Postoperative adhesion (PA) is currently one of the most unpleasant complications following surgical procedures. Researchers have developed several new strategies to alleviate the formation of PA to a great extent, but so far, no single measure or treatment can meet the expectations and requirements of clinical patients needing complete PA prevention. Chinese medicine (CM) has been widely used for thousands of years based on its remarkable efficacy and indispensable advantages CM treatments are gradually being accepted by modern medicine. Therefore, this review summarizes the formating process of PA and the efficacy and action mechanism of CM treatments, including their pharmacological effects, therapeutic mechanisms and advantages in PA prevention. We aim to improve the understanding of clinicians and researchers on CM prevention in the development of PA and promote the in-depth development and industrialization process of related drugs.
Humans ; Medicine, Chinese Traditional ; Tissue Adhesions/prevention & control* ; Industrial Development ; Drugs, Chinese Herbal/therapeutic use*

Post-operative adhesions are a common complication of pelvic and abdominal surgeries. Many approaches for preventing post-operative adhesions have been developed. This review summarizes the recent advances in this topic.
Abdomen ; surgery ; Biomedical and Dental Materials ; Humans ; Pelvis ; surgery ; Postoperative Complications ; prevention & control ; Tissue Adhesions ; etiology ; prevention & control

OBJECTIVETo establish a rabbit double uterine horn model for assessing the time-course of pelvic adhesions and evaluating the effectiveness of different anti-adhesive materials in reducing adhesions.

METHODSA total of 330 Japanese white rabbits underwent laparotomy, followed by uterine horn incision. Animals were euthanized after 3, 7, 14, 28, and 42 days, respectively.

RESULTSThe surgical procedure was smooth. Rabbit double uterine horn model was applied for the evaluation of pelvic adhesions in a three-dimension fashion. Each of the three means-gauze abrasion, needle holder clamping, and direct uterine incision induced postoperative pelvic adhesions, among which direct uterine incision was the best to mimic conditions after gynecological operations. Under normal circumstances, degradation of filmy fibrinous adhesions by locally released proteases of the fibrinolytic system occurred within 3 days of injury. The regeneration of the mesothelium was completed within 7 days. Collagen reached its peak by day 14. Anti-adhesive materials were supposed to be completely absorbed by day 28, and their effectiveness in preventing pelvic adhesions was confirmed at this time point. Whether their effect can be maintained after the absorption of the anti-adhesive materials was investigated in 42 days.

CONCLUSIONSThe animal model was successfully established. It well mimics the postoperative pelvic adhesions after direct uterine horn injury and thus is a suitable model for studying site-specific adhesions. Observations on the 3rd, 7th, 14th, 28th, and 42nd post-operative days provided a full picture of the adhesion formation process.

Animals ; Biocompatible Materials ; Disease Models, Animal ; Female ; Laparotomy ; Postoperative Complications ; prevention & control ; Rabbits ; Tissue Adhesions ; etiology ; prevention & control ; Uterus ; surgery

BACKGROUNDTendon adhesion is one of the most common causes of disability following tendon surgery. Therefore, prevention of peritendinous adhesion after surgical repair of tendon is a major challenge. The aim of this study was to explore the possible application of a collagen membrane for the prevention or attenuation of peritendinous adhesions.

METHODSSprague-Dawley (SD) rat Achilles tendon was cut and sutured by a modified Kessler's technique with or without the collagen membrane wrapped. Macroscopic, morphological and biomechanical evaluations were applied to examine the recovery of the injured tendon at 4 and 8 weeks after surgery.

RESULTSThe surgery group wrapped by collagen membranes had a better outcome than the group with surgery repair only. In the collagen membrane-treated group, less adhesion appeared, stronger tensile strength was detected, and more tendon fibers and collagen I expression were observed morphologically.

CONCLUSIONWrapping the tendon with a collagen membrane may be an efficient approach for tendon repair and preventing tendon adhesion after its ruptures.

