Reduction in postsurgical adhesion formation after cardiac surgery by application of N,O-carboxymethyl chitosan

Objective: The study objectives were to assess the efficacy of N,O carboxymethyl chitosan film in reducing postsurgical adhesion in a rabbit cardiac injury model and to confirm the efficacy of N,O carboxymethyl chitosan gel and film in reducing postsurgical adhesion formation in a pig cardiac injury model. Methods: (1) Rabbit cardiac injury model: Cardiac injury was generated by abrading the anterior surface of the heart and desiccation with oxygen. N,O carboxymethyl chitosan solution and film were administered to the injured surface. (2) Pig cardiac injury model: Cardiac injury was generated as described above. N,O carboxymethyl chitosan solution and gel (or film) were administered to the injured surface. The severity and area of adhesion between the heart and the sternum were evaluated at 14 days postcardiac surgery. Results: (1) Rabbits treated with N,O carboxymethyl chitosan film plus solution showed significantly reduced severity and area of adhesion formation. (2) Both N,O carboxymethyl chitosan gel plus solution and N,O carboxymethyl chitosan film plus solution significantly reduced adhesion formation in the pig model. Conclusions: Application of N,O carboxymethyl chitosan products significantly reduces severity of postsurgical adhesion formation after cardiac surgery in the rabbit and pig models. N,O carboxymethyl chitosan products may act as a biophysical barrier.