Adhesion formation to hemostatic agents and its reduction with a sodium hyaluronate/carboxymethylcellulose adhesion barrier

• Published in: Journal of biomedical materials research. Part A 2012-07, Vol.100A (7), p.1777-1782
• Main Authors: Greenawalt, Keith E., Corazzini, Rubina L., Colt, M. Jude, Holmdahl, Lena
• Format: Article
• Language: English
• Subjects: adhesion prevention; adhesions; Animals; Biological and medical sciences; Carboxymethylcellulose Sodium - chemistry; Female; Hemostasis - drug effects; hemostatic agents; Hyaluronic Acid - chemistry; Medical sciences; Rats; Rats, Sprague-Dawley; seprafilm; sodium hyaluronate/carboxymethylcellulose membrane; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Technology. Biomaterials. Equipments; Tissue Adhesions
• ISSN: 1549-3296; 1552-4965
• DOI: 10.1002/jbm.a.34124

The impact of hemostatic agents on postoperative adhesion formation has not been well studied. We hypothesized that hemostatic agents would be a significant nidus for adhesion formation and that a resorbable barrier would effectively reduce adhesions to hemostatic agents. Four commercial hemostatic agents, each composed of a different biomaterial matrix, were implanted in female Sprague–Dawley rats, and adhesion formation was examined 7 days after surgery. In separate studies, the effects of serosal trauma (via cecal abrasion), added blood, and the presence of chemically modified sodium hyaluronate/carboxymethylcellulose (HA/CMC) barrier on adhesion formation to hemostatic agents were studied. Significant adhesions formed to hemostatic agents even in the absence of traumatized tissue. When applied after cecal abrasion, the incidence of adhesions to the hemostatic agents increased. Addition of blood to this model increased adhesion formation even further, causing adhesions in every animal in the study. An HA/CMC adhesion barrier reduced adhesions to hemostatic agents in the presence of serosal trauma and maintained effectiveness even in the presence of blood. In conclusion, hemostatic agents potentiated adhesion formation at the site of application in a model without trauma. In more challenging models, their adhesiogenic contribution was overwhelmed by trauma and blood. HA/CMC adhesion barrier applied over hemostatic agents at the time of surgery provided significant protection against postoperative adhesions in these preclinical models. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2012.