Decrease in Adhesion Formation by a Single Application of 5-Fluorouracil after Flexor Tendon Injury

Abstract

Using an animal model, the effect of a single intraoperative application of 5-fluorouracil on digital flexor tendon adhesions was assessed. After a standard partial division of the tendon and immobilization with a stitch, the synovial sheath in 30 rabbit tendons was treated with 5-fluorouracil solution (50 mg/ml)-soaked sponge pledgets for 5 minutes. Buffered saline was substituted for 5-fluorouracil in 30 control tendons. The tendons were harvested 1 week postoperatively, and histologic sections were assessed with a light microscope. There was a significant reduction in synovial sheath thickening (p < 0.001), cell counts (p < 0.001) and proportional length of adhesions (p < 0.001) in the treated tendons. The reduction in synovial reaction and adhesion formation using this "one touch" technique presents a novel strategy for the management of the clinical problem of postoperative adhesions complicating tendon injury and repair.

Modulation of peritendinous adhesion formation by alginate solution in a rabbit flexor tendon model

“…6 It is therefore considered that if an intrinsic response could be stimulated at the early stage of tendon healing, the outcome of tendon repair would be preferable with regard to reducing peritendinous adhesion. Based on this idea, a wide range of substances, including fibrin sealant, 11 5-fluorouracil, 12 sodium hyaluronate, 15 aprotinin, 16 and TGF-␤1 neutralizing antibody, 17 have been experimentally applied to the tendon repair, with the aim of reducing extrinsic healing and stimulating the intrinsic mechanism. However, problems such as high cost of raw materials, potential side effects, and limited bioavailability have prevented widespread clinical use of these agents.…”

Autologous venous grafting promotes healing and reduces adhesion formation in experimentally severed canine superficial digital flexor tendons

“…Despite advances in the surgical techniques and postoperative management, difficulties with tendon repair (delayed return of tendon strength for approximately 3 weeks following repair, gap formation, longitudinal fibre orientation complicating sutureholding, adhesion formation) are faced. Furthermore, tendon repair encounters technical (essentially physical problems) and biological (concerns primarily with vascularisation and peri-tendinous fibrosis causing adhesion formation) issues (Akali et al, 1999;Jaibaji, 2000;Ferguson & Rinker, 2006;Temizet al, 2008;Mousavi et al, 2009). …”

Effects of a Single Application of Adcon Gel on Peritendinous Adhesion: An Experimental Study in Rabbits

“…Restrictive adhesion and local inflammation can be modulated by using this simple technique. 11,12,34) In a rabbit flexor tendon injury model, Bates et al 9) observed that a single intraoperative dose of mannose-6-phosphate, a natural inhibitor of transforming growth factor-beta, enhanced the postoperative range of motion. Adcon gel provides a physical barrier to inter-tissue adhesions and inhibits fibroblast migration on and around neural and tendinous structures and prevents adhesion formation.…”

“…Numerous materials and agents have been used as a mechanical barrier to envelop sutured tendons in attempts to minimize the adhesion formation after primary tendon repair. Currently, the modalities used for preventing adhesions without affecting the healing process include; human amniotic fluid, hyaluronic acid, alginate solution, mannose-6-phosphate, 5-fluorouracil, injection of growth factors or platelet concentrate, local application of extracorporeal shock wave therapy or ultrasound therapy, local injection of bone-marrow-derived mesenchymal stem cells, systemic administration of antiinflammatory drugs [7][8][9][10][11][12][13][14][15][16] . The use of a barrier during surgery to protect raw tissue surfaces has been shown to be one of the most effective methods of preventing tendon adhesions.…”