Download PDF
J Reconstr Microsurg 2009; 25(6): 345-354
DOI: 10.1055/s-0029-1215526
© Thieme Medical Publishers

The Short- and Long-Term Effects of Seprafilm® on Peripheral Nerves: A Histological and Functional Study

Christina Kenney Magill1 , 2 , Sami H. Tuffaha2 , Andrew Yee2 , Janina P. Luciano2 , Daniel A. Hunter2 , Susan E. Mackinnon2 , Gregory H. Borschel2 , 3
  • 1Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
  • 2Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
  • 3Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Missouri
Further Information

Publication History

Publication Date:
24 April 2009 (online)

    Permissions and Reprints

ABSTRACT

Extraneural scar reduction is an important goal in peripheral nerve microsurgery. The use of biosynthetic materials, such as Seprafilm®, reduces postoperative adhesions in abdominopelvic gynecologic and orthopedic surgery. The study evaluates the safety of Seprafilm® in proximity to nerve tissue in a noninjury (phase 1) and injury (phase 2) model. Phase 1 groups were: (1) sciatic nerve exposure and neurolysis (n = 15), (2) Seprafilm® placement superficial to the nerve (n = 15), and (3) circumferentially wrapping Seprafilm® around the nerve (n = 15). Outcome measures at 45 and 90 days included wound inspection, histomorphometry, and stereological analysis of vascularity. Phase II groups were: (1) sciatic nerve cut and repair alone (n = 15) or (2) nerve wrapped with Seprafilm® (n = 15). Nerves were evaluated at 18, 32, and 42 days postoperatively, and animals underwent biweekly functional walking tracks. In phase I, no significant differences were detected between groups. In phase II, fewer perineural scar bands were seen with Seprafilm®. Histomorphometric differences favoring Seprafilm® at 18 days and favoring control at 42 days were noted (p < 0.05), though no differences in functional outcomes were detected. Qualitatively less perineural scar tissue was seen when using Seprafilm®. No functional or histological deleterious effects were noted from placing Seprafilm® on intact nerves or cut and repaired nerves.

KEYWORDS

Seprafilm® - carboxymethycellulose hyaluronate - peripheral nerve - scar reduction - adhesions

