Safety of antiadhesion barriers in hand surgery

Adhesions are a major cause of complications and need for repeat surgery in the hand and wrist. They are indication for tenolysis and cause prolonged need for therapy and inability to regain full hand motion. Minimizing adhesions in the hand and wrist would greatly improve surgery, by decreasing cost as well as improved outcome and postoperative function. Antiadhesion barriers, products consisting of hyaluronic acid and methylcellulose were originally advocated for its use in the peritoneal cavity for prevention of adhesions-initially by gynecologist, then general, trauma, and colorectal surgeons. Recently, several authors have looked at its use in animals for prevention of adhesions in regard to tendons, in particular in chickens and rabbits. However, no human studies exist in the literature that shows statistical efficacy or discussing its safety.

All cases of tendon repairs in the hand and wrist from January 2009 to January 2012 with an antiadhesion barrier placed by a single plastic/hand surgeon at our medical center were evaluated for complications and outcomes. Fourteen patients were identified over this period; demographic data and comorbidities were examined.All patients were placed in blocking splints postoperatively and discharged with 5 days of antibiotics.

Of the 14 patients identified over this period, 1 was female and 13 were male. Age of patients ranged from 13 to 74 years. Comorbidities evaluated included diabetes, hypertension, previous wrist or hand injuries or surgery, arthritis, and tobacco use. There was 1 postoperative wound infection with minimal wound separation which resolved with oral antibiotics and Xeroform dressing. One patient experienced spastic muscle disease leading to rerupture of tendon repair. Remainder of patients did not experience any wound complications. No patients required tenolysis after use of the antiadhesion barriers.

Antiadhesion barriers are safe to use in humans for hand/wrist surgery. Studies to evaluate efficacy will require larger numbers of patients, but have already begun at our medical center. According to data from animal studies, antiadhesion barriers should serve as a useful tool for the decrease or even prevention of adhesion formation in the wrist and hand.