Abstract
PURPOSE: Various polymers have been used as postsurgical antiadhesive materials; however, the mechanisms underlying their efficacy remain unclear. Intermediate water has been found to prevent the adhesion between polymer molecules and proteins or cells. The present study investigated the role of intermediate water retained in the polymer in alleviating postsurgical pericardial adhesion. METHODS: Hydrophobic fabrics were prepared using biodegradable polyglycolic acid. To add intermediate water, the fabric fibers were coated with poly(oxyethylene)oleyl ethers. Intermediate water in the hydrated state was detected by a thermal analysis for each material, and cell attachment to the fibers with or without coating was observed in vitro. Using a canine model of postsurgical pericardial adhesion, the severity of adhesion was examined along with a histological assessment during treatment, with or without fabric coating. RESULTS: Intermediate water was detected in the coating materials but not in polyglycolic acid. Coating significantly reduced the cell attachment to the fibers. Coating also alleviated adhesion by reducing inflammation in the fibrous layer and replacing the fabric and granulomas that develop around the surgical sutures in the pericardial space. CONCLUSIONS: Intermediate water in the hydrated polymer of anti-adhesives may play an important role in alleviating postoperative pericardial adhesion.