Surgical Adhesion and Its Prevention

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Comprehensive Biomaterials, 2011, 1, pp. 561 - 572
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Adhesion of freely moving tissues and organs due to surgical injury and trauma can be a serious postoperative complication. High rates of incidence due to surgical intervention, especially associated with abdominal procedures, have been reported. This chapter gives an introduction to the formation of adhesions, with particular focus on peritoneum, urinary and reproductive (female) systems, tendon, ligament, joint, and pericardium. A number of techniques, treatments, and materials have been proposed for the prevention/reduction of adhesion formation. Of these, barrier methods are considered the only effective method currently available. An overview of biomaterials currently used as barriers for postsurgical tissue adhesion is presented. Current clinical practice utilizes solid membranes/mechanical barriers, spray-on, and gel and liquid barriers. These barriers can be either resorbable, nonresorbable, or a combination of both. Complications of barrier films are examined, and design criteria for barrier membranes are presented. Adhesion formation can be beneficial in particular circumstances, such as for anchoring implants, and these uses are commented upon. Much advancement has been made in this area, thanks to the increasing knowledge and understanding regarding the events that control adhesion formation, but there is still a long way to go before an optimum solution to this problem is found.
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