Effect of Hyaluronic Acid-carboxymethylcellulose Adhesion Barrier on Wound Healing: An Experimental Study

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Author(s): 
Erdinc Kamer, MD; Haluk Unalp, MD; Ercument Tarcan, MD, Assoc. Prof.; Gulden Diniz, MD; Kemal Atahan, MD; Ragıp Ortac, MD, Assoc. Prof.; Mehmet Ali Onal, MD

Address correspondence to:
Erdinc Kamer, MD
Department of Surgery
Izmir Ataturk Training and Research Hospital
1834 sk. No: 9/4, 35530
Karsiyaka, Izmir
Turkey
E-mail: erdinc.kamer@gmail.com
Phone: 0090 232 244 4444




Abstract: The aim of this study was to investigate the effects of hyaluronic acid-carboxymethylcellulose (HA-CMC) membrane on the healing process of wounds in rats. One hundred animals were assigned randomly into two equal groups. Midline laparotomies were performed. In group 1, a 5-cm x 3-cm piece of HA-CMC membrane was placed under the laparotomy incision. The same procedure was performed in group 2, but without the HA-CMC membrane. Ten animals from each group were euthanized on postoperative days (POD) 4, 7, 14, 21, and 35 after wounding. Breaking strength, histologic examination, and tissue hydroxyproline levels were analyzed. The tensiometric test showed that there was no significant difference in the breaking strengths between the two groups (P > 0.05). Statistical difference was found to be significant on POD 4, 14, 21, and 35 when the groups were compared with regard to average hydroxyproline levels (P < 0.05). Significant differences were found in the results of histologic examination of the tissue specimens between the two groups in terms of acute inflammation on POD 14, chronic inflammation, and granulation tissue fibroblast maturation on POD 35, collagen deposition on POD 21, and neovascularization on POD 7, 14, 21, and 35 (P < 0.05). The results show that the HA-CMC membrane did not negatively affect the mechanical strength and healing process of the laparotomy incisions.




   Postoperative adhesions are an important, and thus far, unsolved surgical problem. The two main methods to prevent adhesion that have been recently evaluated are to minimize surgical trauma during the operation and by using special materials.1 Most antiadhesive agents have raised concern over their poor healing.2 Abdominal wall healing after laparotomy is important because insufficient incisional wound strength results in prolonged periods of disability for the patient secondary to fascial dehiscence and hernia formation.3

   However, the possible adverse effects of modulating the inflammatory response (infection, delayed wound healing) and applying fibrinolytic stimulations (hemorrhage) have made separation of tissue surfaces the most favored option.1 Therefore, by separating injured adjacent surfaces with a bioresorbable membrane during the critical period, fibrin bridge formation and adhesions can be presumably prevented. Hyaluronic acid (HA)-carboxymethylcellulose (CMC) bioresorbable membrane (Seprafilm®, Genzyme Biosurgery, Cambridge, Mass) has been introduced with this purpose.4 The combination of these two substances (HA and CMC) results in a transparent, thin, adherent, and absorbable membrane, which is included in the category of mechanical separation devices. In animal studies and in one randomized clinical trial, it has been shown that HA-CMC reduces the incidence, extent, and severity of postsurgical adhesions.5

   Although it is an effective option to prevent postoperative adhesions, there are no clear data about wound healing of laporotmy incisions resulting from adhesion reduction with HA-CMC membrane.1 Thus, the present study investigated the effects of the HA-CMC membrane on the wound healing process in rats.

Methods

   Animals. One hundred 5-month-old adult male Wistar-Albino rats at Ege University Faculty of Medicine Animal Research laboratory (Izmir,Turkey) weighing 250–300 g, were acclimated to the new environment for 48 hours; they were maintained on standard rat chow and water. They were fed standard laboratory chow until the night before the operation, and were given water ad libitum.

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