REFERENCES

  • 1 Adanali G, Verdi M, Tuncel A, Erdogan B, Kargi E. Effects of hyaluronic acid-carboxymethylcellulose membrane on extraneural adhesion formation and peripheral nerve regeneration.  J Reconstr Microsurg. 2003;  19 29-35
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Özgenel G Y. Effects of hyaluronic acid on peripheral nerve scarring and regeneration in rats.  Microsurgery. 2003;  23 575-581
    CrossrefPubMedGoogle Scholar
  • 3 Sanders R J, Hammond S L, Rao N M. Observations on the use of Seprafilm on the brachial plexus in 249 operations for neurogenic thoracic outlet syndrome.  Hand. 2007;  2 179-183
    CrossrefPubMedGoogle Scholar
  • 4 Becker J M, Dayton M T, Fazio V W et al.. Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study.  J Am Coll Surg. 1996;  183 297-306
    PubMedGoogle Scholar
  • 5 Fazio V W, Cohen Z, Fleshman J W et al.. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection.  Dis Colon Rectum. 2006;  49 1-11
    CrossrefPubMedGoogle Scholar
  • 6 Klinger P P, Floch N, Seelig M et al.. Seprafilm®-induced peritoneal inflammation: a previously unknown complication: report of a case.  Dis Colon Rectum. 1999;  42 1639-1642
    CrossrefPubMedGoogle Scholar
  • 7 Zeng Q, Yu Z, You J, Zhang Q. Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and meta-analysis.  World J Surg. 2007;  31 2125-2131
    CrossrefPubMedGoogle Scholar
  • 8 Kayaoglu H A, Ozkan N, Hazinedaroglu S M, Ersoy O F, Koseoglu R D. An assessment of the effects of two types of bioresorbable barriers to prevent postoperative intra-abdominal adhesions in rats.  Surg Today. 2005;  35 946-950
    CrossrefPubMedGoogle Scholar
  • 9 Brenner M J, Moradzadeh A, Myckatyn T M et al.. Role of timing in assessment of nerve regeneration.  Microsurgery. 2008;  28 265-272
    CrossrefPubMedGoogle Scholar
  • 10 Gundersen H J, Bagger P, Bendtsen T F et al.. The new stereological tools: disector, fractionator, nucleator and point sampled intercepts and their use in pathological research and diagnosis.  APMIS. 1988;  96 857-881
    CrossrefPubMedGoogle Scholar
  • 11 Hunter D A, Moradzadeh A, Whitlock E L et al.. Binary imaging analysis for comprehensive quantitative histomorphometry of peripheral nerve.  J Neurosci Methods. 2007;  166 116-124
    CrossrefPubMedGoogle Scholar
  • 12 Brown C J, Mackinnon S E, Evans P J et al.. Self-evaluation of walking-track measurement using a Sciatic Function Index.  Microsurgery. 1989;  10 226-235
    CrossrefPubMedGoogle Scholar
  • 13 Sunderland S, Bradley K C. Endoneurial tube shrinkage in the distal segment of a severed nerve.  J Comp Neurol. 1950;  93 411-420
    CrossrefPubMedGoogle Scholar
  • 14 Atkins S, Smith K G, Loescher A R, Boissonade F M, O’Kane S, Ferguson M W, Robinson P P. Scarring impedes regeneration at sites of peripheral nerve repair.  Neuroreport. 2006;  17 1245-1249
    CrossrefPubMedGoogle Scholar
  • 15 Nachemson A K, Lundborg G, Myrhage R, Rank F. Nerve regeneration after pharmacological suppression of the scar reaction at the suture site. An experimental study on the effect of estrogen-progesterone, methylprednisolone-acetate and cis-hydroxyproline in rat sciatic nerve.  Scand J Plast Reconstr Surg. 1985;  19 255-260
    CrossrefPubMedGoogle Scholar
  • 16 Wehling P, Pak M, Cleveland S, Nieper R. The influence of bacterial collagenase on regeneration of severed rat sciatic nerves.  Acta Neurochir (Wien). 1992;  119 121-127
    CrossrefPubMedGoogle Scholar
  • 17 Nath R K, Kwon B, Mackinnon S E, Jensen J N, Reznik S, Boutros S. Antibody to transforming growth factor beta reduces collagen production in injured peripheral nerve.  Plast Reconstr Surg. 1998;  102 1100-1106
    CrossrefPubMedGoogle Scholar
  • 18 Davison S P, McCaffrey T V, Porter M N, Manders E. Improved nerve regeneration with neutralisation of transforming growth factor-beta 1.  Laryngoscope. 1999;  109 631-635
    CrossrefPubMedGoogle Scholar
  • 19 Rydevik M, Bergström F, Mitts C, Danielsen N. Locally-applied collagenase and regeneration of transsected and repaired rat sciatic nerves.  Scand J Plast Reconstr Surg Hand Surg. 2002;  36 193-196
