Reduction of postoperative perineural adhesions by Hyaloglide gel: an experimental study in the rat sciatic nerve.
OBJECTIVE
To assess the effects of Hyaloglide gel (or auto-cross-linked polysaccharide [ACP] gel; Fidia Advanced Biopolymers, Abano Terme, Italy), a hyaluronan-derivative polymer, on peripheral nerve scarring and nerve regeneration.


METHODS
We performed two surgical procedures in adult rats: 1) neurolysis of the sciatic nerve and separation of its tibial and peroneal branches, and 2) transection and immediate suture of the sciatic nerve. After nerve manipulation, ACP gel was applied onto the site of operation. We tested two solutions of ACP gel having different viscosities. Additional animals received Adcon-T/N (Gliatech, Inc., Cleveland, OH), an antiadhesive agent currently available for clinical use. No gel was applied on the contralateral side, which served as a control side. Four weeks later, the animals underwent reoperation. We assessed the quality of wound healing, the presence of perineural adherences, and the separability of nerves from surrounding tissues.


RESULTS
Significantly fewer perineural adhesions were found in animals treated with ACP gel (high viscosity) and Adcon-T/N compared with controls. Quantitative histological analysis revealed a statistically significant reduction in the amount of scar tissue surrounding the nerves treated with ACP gel. No evidence of toxicity was found, and the gel did not interfere with nerve regeneration (counts of regenerating myelinated axons).


CONCLUSIONS
ACP gel with high viscosity seems to be safe and effective in reducing perineural adhesions and scar formation after peripheral nerve surgery.
Dam-Hieu
Phong
P
Experimental Neurosurgery Laboratory, Centre Hospitalier Universitaire de Bicêtre, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France. phong.damhieu@chu-brest.fr
Lacroix
Catherine
C
Said
Gérard
G
Devanz
Pauline
P
Liu
Song
S
Tadie
Marc
M
D000818:Animals; D001369:Axons / Q000648:ultrastructure; D002241:Carbohydrates / Q000494:pharmacology; D002921:Cicatrix / Q000473:pathology / Q000517:prevention & control; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000648:ultrastructure; D009416:Nerve Regeneration / Q000187:drug effects; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011108:Polymers / Q000494:pharmacology; D011134:Polysaccharides / Q000494:pharmacology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012584:Sciatic Nerve / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control*; D014945:Wound Healing / Q000187:drug effects
C101549:ADCON-T-N; D002241:Carbohydrates; D011108:Polymers; D011134:Polysaccharides; C431864:auto-cross-linked polysaccharide