Achilles Tendon ; injuries ; Animals ; Collagen ; Male ; Rats ; Rats, Sprague-Dawley ; Tendon Injuries ; surgery ; Tissue Adhesions ; prevention & control ; Wound Healing

Postoperative epidural adhesion is one of the most common causes of failed back surgery syndrome (FBSS), which can lead to back and leg pain or neurological deficit. Prevention of epidural adhesion after laminectomy is critical for improving the outcomes of lumbar surgery. The main origins of epidural fibrosis are raw surface of erector muscles and rupture fibers of intervertebral disc. The main current preventive methods for epidural adhesion include the usage of implants, chemicals and low dose radiation. However, most of them are still in experiment period. There are still controversies on the clinic usage of autograft free fat, ADCON-L, and Mitomycin C (MMC). The optimal implants are characteristics of better biocompatibility, degradable absorption and capability of existing for a certain period in body. The optimal medicine should have good effect on anti-desmoplasia, less side effects and long half-life. Besides, the combination of biodegradable medical film and drug and the mixture of two or more medical films are also the research frontlines of epidural adhesion. Further researches are required to explore new materials and drugs with stable and most favorable effect in preventing epidural adhesion.
Biocompatible Materials ; administration & dosage ; Epidural Space ; pathology ; Humans ; Laminectomy ; adverse effects ; Lumbar Vertebrae ; surgery ; Tissue Adhesions ; prevention & control

The aim of this paper is to explore the prevention of rabbit postoperative abdominal cavity adhesion with poly (lactic-co-glycotic acid) (PLGA) membrane and the mechanism of this prevention function. Sixty-six Japanese white rabbits were randomly divided into normal control group, model control group and PLGA membrane group. The rabbits were treated with multifactor methods to establish the postoperative abdominal cavity adhesion models except for those in the normal control group. PLGA membrane was used to cover the wounds of rabbits in the PLGA membrane group and nothing covered the wounds of rabbits in the model control group. The hematologic parameters, liver and kidney functions and fibrinogen contents were detected at different time. The rabbit were sacrificed 1, 2, 4, 6, 12 weeks after the operations, respectively. The adhesions were graded blindly, and Masson staining and immunohistochemistry methods were used to observe the proliferation of collagen fiber and the expression of transforming growth factor β1 (TGF-β1) on the cecal tissues, respectively. The grade of abdominal cavity adhesion showed that the PLGA membrane-treated group was significant lower than that in the model control group, and it has no influence on liver and kidney function and hematologic parameters. But the fibrinogen content and the number of white blood cell in the PLGA membrane group were significant lower than those of model control group 1 week and 2 weeks after operation, respectively. The density of collagen fiber and optical density of TGF-β1 in the PLGA membrane group were significant lower than those of model control group. The results demonstrated that PLGA membrane could be effective in preventing the abdominal adhesions in rabbits, and it was mostly involved in the reducing of fibrinogen exudation, and inhibited the proliferation of collagen fiber and over-expression of TGF-β1.
Abdominal Cavity ; surgery ; Animals ; Collagen ; metabolism ; Lactic Acid ; Polyglycolic Acid ; Rabbits ; Tissue Adhesions ; prevention & control ; Transforming Growth Factor beta1 ; metabolism

OBJECTIVETo compare the various methods for prevention of peridural adhesion.

METHODSLaminectomy was performed in lumbar 1, 3 and 5 segments in 30 adult rabbits that were divided into 5 groups. A 10 mmx5 mm dura was exposed, and then covered with autogenou purifieds pearl fat (APPF) mixed with basic fibroblast growth factor (bFGF) in Group A, with APPF treated with insulin in Group B, with APPF in Group C, with 2% sodium hyaluronate (SHA) in Group D, and uncovered in Group E. The slide sections for histological study were observed at 2, 4, 6, 8 and 12 weeks postoperatively. The specimens were observed with a computed imaging analysis system at 4 and 8 weeks postoperatively.

RESULTSSevere peridural adhesions were formed in Groups B, C, D and E after laminectomy. But no adhesion was formed in the Group A at all time points. bFGF could stimulate pearl fat revascularization, increase the number of newly formed vessels and contribute to the survival of pearl fat. However, insulin had no certain effect in preventing degradation and deterioration of pearl fat. SHA had some effect in prevention of peridural adhesions only in the early stage, which was weakened with the lapse of time.

CONCLUSIONSAPPF implantation mixed with bFGF provides a potential new approach to improving fat survival and preventing peridural adhesion postlaminectomy.

Adipose Tissue ; transplantation ; Animals ; Cicatrix ; prevention & control ; Dissection ; Female ; Fibroblast Growth Factor 2 ; therapeutic use ; Hyaluronic Acid ; Laminectomy ; Male ; Models, Animal ; Rabbits ; Tissue Adhesions ; prevention & control

OBJECTIVETo study the effect of methylene blue combined with aprotinin on intraperitoneal adhesion.

