REDUCTION OF ADHESION FORMATION BY POSTOPERATIVE ADMINISTRATION OF IONICALLY CROSS-LINKED HYALURONIC-ACID

Objective: To examine the efficacy of various formulations of hyaluron ic acid (HA), including HA ionically cross-linked with trivalent iron, in animal models of adhesion formation. Design: Hyaluronic acid formu lations of varying concentrations and cross-linked densities were prep ared and evaluated in a rabbit uterine horn model and a rabbit sidewal l model. Setting: ETHICON, Inc., Somerville, New Jersey. Subject(s): N ew Zealand White rabbits. Intervention(s): Test formulations were appl ied as intraperitoneal instillates after surgery. Main Outcome Measure (s): Adhesion formation was assessed at 7 and 14 days (sidewall and ut erine horn model, respectively). Result(s): Hyaluronic acid that was n ot ionically cross-linked was ineffective in reducing adhesions in the se models even at high viscosity, whereas the ionically cross-linked f ormulations of HA with trivalent iron were highly effective. Efficacy improved with increased levels of ionic cross-linking. Flowable gels, which could be delivered readily by syringe and cannula, also were eff ective when administered at a site remote from injury and with saline present. Conclusion(s): Whereas previous studies showed that HA was ef fective in reducing adhesions peripheral to the site of injury, HA ion ically cross-linked with trivalent iron was effective in reducing adhe sions at all sites. From these studies, a formulation of HA. ionically cross-linked with trivalent iron, 0.5% Ferric Hyaluronate Gel (LUBRIC OAT; ETHICON, Inc., Somerville, NJ), was identified for subsequent cli nical evaluations. (C) 1997 by American Society for Reproductive Medic ine.