Reduction of retrosternal and pericardial adhesions with rapidly resorbable polymer films

Okuyama, Naoki; Wang, Catherine Y.; Rose, Eric A.; Rodgers, Kathleen E.; Pines, Eli; diZerega, Gere S.; Öz, Mehmet C.

doi:10.1016/s0003-4975(99)00556-1

Cited by 45 publications

(41 citation statements)

References 24 publications

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“…Fibrin sealants prepared from platelet poor plasma (PPP) and also activated with thrombin, have been used in a variety of surgical procedures in order to control bleeding, with a subsequent reduction in postoperative tissue adhesions [24,33,35].…”

Section: Introductionmentioning

confidence: 99%

Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis

Everts

Devilee

Oosterbos

et al. 2007

Knee Surg Sports Traumatol Arthr

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In this study we describe the potential role of autologous platelet gel and fibrin sealant in unilateral total knee arthroplasty to improve the postoperative range of motion and to reduce the incidence of arthrofibrosis. Total knee arthroplasty is often associated with a considerable amount of post-operative blood loss. Persistent limited motion directly after surgery may ultimately result in arthrofibrosis. To counteract these effects we investigated whether the use of autologous derived platelet gel and fibrin sealant would reduce postoperative blood loss, decrease the impaired range of motion and the incidence of arthrofibrosis. All patients were consecutively operated and assigned to the study or control groups. Study group patients (n = 85) were treated with the application of autologous platelet gel and fibrin sealant at the end of surgery. Eighty patients were operated without the use of platelet gel and fibrin sealant, and served as the control group. The postoperative hemoglobin decrease, range of motion and length of hospitalization were recorded. During a 5-month postoperative period patients were followed to observe the incidence of arthrofibrosis. In patients in the treatment group the hemoglobin concentration in blood decreased significantly less when compared to the control group. They also showed a superior postoperative range of motion when compared to those of the control group (P < 0.001). The incidence of arthrofibrosis and subsequent forced manipulation was significantly less (P < 0.001) in patients managed with platelet gel and fibrin sealant. We conclude that peri-operatively applied platelet gel and fibrin sealant may improve the range of motion after total knee arthroplasty, decreases the length of stay and may reduce the incidence of arthrofibrosis.

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Section: Introductionmentioning

confidence: 99%

Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis

Everts

Devilee

Oosterbos

et al. 2007

Knee Surg Sports Traumatol Arthr

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show abstract

“…The initial process takes around a week, whereas the consolidation of the adhesions takes several weeks. Based upon this evidence, we chose an observation period of 4 weeks postoperatively, a similar timeframe to that used by Okuyama et al [13]. …”

Section: Discussionmentioning

confidence: 99%

“…The following scoring system, which has been adopted in similar studies [13], was used: grade 0 - no adhesions; grade 1 - light adhesions easy to dissect manually; grade 2 - stronger and cohesive adhesions that can be dissected manually; grade 3 - cohesive adhesions requiring sharp dissection. After macroscopic evaluation, the tissue block was fixed in 10% formaldehyde for later microscopic evaluation.…”

Section: Methodsmentioning

confidence: 99%

No Effect of Rapamycin on Cardiac Adhesion Formation: A Drug-Loaded Bioresorbable Polylactone Patch in a Porcine Cardiac Surgical Model

Qazi

Kjærgaard

Shen³

et al. 2016

Eur Surg Res

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Background: The fusing of the epicardium and sternum due to adhesion is a common problem during repeated cardiac surgery and carries with it an increased risk of bleeding. The use of barriers and patches has been tested to prevent the formation of adhesions, but the very presence of a patch can provoke adhesion formation. The objective of this study was, therefore, to investigate both biodegradable and bioresorbable polylactone patches [(polycaprolactone-poly(ethylene oxide)-polycaprolactone tri-block copolymer (PCE)]. The patches were also tested with a controlled release of rapamycin, which prevents cell migration and extracellular matrix deposition. The clinical effectiveness of rapamycin in pericardial patches has not previously been examined. Materials and Methods: Three groups of 6 female Danish Landrace pigs underwent sternotomy and abrasion of the epicardium, before being randomized to either group 1 - the control group (with no patch), group 2 - PCE patch implanted between the sternum and epicardium, or group 3 - PCE patch and slow-release 1.6-mg rapamycin. After a median time period of 26 days, the pigs were euthanized and their hearts removed en bloc with the sternum, for macroscopic, histological and pathological examination. Results: Upon macroscopic examination, a significantly lower degree of adhesion in group 2, as compared to group 1 (p < 0.05), was found. Histological analysis of the tissues showed significantly more fibrosis, inflammation and foreign body granulomas (p < 0.05) in both group 2 and group 3, when compared to group 1. Conclusion: A PCE patch following sternotomy in animal subjects reduces postoperative macroscopic adhesions without reducing microscopic fibrosis or inflammation. Loading the patch with rapamycin was found not to increase the antifibrotic effect.

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“…Most of the patients with congenital heart defects require re-surgery and in these cases, re-surgery risk is observed clearly [1][2][3] pericardial adhesion and mediastinal can cause damage to right ventricle, Aorta, right atrium and any aortocoronary bypass graft 4 .…”

Section: Introductionmentioning

confidence: 99%

Surgical application of fascia lata as a pericardial substitute in rabbits

Abedi

Shahzamani²,

Shahzamani³

et al. 2012

Acta Cir. Bras.

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PURPOSE:To use fascia lata instead of pericardium and observe the presence of adhesions. METHODS:Twenty rabbits were divided into two group of ten. In group A, a 1×1 cm segment of pericardium was excised and resutured. In group B excised pericardium was substituted for autologous fascia lata. RESULTS:In the comparison of microscopic adhesion rate between two groups A, B after eight weeks, there was no significant statistical difference. CONCLUSION:Fascia lata is safe and it can be substituted for pericardium especially in repeat sternotomy in repairing congenital heart defects to avoid heart injury.

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Reduction of retrosternal and pericardial adhesions with rapidly resorbable polymer films

Cited by 45 publications

References 24 publications

Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis

Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty: improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis

No Effect of Rapamycin on Cardiac Adhesion Formation: A Drug-Loaded Bioresorbable Polylactone Patch in a Porcine Cardiac Surgical Model

Surgical application of fascia lata as a pericardial substitute in rabbits

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