The Effect of Adhesion Barriers in Preventing Pericardial Adhesion Depending on the Type of Barrier: Solution Type versus Film Type

Abstract

Background: Pericardial adhesion is a significant challenge for re-sternotomy. An adhesion barrier made with hyaluronate and carboxymethylcellulose (HA-CMC) has been used. The solution type and film type of HA-CMC barrier was commercially introduced. While the solution type is easy to apply but possible to stream down the wound sites, the film type showed fixation on the wound sites but difficulty in handling. This study was designed to investigate the effect of adhesion barriers according to the type of barriers Methods: Twelve mongrel dogs were classified into two group; the S group (n=6) which received the solution type of barrier, and the F group (n=6) which was received the film type. After making an abrasion wound on left ventricular wall, the wound was covered with a solution or film type of barrier. After 4 weeks, adhesion severity (Grade 0-5) and adhesion strength (grade 0-4) were measured. The number of white blood cells (WBC), rate of erythrocyte sedimentation (ESR), and the amount of serum C-reactive protein (CRP) were measured for the estimation of systemic inflammation at 1 week and 4 weeks postoperatively. Microscopic examination was also performed. Results: Adhesion severities of the S and F groups were both scored as 4. The adhesion strengths of the S group and F group were 4 and 3, respectively. There were no significant differences between groups when WBC count, CRP, and ESR were compared. Degrees of fibrosis, regeneration of the mesothelial cell, inflammation, and foreign body reaction were not also significantly different between the groups. Conclusion: Although the concern that solution type of barrier might be decreased the anti-adhesion effect because of the possibility of streaming down the wound sites, the anti-adhesion effect was not significantly different between groups. These results may help surgeons decide the appropriate type of adhesion barrier to use.