title: A novel combination of bioresorbable polymeric film and expanded polytetrafluoroethylene provides a protective barrier and reduces adhesions.
abstract: OBJECTIVE
  A bioresorbable polymeric film reduces the extent and severity of postoperative adhesions in infants undergoing repeat sternotomy. Resorption of the bioresorbable polymeric film, however, leaves no barrier between the sternum and the epicardium. A sheet of expanded polytetrafluoroethylene is used by many surgeons to create a physical barrier between the sternum and the cardiac structures. We hypothesized that placing bioresorbable polymeric film beneath an expanded polytetrafluoroethylene pericardial membrane would both decrease pericardial adhesions and provide a physical barrier.
  
  
  METHODS
  A novel combination of bioresorbable polymeric film underneath an expanded polytetrafluoroethylene membrane was tested in an established rabbit model of pericardial adhesion formation. After sternotomy, a portion of pericardium was resected and the epicardium was abraded. Rabbits (n = 36) were randomly assigned to 4 treatment groups: control group, no bioresorbable polymeric film or expanded polytetrafluoroethylene; bioresorbable polymeric film group; expanded polytetrafluoroethylene group; and bioresorbable polymeric film + expanded polytetrafluoroethylene group. At 4 weeks post-sternotomy, pericardial adhesions were scored grossly for area and density of adhesions using an established 4-point (0-3) grading system.
  
  
  RESULTS
  The bioresorbable polymeric film group had a significant reduction in mean adhesion score compared with the control group (control = 2.86 ± 0.37 vs bioresorbable polymeric film = 0.57 ± 0.53, P < .0001) and expanded polytetrafluoroethylene group (expanded polytetrafluoroethylene = 2.75 ± 0.46 vs bioresorbable polymeric film = 0.57 ± 0.53, P < .0001). The bioresorbable polymeric film + expanded polytetrafluoroethylene group had a low adhesion profile similar to the bioresorbable polymeric film group (bioresorbable polymeric film + expanded polytetrafluoroethylene = 1.0 ± 0, vs bioresorbable polymeric film = 0.57 ± 0.53), but a considerably lower mean adhesion score than the expanded polytetrafluoroethylene group (expanded polytetrafluoroethylene = 2.75 ± 0.46, vs bioresorbable polymeric film + expanded polytetrafluoroethylene = 1.0 ± 0, P < .0001).
  
  
  CONCLUSIONS
  Placement of bioresorbable polymeric film resulted in minimal pericardial adhesions compared with controls. The placement of bioresorbable polymeric film underneath expanded polytetrafluoroethylene at the time of sternal closure provides a novel combination to reduce the extent and severity of pericardial adhesions while providing a physical barrier between the sternum and the cardiac structures.
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, Ill 60614, USA. skaushal@childrensmemorial.org
authors.forename: Sunjay
authors.initials: S
authors.lastname: Kaushal
authors.forename: Shivani K
authors.initials: SK
authors.lastname: Patel
authors.forename: Saik-Kia
authors.initials: SK
authors.lastname: Goh
authors.forename: Aditya
authors.initials: A
authors.lastname: Sood
authors.forename: Brandon L
authors.initials: BL
authors.lastname: Walker
authors.forename: Carl L
authors.initials: CL
authors.lastname: Backer
mesh_terms: D000818:Animals; D001672:Biocompatible Materials; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D008422:Materials Testing; D010496:Pericardium / Q000473:pathology / Q000601:surgery*; D011138:Polytetrafluoroethylene; D011817:Rabbits; D056346:Sternotomy / Q000009:adverse effects / Q000295:instrumentation; D013997:Time Factors; D000267:Tissue Adhesions
chemical_list: D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene