title: A chitosan-based sinus sealant for reduction of adhesion formation in rabbit and sheep models.
abstract: OBJECTIVE
  Chronic sinusitis is the most prevalent chronic disease in the United States in adults aged 18 to 44 years, with approximately 250,000 operations performed annually. Although often successful, sinus surgery fails in greater than 15% of patients. Adhesion formation is a common complication and cause for subsequent revision surgery. Here, the authors evaluate a sprayable chitosan/starch-based sinus sealant and demonstrate its ability to reduce adhesion formation both in vitro and in 2 animal models.
  
  
  METHODS
  Randomized, controlled, animal trials.
  
  
  METHODS
  Academic medical center (fibroblast experiments) and animal laboratories (sheep and rabbit studies).
  
  
  METHODS
  This sinus sealant was applied to human cultured fibroblasts obtained from surgically removed polyps to examine its ability to inhibit fibroblast migration and proliferation. The sinus sealant was applied to New Zealand White rabbits (n = 20) in an established cecal-sidewall abrasion model and to sheep (n = 10) in a sinus surgical adhesion model to examine its ability to reduce adhesion formation.
  
  
  RESULTS
  This sinus sealant inhibited migration and proliferation of human cultured fibroblasts and reduced the total adhesion score from 4.9 to 0.3 for a total reduction of 94% (95th percentile confidence interval [CI], 78%, 100%; P < .001) in a well-established rabbit cecal-sidewall model commonly used for adhesion testing. Moreover, this sealant reduced adhesion formation from 80% to 10% for a total reduction of 70% (95th percentile CI, 57%, 93%; P = .003) in a sheep sinus adhesion surgical model.
  
  
  CONCLUSIONS
  This chitosan-based sealant demonstrates promise for reducing adhesion formation in sinus surgery.
authors.affiliation: Biomaterials Team, Research and Development, Medtronic Surgical Technologies, Jacksonville, Florida, USA.
authors.forename: Jennifer G
authors.initials: JG
authors.lastname: Medina
authors.forename: John W
authors.initials: JW
authors.lastname: Steinke
authors.forename: Subinoy
authors.initials: S
authors.lastname: Das
mesh_terms: D000818:Animals; D001672:Biocompatible Materials; D048271:Chitosan; D004195:Disease Models, Animal; D010256:Paranasal Sinuses / Q000601:surgery*; D011817:Rabbits; D012756:Sheep; D012852:Sinusitis / Q000601:surgery; D000267:Tissue Adhesions / Q000517:prevention & control*; D014014:Tissue Adhesives
chemical_list: D001672:Biocompatible Materials; D014014:Tissue Adhesives; D048271:Chitosan