J Korean Surg Soc.  2013 Nov;85(5):199-204.

Antiadhesive effect and safety of sodium hyaluronate-carboxymethyl cellulose membrane in thyroid surgery

• Bae DS
• Woo JW
• Paek SH
• Kwon H
• Chai YJ
• Kim SJ
• Choi JY
• Lee KE
• Youn YK

Abstract

PURPOSE
A number of researchers have suggested the use of sodium hyaluronate carboxymethyl cellulose (HA-CMC) membrane for preventing postoperative adhesion. This study evaluated the antiadhesive effect and safety of HA-CMC membrane in thyroidectomy for papillary thyroid cancer.
METHODS
One hundred sixty-two patients who underwent thyroidectomy were prospectively randomized. In the study group of 80 patients, the 7.5 cm x 13 cm HA-CMC membrane was applied to the operative field after thyroidectomy. The subjects were asked about complications including adhesive symptoms using an 8-item questionnaire at 2 weeks, 3 months, and 6 months after surgery. In addition, items on the appearance of neck wrinkles and scars were evaluated by a physician who had no information about the patient's allocation.
RESULTS
There were no significant differences in complications such as swallowing difficulty, and wrinkles between study and control groups. Both groups presented significantly decreased scores over time in swallowing difficulty, and wrinkles. There were no complications regarding the HA-CMC membrane.
CONCLUSION
The antiadhesive effect of HA-CMC membrane in thyroid surgery is still uncertain, although it is biologically safe. Further investigation is needed to confirm the antiadhesive effect of HA-CMC membrane in thyroid surgery.

Keyword

Sodium hyaluronate carboxymethyl cellulose; HA-CMC; Seprafilm; Adhesion; Thyroid

MeSH Terms

Adhesives
Carboxymethylcellulose Sodium
Cellulose*
Cicatrix
Deglutition
Humans
Hyaluronic Acid
Membranes*
Neck
Prospective Studies
Surveys and Questionnaires
Sodium*
Thyroid Gland*
Thyroidectomy
Adhesives
Carboxymethylcellulose Sodium
Cellulose
Hyaluronic Acid
Sodium

Figure

• 

  Fig. 1 Postthyroidectomy adhesion. A noticeable scar and marked sunken wrinkles above the scar are evident (pictured at postoperative month 3).

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  Fig. 2 Application of hyaluronate carboxymethyl cellulose (HA-CMC) membrane after total thyroidectomy. (A) HA-CMC membrane is rapping trachea in operative bed. (B) Subflap application of the HA-CMC membrane. HA-CMC membrane is rapping strap muscles in neck.

• 

  Fig. 3 Swallowing difficulty score (A) and wrinkle score (B) at each postoperative time point. The scores significantly decreased over time (P < 0.0001). A repeated measures analysis of variance test was used to analyze the changes in complications between different postoperative periods. Each box shows the range from the 25th percentile to the 75th percentile. Mild outliers are any score more than 1.5 × IQR from the rest of the scores and are indicated by open dots. IQR stands for "interquartile range", and is the middle 50% of the scores. Extreme outliers are any score more than 3 × IQR from the rest of the scores and are indicated by stars.

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