METHODSFrom May 2000 to February 2004, there were 83 patients receiving total or partial colectomy and temporary ileostomy or colostomy, and second anastomosis was performed within 8-12 weeks after the first operation. These patients were divided into four groups and followed by intraperitoneal administration of saline,methylene blue,aprotinin,combined methylene blue and aprotinin respectively during the second operation, then adhesion formation was quantitatively graded.

RESULTSThe adhesion rate was 15% in combination group, 83% in saline group, 40% in methylene blue group, and 45% in aprotinin group, respectively. The adhesion rate was significantly lower in combination group(P< 0.05).

CONCLUSIONSMethylene blue and aprotinin can decrease the incidence of intraperitoneal adhesion significantly. The combination of these two drugs has significant effectiveness in the treatment of intraperitoneal adhesion.

Aprotinin ; therapeutic use ; Drug Therapy, Combination ; Female ; Humans ; Methylene Blue ; therapeutic use ; Peritoneal Diseases ; pathology ; prevention & control ; Postoperative Complications ; prevention & control ; Tissue Adhesions ; prevention & control

O-Carboxymethylchitosan (O-CMC) in 1000 g batch was prepared from chitin as starting material and its chemical structure was confirmed by analysis of IR and NMR. O-CMC solution, sodium hyaluronate (HA) solution and physiological saline were used in Sprague-Dawley rat model for prevention of postsurgical adhesions; after 7 days of an abdominal operation, the 3 groups were evaluated according to Belluco standard, the mean scores of O-CMC group, HA group and physiological saline group were 2.5 +/- 3.1, 3.3 +/- 3.6 and 10.3 +/- 1.0, respectively. Histological inspection showed that in O-CMC group, mesothelial cells on peritonaeum or cecum surfaces were almost restored; in HA group the injured surface of peritonaeum was mostly repaired, but in physiological saline group the injured surface of cecum was just a little repaired; there were extensive adhesions between peritonaeum and cecum, and inflammatory response was quite serious. Experimental results indicated that O-CMC and HA had excellent efficiency and O-CMC was slightly better than HA for the prevention of postsurgical adhesions.
Abdomen ; surgery ; Animals ; Chitosan ; analogs & derivatives ; therapeutic use ; Female ; Intestinal Diseases ; prevention & control ; Male ; Postoperative Complications ; prevention & control ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Tissue Adhesions ; prevention & control

OBJECTIVETo determine the efficacy of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits.

METHODSTwenty-four Japanese white rabbits underwent laminectomy (including the attached ligaments) at L(2 ) and L(5). After laminectomy at L(5), polylactic acid glue was sprayed on the dura and nerve roots and this segment was taken as the experimental group. After laminectomy at L(2), nothing was used and this segment was enrolled as the self control group. Four rabbits were killed every two weeks postoperatively till the end of the experiment at 12 weeks. Then the operated spine was observed grossly, histologically and ultrastructurally to check the degree of scar formation, the status of epidural scar adhesion, the absorption of the glue, and the intracellular structure of fibroblasts.

RESULTSThe glue coagulated immediately after spraying and showed excellent hemostatic effect. The glue membrane was easy to be taken away from the dura mater of the samples for 2 weeks and there were no cells in the epidural space in the experimental group. But the dura mater was covered by hematoma in the control group, which formed mild adhesion, with fibroblasts proliferating actively. In the 4th week, some glue shivers remained in the epidural space with fibroblasts increasing a little, and the dura mater was smooth in the experimental group. However, in the control group, the formed scar was fragile and conglutinated with the dura mater diffusely and fibroblasts were much more than those in the experimental group. In the 6th-12th weeks, there was a potential interspace between the scar and the dura mater, and the polylactic acid glue was absorbed completely in the experimental group. Much tough scar was found in the control group, which was very difficult to dissect from the dura mater and the surrounding tissues. From the ultrastructural observation of the fibroblasts, the nucleus became much bigger and the rough endoplasmic reticulum was much more plentiful in the control group than that in the experimental group.

CONCLUSIONSPolylactic acid glue can effectively reduce epidural cicatrization and adhesion.

Animals ; Biocompatible Materials ; Cicatrix ; prevention & control ; Lactic Acid ; administration & dosage ; pharmacology ; Laminectomy ; Membranes, Artificial ; Polyesters ; Polymers ; administration & dosage ; pharmacology ; Postoperative Complications ; prevention & control ; Rabbits ; Tissue Adhesions ; prevention & control