of a rectal stump. Thirty pigs underwent laparoscopic colorectal anastomosis. In group A (n=15), the division of the intestine and distal stump closure were done with a 10-mm LigaSure Atlas(®) device. In group B, these steps were carried out using an endoscopic stapler. Subsequently, the colorectal anastomosis was performed using circular stapling in both groups. The 4-week follow-up included health status, weight gain, blood tests, X-rays, and colonoscopy. Anastomotic tissue was processed to study the mechanical tensile strength and histopathology. There was no difference in the rate of conversion to open surgery or in average operating time between the groups. In the sealing device group, there was a significantly higher rate of failure in rectal stump closure (p=0.042). There was one death in group B due to anastomotic leak. There was no difference in adhesion formation or stenosis. Mid-section anastomosis area was 89.7mm(2) in group A compared with 100mm(2) in group B (p=0.52). In tensile strength studies, the maximum load resisted by the sample was 13.8±4.9N (group A) versus 15.7±4.4N (group B) (p=0.17). There was no difference between the groups in degree of reepithelialization, number of inflammatory cells, or the presence of microabscesses. Division and sealing of the rectal stump with the LigaSure(®) device is feasible in the proposed experimental model, but it is less reliable than conventional closure with a stapler, since it has a significantly greater failure rate. Therefore, The LigaSure(®) device should not be used for this purpose in the clinical setting as this could lead to serious and dramatic complications.

Effects of alcohol on pericardial adhesion formation in hypercholesterolemic swine

Reoperative cardiac surgery is complicated in part because of extensive adhesions encountered during the second operation. The purpose of this study was to examine the effects of alcohol with and without resveratrol (red wine vs vodka) on postoperative pericardial adhesion formation in a porcine model of hypercholesterolemia and chronic myocardial ischemia. Male Yorkshire swine were fed a high-cholesterol diet to simulate conditions of coronary artery disease followed by surgical placement of an ameroid constrictor to induce chronic ischemia. Postoperatively, control pigs continued their high-cholesterol diet alone, whereas the 2 experimental groups had diets supplemented with red wine or vodka. Seven weeks after ameroid placement, all animals underwent reoperative sternotomy. Compared with controls, pericardial adhesion grade was markedly reduced in the vodka group, whereas there was no difference in the wine group. Intramyocardial fibrosis was significantly reduced in the vodka group compared with controls. There was no difference in expression of proteins involved in focal adhesion formation between any groups (focal adhesion kinase, integrin alpha-5, integrin beta-1, paxillin, vinculin, protein tyrosine kinase 2, protein kinase C ε, and phosphorylated protein kinase C ε). The wine group exhibited elevated C-reactive protein levels versus the control and vodka groups. Postoperative vodka consumption markedly reduced the formation of pericardial adhesions and intramyocardial fibrosis, whereas red wine had no effect. Analysis of protein expression did not reveal any obvious explanation for this phenomenon, suggesting a post-translational effect of alcohol on fibrous tissue deposition. The difference in adhesion formation in the vodka versus wine groups may be due to increased inflammation in the wine group.

Evaluation of healing prosthetic materials polyester mesh resorbable film and collagen elastin matrix /polypropylene used in rabbits abdominal wall defects

To compare polyester with absorbable layer prosthesis with collagen-elastin/polypropylene prosthesis in the repair of abdominal wall defects. The 16 studied rabbits were divided in groups A and B (euthanized on the 30th and 60th days, after the implant of the mesh). The animals underwent laparotomy and received a 2 cm wall 'defect' on each side of the Alba linea. The repair was made with the suture of a polyester mesh with absorbable film on the left side of the Alba Linea and with collagen-elastin/polypropylene mesh on the right side. Adherences were classified according to Nair Score and microscopic evaluation observing types I and III collagen formation and other immunohistochemical analyses. There were no significant differences in adhesion formation. The collagen type I showed higher deposition in polyester with absorbable layer. In group B, the difference between the meshes was significant, with higher collagen III deposition in polyester with absorbable layer (60 masculine P.O.). About the metalloproteinases, the presence of MMP -1 and MMP-8 were about the same; the expression of MMP-13 increased near to the 60th day. There is no significant difference between the two meshes in adhesion formation and immunohistochemical evaluation. The polyester mesh resorbable film presented a higher deposition of collagen.

