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What are adhesions?
Adhesions are fibrous bands connecting structures that are normally separate. Adhesions develop as normal tissue responds to some form of injury.
Why are adhesions a problem?
Adhesions can lead to a variety of complications which include pelvic pain, infertility, bowel obstruction and prolonged operative and recovery times.
Why do adhesions form?
Some of the causes of adhesion formation are: Trauma Ischemia Foreign Bodies Hemorrhage Raw Surfaces Infection
Trauma is frequently a major contributor to the formation of adhesions. It has been shown that adhesions which form or develop after surgery are a result of the body's normal healing process.
During a surgical procedure blood flow often must be disrupted by the cutting, coagulation or tying of sutures. This disruption can result in ischemia (lack of blood supply). This can also lead to inflammation and cause adhesion formation.
Foreign bodies can also cause an inflammatory reaction in the body. A foreign body can be suture material, lint from sponges, or talc from gloves. Local cells respond to the foreign body causing cells to release factors that incite an inflammatory reaction and adhesions may result.
Hemorrhage or bleeding brings blood products into the operating field. The raw surfaces from the operation plus the blood from tissues can enhance the formation of adhesions. Infection from a variety of sources, endometriosis, or pelvic inflammatory disease can cause inflammation which results in adhesion formation.
What can be done?
Surgeons have developed microsurgical techniques that minimize trauma, ischemia, foreign bodies, hemorrhage, raw surfaces and infection to reduce adhesion formation.
Microsurgical Techniques
Important surgical practices include: * minimization of tissue handling * use of delicate instruments * use of magnification * constant wetting of all tissues
These principles are important to keep the formation of adhesions to a minimum. Due to the inevitability of adhesion formation, surgeons have concentrated their efforts on intervening at varying points in the pathway of adhesion formation.
As a result, the use of various adjuvants has been employed to reduce adhesion formation. These agents can act at one or more of the stages of adhesion formation. There are several ways to try to impact on the formation of adhesions either with chemical methods or barrier methods.
Chemical Methods
The use of various drugs has been evaluated in an effort to reduce the postoperative incidence of adhesions. To date no well-controlled study has documented the efficacy of these drugs.
Barrier Methods
The use of a barrier between raw tissue surfaces appears to be one of the most promising methods of adhesion prevention. Barriers mechanically separate the surgical surfaces and keep those surfaces apart.
INTERCEED* (TC7) Absorbable Adhesion Barrier is the first surgical adjuvant specifically indicated for the reduction of adhesions in gynecologic pelvic surgery over raw surfaces. INTERCEED Barrier breaks down to form a protective coating during the critical healing time when adhesions may occur. It is absorbed from the site of implantation within four weeks.
What is INTERCEED* (TC7) Absorbable Adhesion Barrier?
INTERCEED Barrier is a satin-like fabric made from oxidized regenerated cellulose. This barrier mechanically separates the tissue surfaces. It breaks down to form a protective coating during the critical healing time when adhesions may occur. When used as directed it is absorbed within 28 days.
Clinical Studies(1)
In a human clinical study INTERCEED Barrier was twice as effective as surgery alone in reducing adhesions in patients known to form adhesions previously. No adverse reactions have been reported attributable to the use of INTERCEED Barrier. Based on these findings, the barrier appears to be both safe and effective as a surgical adjuvant for the reduction of the incidence of pelvic adhesions(1). (1) Fertility and Sterility Vol. 51, Pg. 933. June 1989.