The Efficacy of a Novel Chitosan Gel on Hemostasis and Wound Healing after Endoscopic Sinus Surgery

Valentine, Rowan; Athanasiadis, Theo; Moratti, Stephen C.; Hanton, Lyall R.; Robinson, Simon; Wormald, Peter‐John

doi:10.2500/ajra.2010.24.3422

Cited by 122 publications

(143 citation statements)

References 45 publications

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“…There is some evidence to suggest that presoaking Nasopore R with lidocaine may improve its hemostatic effect within the first 24 hours after surgery, 1286 1289 Merogel R (Medtronic ENT, Jacksonville, FL), 1290 Sepragel R , 1291 and CD gel. 1268 Only CD gel, Merocel R , and Sepragel R were shown to confer any advantage over not packing at all, with both showing lower adhesion rates in their active treatment arms. 1268,1287 CD gel was also shown, in another RCT, to be associated with significantly larger sinus ostial sizes at 3 months, although this study did not report any difference in adhesion rates between treated and untreated cavities.…”

Section: Xd5 Surgical Principles/techniques: Use Of Packingmentioning

confidence: 99%

“…1268 Only CD gel, Merocel R , and Sepragel R were shown to confer any advantage over not packing at all, with both showing lower adhesion rates in their active treatment arms. 1268,1287 CD gel was also shown, in another RCT, to be associated with significantly larger sinus ostial sizes at 3 months, although this study did not report any difference in adhesion rates between treated and untreated cavities. 1292 A small noncontrolled study by Kim et al 1282 suggests that gloving the Merocel R pack prior to insertion may further reduce its postoperative adhesion rate; however, this finding has yet to be validated in a controlled study.…”

Section: Xd5 Surgical Principles/techniques: Use Of Packingmentioning

confidence: 99%

“…[1268][1269][1270][1271] Three RCTs comparing packing to no-packing reported no evidence of significant postoperative bleeding requiring intervention in their unpacked arms. [1268][1269][1270] This is further supported by a large retrospective series by Orlandi and Lanza 1271 of 165 patients undergoing ESS. This study observed that only 11.2% of patients required packing at the end of their sinus procedure, with no reports of significant postoperative bleeding in those left unpacked.…”

Section: Xd5 Surgical Principles/techniques: Use Of Packingmentioning

confidence: 99%

See 2 more Smart Citations

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

Self Cite

557

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Xd5 Surgical Principles/techniques: Use Of Packingmentioning

confidence: 99%

Section: Xd5 Surgical Principles/techniques: Use Of Packingmentioning

confidence: 99%

Section: Xd5 Surgical Principles/techniques: Use Of Packingmentioning

confidence: 99%

See 1 more Smart Citation

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

Self Cite

557

888

View full text Add to dashboard Cite

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“…Current phase I/II trials of a chitosan-dextran hydrogel demonstrate improved clinical outcomes after sinus surgery (11). When prepared in situ, succinyl-chitosan and dextran-aldehyde form a nontoxic, biocompatible, biodegradable gel that facilitates postoperative wound healing by promoting homeostasis and preventing adhesions (11)(12)(13)(14)(15). The latter is a particularly important postsurgical complication of endoscopic sinus surgery that frequently causes surgical failure (16).…”

mentioning

confidence: 99%

A Topical Hydrogel with Deferiprone and Gallium-Protoporphyrin Targets Bacterial Iron Metabolism and Has Antibiofilm Activity