Auto‐crosslinked hyaluronic acid gel accelerates healing of rabbit flexor tendons in vivo

This study's purpose was to assess the in vivo effect of auto-crosslinked hyaluronic acid (HA) gel, a natural HA derivative with increased viscosity and tissue residence time, on adhesions and healing of injured and surgically repaired rabbit digital flexor tendons. The second and third right deep digital flexor tendons from 48 rabbits (n = 96 tendons) were cut and repaired with a modified Kessler and running peripheral suture. Animals were randomized to two groups, receiving either HA gel or saline injected around both freshly repaired tendons. After 2, 3, 6, and 12 weeks, six rabbits in each group were euthanized. Tendon pull-out force and breaking strength were measured as a value for adhesion formation and tendon healing, respectively. A histological assessment of adhesions and healing was related to the mechanical results. A significantly faster increase in breaking strength was found in HA gel-treated compared to saline-treated tendons; this coincided with a significantly accelerated tissue repair response after injury. No significant difference in adhesion formation was found between the two groups at any time. Our results indicate a significant acceleration of in vivo healing of tendons treated with HA gel. Adhesion formation was unaffected. These results could have important clinical value in promoting rehabilitation after tendon injury.

Prótesis compuestas en las reparaciones de defectos de pared abdominal. Estudio comparativo del empleo de barreras físicas y/o químicas

Composite biomaterials designed for the repair of abdominal wall defects are usually composed of a reticular component and a second component, or barrier, which is laminar (absorbable or non-reabsorbable) and which is placed in contact with the visceral peritoneum. This study was designed to evaluate how the composition of this second component affects the biological behavior of the biomaterial and the formation of adhesions. Defects (7 x 5 cm) comprising all the tissue planes except the skin were created in the anterior abdominal wall of white, New Zealand rabbits. In group A (n = 12) the defects were then repaired with composite prostheses with a non-reabsorbable physical barrier, polypropylene + ePTFE (PL + ePTFE) and PL + polyurethane (PL + PU). In group B (n = 12) the defects were repaired with a reabsorbable chemical barrier, polyester + a polyethyleneglycol/glycerol film (PO + gl) and PL + hyaluronate (PL + hy). Fourteen days after surgery, the animals were sacrificed and specimens were taken for light and scanning electron microscopy and immunohistochemical labeling for macrophages (RAM-11). Adhesions forming at the prostheses/visceral peritoneum interface were quantified. All the materials showed optimal tissue infiltration and mesothelialization. Adhesion formation was similar in prostheses with a physical barrier (PL + ePTFE, 0.49 +/- 0.14%; PL-PU, 0.29 +/- 0.2%). In contrast, those with a chemical barrier showed a significant difference in adhesion formation (PO + gl, 0.55 +/- 0.06%; PL + hy, 18.55 +/- 4.96%; p < 0.05). Physical barriers seem to induce similar adhesions, while adhesions formed to prostheses with chemical barriers can vary considerably, possibly depending on the chemical composition of the barrier.

Adhesion formation after flexor tendon repair: a histologic and biomechanical comparison of 2- and 4-strand repairs in a chicken model

Purpose Both increased handling and increased bulk at the repair site have been hypothesized as affecting adhesion formation and gliding after tendon repair. Tendons repaired with 2- and 4-strand techniques were compared using both biomechanical and histopathologic measurements to determine the influence of increasing strand number on adhesion formation and gliding. Methods The flexor digitorum profundus tendon of the right middle toe of 80 broiler chickens was cut and then repaired with either a single (2-strand) or double (4-strand) modified Kessler core suture, followed by a running epitendinous suture. The limb was immobilized after surgery. Birds were killed at either 3 days or 4 weeks after tendon repair and adhesion formation measured using either biomechanical testing or quantitative and qualitative histology. For biomechanical testing, the tendon was pulled free of the sheath and a force versus displacement curve was generated. Comparisons of peak force and work to peak were made. Histologic specimens were examined by a pathologist blinded to the treatment group who scored the length and density of adhesions and made qualitative observations. Results Both biomechanical and histologic data showed expected differences in adhesion formation for early (3 days) and late (4 weeks) healing but no significant differences between 2- and 4-strand repairs. Biomechanical testing of 4-week specimens showed a nonsignificant tendency toward greater work required to break adhesions in 4-strand repairs. Conclusions Adhesion formation and gliding resistance of tendons after 2- or 4-strand modified Kessler core suture were not significantly different, which suggests that simply increasing the number of strands crossing a repair does not necessarily result in more adhesions or resistance in this model.