    CrossrefPubMedGoogle Scholar
  • 20 Ozay R, Bekar A, Kocaeli H, Karli N, Filiz G, Ulus I H. Citicoline improves functional recovery, promotes nerve regeneration, and reduces postoperative scarring after peripheral nerve surgery in rats.  Surg Neurol. 2007;  68 615-622
    CrossrefPubMedGoogle Scholar
  • 21 Atkins S, Smith K G, Loescher A R, Boissonade F M, Ferguson M W, Robinson P P. The effect of antibodies to TGF-beta1 and TGF-beta2 at a site of sciatic nerve repair.  J Peripher Nerv Syst. 2006;  11 286-293
    CrossrefPubMedGoogle Scholar
  • 22 Wang K K, Nemeth I R, Seckel B R et al.. Hyaluronic acid enhances peripheral nerve regeneration in vivo.  Microsurgery. 1998;  18 270-275
    CrossrefPubMedGoogle Scholar
  • 23 Özgenel G Y, Fílíz G. Combined application of human amniotic membrane wrapping and hyaluronic acid injection in epineurectomized rat sciatic nerve.  J Reconstr Microsurg. 2004;  20 153-157
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Beck D E, Cohen Z, Fleshman J W et al.. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine.  Dis Colon Rectum. 2003;  46 1310-1319
    CrossrefPubMedGoogle Scholar
  • 25 Menderes A, Mola F, Tayfur V, Vayvada H, Barutçu A. Prevention of peritendinous adhesions following flexor tendon injury with seprafilm.  Ann Plast Surg. 2004;  53 560-564
    CrossrefPubMedGoogle Scholar
  • 26 Cohen Z, Senagore A J, Dayton M T et al.. Prevention of postoperative abdominal adhesions by a novel, glycerol/sodium hyaluronate/carboxymethycellulose-based bioresorbable membrane: a prospective, randomized, evaluator-blinded multicenter study.  Dis Colon Rectum. 2005;  48 1130-1139
    CrossrefPubMedGoogle Scholar
  • 27 Mohri Y, Uchida K, Araki T et al.. Hyaluronic acidcarboxycellulose membrane (Seprafilm) reduces early postoperative small bowel obstruction in gastrointestinal surgery.  Am Surg. 2005;  71 861-863
    PubMedGoogle Scholar
  • 28 Bristow R E, Santillan A, Diaz-Montes T P, Gardner G J, Giuntoli II R L, Peeler S T. Prevention of adhesion formation after radical hysterectomy using a sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier: a cost-effectiveness analysis.  Gynecol Oncol. 2007;  104 739-746
    CrossrefPubMedGoogle Scholar
  • 29 Caylan R, Bektas D. Preservation of the mastoid aeration and prevention of mastoid dimpling in chronic otitis media with cholesteatoma surgery using hyaluronate-based bioresorbable membrane (Seprafilm).  Eur Arch Otorhinolaryngol. 2007;  264 377-380
    CrossrefPubMedGoogle Scholar
  • 30 Konakçi E, Koyuncu M, Unal R, Tekat A, Uyar M. Repair of subtotal tympanic membrane perforations with Seprafilm.  J Laryngol Otol. 2004;  118 862-865
    PubMedGoogle Scholar
  • 31 Sanger J R, Kolachalam R, Komorowski R A, Yousif N J, Matloub H S. Short-term effect of silicone gel on peripheral nerves: a histologic study.  Plast Reconstr Surg. 1992;  89 931-940
    PubMedGoogle Scholar
  • 32 David M, Sarani B, Moid F, Tabbara S, Orkin B A. Paradoxical inflammatory reaction to Seprafilm: case report and review of the literature.  South Med J. 2005;  98 1039-1041
    CrossrefPubMedGoogle Scholar
  • 33 Klinger P P, Floch N, Seelig M et al.. Seprafilm®-induced peritoneal inflammation: a previously unknown complication: report of a case.  Dis Colon Rectum. 1999;  42 1639-1642
    CrossrefPubMedGoogle Scholar
  • 34 Remzi F H, Oncel M, Church J M, Senagore A J, Delaney C P, Fazio V W. An unusual complication after hyaluronate-based bioresorbable membrane (Seprafilm) application.  Am Surg. 2003;  69 356-357
    PubMedGoogle Scholar
  • 35 Best T J, Mackinnon S E, Midha R, Hunter D A, Evans P J. Revascularization of peripheral nerve autografts and allografts.  Plast Reconstr Surg. 1999;  104 152-160
    CrossrefPubMedGoogle Scholar

Gregory H BorschelM.D. 

Assistant Professor, Division of Plastic and Reconstructive Surgery, Washington School of Medicine, and Department of Biomedical Engineering

660 S. Euclid Ave, Campus Box 8238, St. Louis, MO 63110

Email: borschelg@wudosis.wustl.edu; schlemmerc@wudosis.wustl.edu

      >