Abstract
In this experimental study, we aimed to examine the ability of absorbable oxidised regenerated cellulose (Interceed, TC-7, Johnson & Johnson, USA) to inhibit the formation of peritendinous fibrotic adhesions after tendon repair in rats. Both Achilles tendons of 23 female Wistar-Albino rats weighing between 350 and 450 grams were cut and repaired. On the right side, Interceed absorbable adhesion barriers were wrapped around the repaired tendon (group I). On the left, the same procedures were applied except for the Interceed wrapping and these were grouped as control (group II). Animals were sacrificed at postoperative day 28 and macroscopic and histological examination was performed. All the animals survived and no tendon rupture was observed. No wound dehiscence, wound infection or exposure of repaired tendons occurred. Macroscopically, there were three (13.1%) tendons without adhesion formation and 20 (86.9%) tendons with inferior adhesion formation in group I; on the other hand, there were 16 tendons (69.5%) with medium grade adhesion formation and seven tendons (30.5%) with severe peritendinous adhesion formation in group II (control group) (p < 0.05). Histologically, adhesion formation was absent in 11 tendons (47.8%) and slight in 12 tendons (52.2%) in group I; while in group II, it was slight in two (8.6%), moderate in 15 (65.2%) and severe in six tendons (26.2%) (p < 0.05). Sixteen (69.5%) of 23 tendons in group I and 11 (47.8%) of 23 tendons in group II showed no inflammatory reaction (p < 0.05). Nineteen (82.6%) tendons in group I and only one tendon in group II showed excellent to good tendon healing (p = 0.00). According to our results, we feel that Interceed may have an intraoperative role to play in the reduction of adhesions after surgical tendon repair. This study suggests that absorbable oxidised regenerated cellulose merits further evaluation as a potential treatment to inhibit the formation of peritendinous adhesions. Rigorous and extensive controlled trials should be undertaken on patients undergoing tendon repair with or without this barrier.
Résumé
Cette étude expérimentale a pour but de mettre en évidence l’action de l’Interceed TC-7 de Johnson & Johnson afin d’éliminer la formation d’adhérence péri-tendineuse dans la réparation de tendons chez le rat. Les deux tendons d’Achilles de 23 rats albinos femelles pesant entre 350 et 450 grammes ont été sectionnés puis réparés. Du côté droit, le produit Interceed a été appliqué autour du tendon (groupe I), le côté gauche a constitué le groupe contrôle. Les animaux ont été sacrifiés à J28 avec un examen macroscopique et histologique. Tous les animaux ont survécu à la réparation et aucun n’a présenté de rupture du tendon. Il n’y a pas eu d’infection. Macroscopiquement, dans le groupe I, 3 tendons (13.1%) n’ont pas présenté d’adhérence péri-tendineuse et 20 (86.9%) ont présenté des adhérences inférieures. Dans le groupe contrôle 16 rats (69.5%) présentaient des adhérences de grade moyen et 7 (30.5%) des adhérences importantes, cette différence était significative (p < 0.05). Histologiquement, la formation d’adhérences est nulle chez 11 rats (47.8%) et légère chez 12 (52.2%). Dans le groupe I, en ce qui concerne le groupe contrôle, les adhérences sont présentées chez deux rats (8.6%) sont modérées chez 15 rats (65.2%) et sévères chez 6 rats (26.2%) dans le groupe II (p < 0.05). 16 (69.5%) des 23 tendons du groupe I et II (47.8%) des 23 tendons du groupe II ne montrent pas de réaction inflammatoire (p < 0.05). 19 (82.6%) tendons du groupe I et seulement 1 tendon du groupe II montrent une excellente cicatrisation. Ces résultats démontrent que l’Interceed peut avoir un rôle important dans la réduction des adhérences après réparation chirurgicale des tendons. Après cette étude, nous pouvons penser que ce produit nécessite d’autres évaluations quant à son potentiel d’inhibition dans la formation d’adhérences péri-tendineuses.