Intestinal anastomoses detected with a photopolymerized hydrogel

Background. This study examines the efficacy of a novel, absorbable photopolymerized hydrogel sealant, Focalseal (Focal Inc, Lexington, Mass), in protecting high-risk suture deficient intestinal anastomoses (HRA) compared with conventional sutured anastomoses (CSA). Methods. Twenty-four New Zealand white rabbits were either randomized to small bowel HRA constructed with 4 interrupted 5/0 polyglyconate sutures and treated with Focalseal or small bowel CSA constructed with 8 to 10 interrupted 5/0 polyglyconate sutures. Four rabbits from each group were killed at postoperative days 3, 7, and 21. Anastomoses were assessed for evidence of dehiscence, adhesion formation, stenosis, and bursting pressure; they were also examined histologically for collagen content estimation and blood vessel formation. Results. Mean operative time was 35 minutes (SD 5) for CSA and 35 minutes (SD 5) for HRA. There was 1 postoperative death in the HRA group. A postmortem examination revealed no evidence of anastomotic leak. The remaining 23 animals were assessed as planned. There was no evidence of anastomotic dehiscence in any animal. There was no significant difference in adhesion formation (P =.09), stenosis (P =.6), or bursting pressure (P =.2) between HRA and CSA groups. Collagen (P =.007) and blood vessel (P =.002) formation were significantly increased in HRA. Conclusions. HRA treated with Focalseal heal well and have similar strength to CSA. This technique may prove valuable in procedures such as laparoscopic bowel resection. (Surgery 2002;131:185-9.)

Laparoscopy versus laparotomy: An evaluation of adhesion formation after pelvic and paraaortic lymphadenectomy in a porcine model

Objective: Our purpose was to determine whether there is a difference in adhesion formation after pelvic and paraaortic lymphadenectomy with transperitoneal laparoscopy compared with both extraperitoneal laparotomy and transperitoneal laparotomy in a porcine model. Study Design: Ninety female hogs underwent pelvic and paraaortic lymphadenectomy: 40 with transperitoneal laparoscopy, 40 with extraperitoneal laparotomy, and 10 with transperitoneal laparotomy. Three weeks after the initial surgery, a laparotomy was performed to assess adhesion formation. Results: The transperitoneal laparotomy group had significantly higher adhesion formation, with a 100% (10 of 10) adhesion rate. In the transperitoneal laparoscopy group, 12 of 40 hogs (30%) had adhesions develop versus 8 of 38 (21%) in the extraperitoneal laparotomy group ( p = not significant). Also no differences were found in the transperitoneal laparoscopy and extraperitoneal laparotomy groups when comparing adhesion thickness or the total surface area of adhesions. More anterior abdominal wall adhesions were noted in the extraperitoneal laparotomy group (5 of 38) than in the transperitoneal laparoscopy group (0 of 40, p = 0.02). Conclusions: Pelvic and paraaortic lymphadenectomy performed with transperitoneal laparoscopy does not increase adhesion formation when compared with extraperitoneal laparotomy in a porcine model. The transperitoneal laparoscopy (and extraperitoneal laparotomy) approach also induces significantly fewer adhesions than transperitoneal laparotomy. (Am J Obstet Gynecol 1998;178:499-503.)

Adhesion formation in laparoscopic inguinal hernia repair.

In laparoscopic inguinal hernia repair controversy exists concerning the most appropriate repair method and implant material to use if intraabdominal adhesions are to be minimized. In 108 pigs, we implanted three different types of mesh by both the TAPP (transabdominal preperitoneal) and Onlay (prosthesis placed directly upon the peritoneum) methods. Specimens were harvested in three time periods and adhesion formation was compared. Average adhesions at 3 days were TAPP 18% and Onlay 49% (p < 0.001). At 3 weeks average adhesions were TAPP 8% and Onlay 23% (p < 0.04). Three-month figures were TAPP 1% and Onlay 13% (p < 0.001). In contrast, there were no differences in adhesion formation due to material type in any of the three time periods (all p > 0.17). A peritoneal covering over a laparoscopic inguinal implant significantly reduced adhesions. Prosthetic material type did not affect adhesion formation in this study.