Richter

Thomas

Claeys

et al. 2017

Antimicrob Agents Chemother

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Many infectious diseases are associated with multidrug-resistant (MDR) bacteria residing in biofilms that require high antibiotic concentrations. While oral drug delivery is frequently ineffective, topical treatments have the potential to deliver higher drug concentrations to the infection site while reducing systemic side effects. This study determined the antibiofilm activity of a surgical wound gel loaded with the iron chelator deferiprone (Def) and the heme analogue gallium-protoporphyrin (GaPP), alone and in combination with ciprofloxacin. Activity against MDR Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Acinetobacter johnsonii biofilms was assessed in the colony biofilm and artificial wound model by enumeration of CFU and correlative light/electron microscopy. While Staphylococcus biofilms were equally susceptible to GaPP and Def-GaPP gels (log 10 reduction of 3.8 and 3.7, respectively), the Def-GaPP combination was crucial for significant activity against P. aeruginosa biofilms (log 10 reduction of 1.3 for GaPP and 3.3 for DefGaPP). When Def-GaPP gel was combined with ciprofloxacin, the efficacy exceeded the activity of the individual compounds. Def-GaPP delivered in a surgical wound gel showed significant antibiofilm activity against different MDR strains and could enhance the gel's wound-healing properties. Moreover, Def-GaPP indicated a potentiation of ciprofloxacin. This antibiofilm strategy has potential for clinical utilization as a therapy for topical biofilm-related infections.KEYWORDS antimicrobial combinations, biofilms, drug delivery, iron metabolism M edical treatments for chronic infectious diseases are typically based on oral delivery of high-dose, long-term antibiotic therapies. Despite the risk for emerging antimicrobial resistance and the potential of side effects (e.g., gastrointestinal disorders, neutropenia, nephrotoxicity), there is a lack of suitable alternatives. Depending on the disease nature and localization, topical treatments can deliver high dosages of antimicrobials directly to an infection site while reducing unwanted systemic effects. Higher drug dosages are particularly needed to combat microbial biofilms (1). The ability of bacteria to form biofilms and establish resistance to antibiotics is a major biomedical threat, adding billions of dollars to health care costs worldwide (1-3). Biofilms are responsible for 80% of microbial infections in humans and are a common cause of chronic infections, including chronic wound and chronic sinus infections (4, 5), with increasing tolerance and subtle resistance mechanisms to antibiotic therapies (6-8).

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“…A chitosan/dextran-based (CD) hydrogel has been developed as a postsurgical aid in endoscopic sinus surgeries (ESS). The CD hydrogel significantly reduced the number of adhesions, as well as exhibiting excellent haemostatic, mucoadhesive, and antimicrobial properties (4,24). Chitosan, a natural polymer derived from the alkaline deacetylation of chitin, was selected due to its nontoxicity, biocompatibility, and biodegradability (9).…”

mentioning

confidence: 99%

Antimicrobial Properties of a Chitosan Dextran-Based Hydrogel for Surgical Use

Aziz

Cabral

Brooks

et al. 2012

Antimicrob Agents Chemother

129

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A chitosan dextran-based (CD) hydrogel, developed for use in endoscopic sinus surgery, was tested for antimicrobial activity in vitro against a range of pathogenic microorganisms. The microdilution technique was used to determine minimum inhibitory, minimum bactericidal, and minimum fungicidal concentrations. In addition, the time-kill efficacy of CD hydrogel was determined for two bacterial species. Scanning and transmission electron microscopy were carried out to elucidate the antimicrobial mechanism of this compound. CD hydrogel was found to be effective against Staphylococcus aureus, Streptococcus pyogenes, Escherichia coli, and Clostridium perfringens at its surgical concentration of 50,000 mg/liter. Minimum bactericidal concentrations ranged from 2,000 to 50,000 mg/liter. Dextran aldehyde (DA) was found to be the antimicrobial component of the CD hydrogel with MBC ranging from 2,000 to 32,000 mg/liter. S. aureus appeared to be killed at a slightly faster rate than E. coli. Candida albicans and Pseudomonas aeruginosa were more resistant to CD hydrogel and DA. Scanning and transmission electron microscopy of E. coli and S. aureus incubated with CD hydrogel and DA alone revealed morphological damage, disrupted cell walls, and loss of cytosolic contents, compatible with the proposed mode of action involving binding to cell wall proteins and disruption of peptide bonds. Motility and chemotaxis tests showed E. coli to be inhibited when incubated with DA. The antibacterial activity of CD hydrogel may make it a useful postsurgical aid at other body sites, especially where there is a risk of Grampositive infections.

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The Efficacy of a Novel Chitosan Gel on Hemostasis and Wound Healing after Endoscopic Sinus Surgery

Abstract: CD gel is rapidly hemostatic immediately after ESS and prevents adhesion formation, addressing two of the most common complications of sinus surgery.

Cited by 122 publications

References 45 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

A Topical Hydrogel with Deferiprone and Gallium-Protoporphyrin Targets Bacterial Iron Metabolism and Has Antibiofilm Activity

Antimicrobial Properties of a Chitosan Dextran-Based Hydrogel for Surgical Use

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