Similar content being viewed by others
References
Akali A, Khan U, Khaw PT, McGrouther AD (1999) Decrease in adhesion formation by a single application of 5-fluorouracil after flexor tendon injury. Plast Reconstr Surg 103:151–158
Bora Jr FW, Lane JM, Prockop DJ (1972) Inhibitors of collagen biosynthesis as a means of controlling scar formation in tendon injury. J Bone Jt Surg Am 54:1501–1508
Demirkan F, Colakoglu N, Herek O, Erkula G (2002) The use of amniotic membrane in flexor tendon repair: an experimental model. Arch Orthop Trauma Surg 122:396–399
Diamond MP, DeCherney AH (1987) Pathogenesis of adhesion formation/reformation: application to reproductive pelvic surgery. Microsurgery 8:103–107
Diamond MP (2001) Prevention of adhesions. In: Gershensopn DM, DeCherney AH (eds) Operative gynecology, 2nd edn. Saunders, Philadelphia, pp 211–222
Ferguson REH, Rinker B (2006) The use of hydrogel sealant on flexor tendon repairs to prevent adhesion formation. Ann Plast Surg 56:54–58
Frykman E, Jacobson S, Widenfalk B (1973) Fibrin sealant in prevention of flexor tendon adhesions: an experimental study in the rabbit. J Hand Surg Am 18:68–75
Gago LA, Saed GM, Wang RX (2003) Effects of oxidized regenerated cellulose on the expression of extracellular matrix and transforming growth factor-beta1 in human peritoneal fibroblasts and mesothelial cells. Am J Obstet Gynecol 189:1620–1625
Gelberman RH, Woo SLY, Amiel D, Horibe S, Lee D (1990) Influences of flexor sheath continuity and early motion on tendon healing in dogs. J Hand Surg Am 15:69–77
Green S, Szabo R, Langa V, Klein M (1986) The inhibition of flexor tendon adhesions. Bull Hosp Joint Dis 46:16–21
Gudemez E, Eksioglu F, Korkusuz P, Asan E, Gursel I, Hasirci V (2002) Chondroitin sulfate-coated polyhydroxyethyl methacrylate membrane prevents adhesion in full-thickness tendon tears of rabbits. J Hand Surg Am 27:293–306
Isik S, Ozturk S, Gurses S, Yetmez M, Guler MM, Selmanpakoglu N, Gunhan O (1999) Prevention of restrictive adhesions in primary tendon repair by HA-membrane: experimental research in chickens. Br J Plast Surg 52:373–379
Jones MM, Burnett S, Southgate A, Sibbons P, Grobbelaar AO, Green CJ (2002) The role of human-derived fibrin sealant in the reduction of postoperative flexor tendon adhesion formation in rabbits. J Hand Surg Br 27:278–282
Linsky C, Diamond M, Cunningham T, Constantine B, De Cherney A, di Zerega G (1987) Adhesion reduction in the rabbit uterine horn model using an absorbable barrier, TC-7. J Reprod Med 32:17–21
Matloub HS, Dzwierzynski WW, Erickson S (1996) Magnetic resonance imaging scanning in the diagnosis of zone II flexor tendon rupture. J Hand Surg Am 21:451–455
Menderes A, Mola F, Tayfur V, Vayvada H, Barutcu A (2004) Prevention of peritendinous adhesions following flexor tendon injury with seprafilm. Ann Plast Surg 53:560–564
Mentzel M, Hoss H, Keppler P (2000) The effectiveness of ADCON-T/N, a new anti-adhesion barrier gel, in fresh divisions of the flexor tendons in zone II. J Hand Surg Br 25:590–592
Moran SL, Ryan CK, Orlando GS, Pratt CE, Michalko KB (2000) Effects of 5-fluorouracil on flexor tendon repair. J Hand Surg Am 25:242–251
Ozgenel GY (2004) The effects of a combination of hyaluronic and amniotic membrane on the formation of peritendinous adhesions after flexor tendon surgery in chickens. J Bone Jt Surg Br 86:301–307
Siddiqi NA, Hamada Y, Ide T, Akamatsu N (1995) Effects of hydroxyapatite and alumina sheaths on postoperative peritendinous adhesions in chickens. J Appl Biomat 6:43–53
Szabo RM, Younger E (1990) Effects of indomethacin on adhesion formation after repair of zone II tendon lacerations in the rabbit. J Hand Surg Am 15:480–483
Tang JB, Shi D, Zhag QG (1996) Biochemical and histologic evaluation of tendon sheath management. J Hand Surg Am 21:900–908
Walker FG, Bensley SH, Lindsay WK (1961) The effects of an antihistamine (promethazine) on the reaction of the tendons to trauma: a histological study. Can J Biochem Physiol 39:89–101
Wrenn RN, Golduer JL, Markee JL (1954) An experimental study of the effect of cortisone on the healing process and tensile strength of tendons. J Bone Jt Surg Am 36:588–601
Zhang H, Sheng ZJ, Hou CL (1997) Effect of chitosan membrane on tendon adhesion and healing. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 13:382–387
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Temiz, A., Ozturk, C., Bakunov, A. et al. A new material for prevention of peritendinous fibrotic adhesions after tendon repair: oxidised regenerated cellulose (Interceed), an absorbable adhesion barrier. International Orthopaedics (SICO 32, 389–394 (2008). https://doi.org/10.1007/s00264-007-0335-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-007-0335-8