Experimental Models for Quantitative Studies on Adhesion Formation in Rats and Rabbits

Postoperative formation of adhesions is a common complication in abdominal surgery. The aim of the present study was to develop standardized experimental models for quantitative studies of the formation of adhesions in rats and rabbits. In rats the suturing of a peritoneal wound increased adhesion formation significantly compared to leaving it open, 77.9 +/- 4.8 and 5.3 +/- 2.8%, respectively (p < 0.001). The suturing technique, when comparing the interrupted and continuous method after 1 week, had no influence, 84.5 +/- 6.3% and 73.1 +/- 11.2%, respectively (p > 0.05). Different types of trauma resulted in differences in adhesion formation to noninjured parts in the abdominal cavity, adhesions in 17.5 and 2.5% of the animals, respectively (p < 0.05). In rabbits adhesions formed more frequently (p < 0.001) to visceral peritoneum (59.3 +/- 3.7%) than to the parietal one (22.3 +/- 1.6%) indicating a different propensity of tissues to have adhesions. These models enable detailed quantitative studies on experimental formation of adhesions.

Fibrin sealant in prevention of flexor tendon adhesions: An experimental study in the rabbit

The effect of fibrin sealant on the development of adhesions in flexor tendon surgery was studied in both immobilized and active weight-bearing paws of rabbits. A partial laceration was produced and was treated with sutures alone or with both sutures and glue. Immobilized tendons treated in these ways showed no difference in adhesion formation, but in mobile tendons there was a difference at 6 weeks in gross appearance, scanning electron micrographic appearance, and strength of adhesions as measured when the distally cut tendon was pulled out of its sheath. These observations indicate that, after repair, a mobile flexor tendon heals with a smooth gliding surface and without formation of restricting adhesions when treated with fibrin glue around the suture site.

Effects of fibrin sealant on tubal anastomosis and adhesion formation

The results of the present study suggest that there is no difference in adhesion formation and PR after tubal anastomosis using sutures or fibrin sealant. It appears that the use of fibrin sealant is associated with decreased incidence of ectopic pregnancy.

Zone II flexor tendon repair: Effects of vitamins A, E, β-carotene

Ninety-six adult Leghorn chickens each had the flexor profundus tendon in each middle toe sharply divided in Zone II with immediate repair (pentabarbital, ketamine anesthesia). Animals were then randomly assigned to receive unsupplemented standard chick chow or the chow supplemented with vitamin A (150,000 IU/kg chow), Vitamin E (1000 IU/kg chow), or β-carotene (90 mg/kg chow). Eight animals from each of the four groups were examined at 7, 30, or 45 days post repair. After sacrifice, in situ composite wound breaking strength was measured in the amputated toe by constant speed tensiometry. Vitamin A-supplemented animals demonstrated breaking strength more than double that of control at each post-operative test day, while those animals receiving supplemental Vitamin E had breaking strength less than half that of control at Day 7 and Day 45. These results are statistically significant. Tensiometry curves differed markedly at all time points among the groups: Vitamin A curves being broader, higher, and having more spikes. These differences in the tensiometry curves, both qualitative and quantitative, may be due to differences in intrinsic tendon healing or to differences in adhesion formation or a combination of both. β-Carotene supplementation had modest effect. We conclude that supplemental dietary vitamin A increases the breaking strength of composite tendon wounds and that supplemental dietary vitamin E decreases it.

Efficacy of a modified oxidized cellulose fabric in the prevention of adhesion formation.

A new fabric of regenerated oxidized cellulose (TC-7) was evaluated for the prevention of postoperative adhesions. Standardized injuries were performed on the uterine fundal serosa, the unilateral uterine cornu, and the contralateral ovary in 24 New Zealand rabbits. TC-7 was applied to the injured surfaces in 12 rabbits utilizing a randomized study design. At second-look laparotomy 3 weeks later, adhesions were graded without knowledge of the treatment category in the 22 rabbits surviving the study. There were no statistically significant differences in adhesion formation between treated and control animals at any of the injury sites. No gross or histologic residua of the TC-7 were evident 3 weeks after intraperitoneal application. Further studies will be needed to clarify the clinical role of this new fabric.