George T. Rodeheaver

Resistance to adhesion formation: A comparative study of treated and untreated mesh products placed in the abdominal cavity

Background: New materials have been devised to prevent postoperative adhesions when placing a prosthesis in contact with abdominal contents.Methods:Eighty rats underwent laparotomy and denudation of the serosa of the cecum and peritoneal covering of the abdominal wall. Five treated mesh products (Parietex Composite, Parietene Composite, Bard Composix E/X, Sepramesh, and Gore-Tex Dual Mesh) and one untreated mesh product (untreated Parietene) were randomly placed between the cecum and abdominal wall. A group without mesh was used as control. The animals were sacrificed at 21xa0days following surgery and analyzed for the presence of adhesions.Results:The incidence of adhesion formation, mean adhesion area, maximum adhesion length, and strength of adhesion separation were similar between Parietex Composite, Parietene Composite, and Bard Composix E/X, and they were significantly less than with Sepramesh, untreated Parietene, and the control group. Gore-Tex Dual Mesh resulted in less adhesions, adhesion area, mean strength of separation, and work of separation than the untreated Parietene group and the control group. Sepramesh resulted in less strength and work of separation compared to the control group.Conclusions: The incidence of adhesions and work and strength of adhesion separation are reduced when using a treated mesh, compared to the untreated mesh and the control group without mesh. Parietex Composite, Parietene Composite, Bard Composix E/X, and Gore-Tex Dual Mesh were superior to Sepramesh, untreated Parietene, and the control group in the prevention of adhesion formation.

Evaluation of resorbable barriers for preventing surgical adhesions

OBJECTIVEnTo evaluate the ability of collagen film, collagen gel, sodium hyaluronate/carboxymethylcellulose film, and fibrin glue to prevent adhesion formation.nnnDESIGNnRandomized trial using a rat model of a standardized abdominal wound and cecal wound.nnnSETTINGnUniversity research laboratory.nnnANIMAL(S)nSprague-Dawley female rats.nnnINTERVENTION(S)nResorbable barriers or no barrier (controls) were placed between an abdominal wall wound (1 cm x 2 cm) and a similarly sized cecal wound.nnnMAIN OUTCOME MEASURE(S)nAdhesion formation between wounds was assessed and quantitated 7 days after surgery.nnnRESULT(S)nWithout treatment, 34 of 35 untreated rats (97%) developed adhesions. Treatment with collagen gel (3 of 33 rats), collagen film (3 of 10 rats), or sodium hyaluronate/carboxymethylcellulose film (2 of 10 rats) significantly reduced the incidence of adhesion formation. Treatment with fibrin sealant resulted in 9 of 10 animals having adherent wounds 7 days after surgery.nnnCONCLUSION(S)nResorbable barriers of collagen gel, collagen films and sodium hyaluronate/carboxymethylcellulose film were effective in significantly reducing adhesion formation. Fibrin sealant at 7 days had an incidence of adhesion formation similar to that in untreated control animals.

Citizen's Petition to Food and Drug Administration to ban cornstarch powder on medical gloves: Maltese cross birefringence

BACKGROUNDnDuring the last 25 years, scientific experimental and clinical studies have documented the dangers of cornstarch powder on examination and surgical gloves because the cornstarch promotes wound infection, causes serious peritoneal adhesions and granulomatous peritonitis, and is a well-documented vector of the latex allergy epidemic in the world. Realizing the dangers of cornstarch on examination and surgical gloves, Germanys regulations of personal protective equipment banned the use of surgical glove powder cornstarch in 1997. In 2000, the Purchasing and Supply agency for the United Kingdom ceased to purchase any gloves lubricated with cornstarch.nnnDISCUSSIONnRealizing the dangers of cornstarch-powdered gloves, many hospitals and clinics in the United States have banned the use of cornstarch-powdered examination and surgical gloves. Hospitals that have banned cornstarch in their examination and surgical gloves have noted a marked reduction in the latex allergy epidemic in their facilities. Realizing the dangers of cornstarch-powdered examination and surgical gloves, Dr Sheila A. Murphey, branch chief, Infection Control Devices Branch, Division of Anesthesiology, General Hospital, Infection Control, and Dental Devices Office of Device Evaluation, Center for Devices and Radiological Health of the Food and Drug Administration (FDA), recommended that a Citizens Petition be filed to the FDA to ban cornstarch on surgical and examination gloves.nnnCONCLUSIONnThe 12 authors of this report have attached the enclosed petition to the FDA to ban the use of cornstarch on all synthetic and latex examination and surgical gloves used in the United States.