Long-term effects of FloSeal packing after endoscopic sinus surgery.
BACKGROUND
A previous study by our group showed increased adhesions and granulation tissue in ethmoid cavities packed with FloSeal (FS) compared with those packed with thrombin-soaked gelatin foam after endoscopic sinus surgery (ESS). That study included 20 patients whose cavities were graded 6-8 weeks postoperatively. The goal of this study was to report long-term follow-up on this cohort.


METHODS
At least 1 year follow-up was available in 18/20 patients. The number of office procedures required to lyse adhesions during the follow-up period was tabulated also. Pathology was available from one patient who underwent lysis of adhesions on an FS side. The histopathological findings are presented.


RESULTS
The mean follow-up period was 21.4 (+/- 2.3) months, and none of the 18 patients required revision ESS during this interval. The overall incidence of adhesions (p = 0.013) and the number requiring lysis of adhesions (p = 0.046) were both greater in the FS group. During the interval between previous study evaluation (6-8 weeks postop) and last follow-up, five FS sides required a total of seven procedures to lyse adhesions. Silent adhesions were observed in an additional five FS sides. Although asymptomatic adhesions were observed in two thrombin-soaked gelatin sides at last examination, none underwent lysis. Biopsy of an adhesion from a patient packed with FS 25 months earlier revealed incorporated foreign material.


CONCLUSIONS
FS appears to be associated with scar tissue formation and may be incorporated into recovering mucosa. Use of FS may increase the degree of postoperative care required after ESS.
Chandra
Rakesh K
RK
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Conley
David B
DB
Haines
G Kenneth
GK
Kern
Robert C
RC
D015331:Cohort Studies; D004724:Endoscopy; D005005:Ethmoid Sinus / Q000473:pathology* / Q000601:surgery*; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects* / Q000627:therapeutic use; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D010254:Paranasal Sinus Diseases / Q000209:etiology*; D011182:Postoperative Care; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D013917:Thrombin / Q000009:adverse effects / Q000627:therapeutic use; D000267:Tissue Adhesions / Q000209:etiology; D016896:Treatment Outcome
C411004:FloSeal Matrix; D013917:Thrombin