Ann Surg Treat Res.  2021 Oct;101(4):206-213. 10.4174/astr.2021.101.4.206.

Efficacy of hyaluronic acid film on perianal wound healing in a rat model

• Cho JR
• Lee MH
• Oh HK
• Kim H
• Kweon DK
• Kang SM
• Kim BK
• Heo CY
• Kim DW
• Kang SB

• KMID: 2520651
• DOI: http://doi.org/10.4174/astr.2021.101.4.206

Abstract

Purpose
Postoperative pain and delayed wound healing are the main complications following anal surgery associated with poor quality of life. Hyaluronic acid (HA) supports tissue regeneration and rapid wound healing by promoting cell proliferation and migration. We investigated the effects of HA on perianal wound healing in a rat model.
Methods
Forty-eight 8-week-old Sprague-Dawley rats with perianal wounds created by biopsy punch were divided into 3 groups: simple dressing with gauze (control), dressing with topical HA film, and dressing with topical HA gel. HA agents were not reapplied postoperatively. Wound healing was evaluated by measuring the healed area, and histological analyses were randomly performed using hematoxylin and eosin and Masson trichrome staining.
Results
Fewer mean days were required for complete wound healing in the HA film and HA gel groups than in the control group (11.6 vs. 11.9 vs. 13.8 days, respectively; P = 0.010). The healed area in the HA film group on day 11 was larger than that in the HA gel and control groups (80.2% vs. 61.9% vs. 53.2%, respectively; P < 0.001). Histologically, the HA film group showed accelerated reepithelialization, a rapid transition to lymphocyte-predominant inflammation, and increased fibroblastic proliferation and collagen deposition compared to the other groups. There was no treatment-related toxicity in the HA application groups.
Conclusion
Topical application of HA film to perianal wounds improves the wound healing rate in a rat model. This finding suggests a potential benefit of HA film application in promoting wound healing after anal surgery in humans.

Keyword

Hemorrhoidectomy; Hyaluronic acid; Hyaluronic acid film; Perianal wound; Wound healing

Figure

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  Fig. 1 A simplified diagram of animal experiments. The wound was made in the perianal area with a 4-mm biopsy punch, and rats were divided randomly into 3 groups: (A) control, (B) hyaluronic acid (HA) film, and (C) HA gel.

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  Fig. 2 Estimation of wound healing rate. (A, B) Wound size on postoperative day 0 (a) was compared with wound size on each subsequent postoperative day (b) to obtain the rate of reduction in wound size. Wound healing rate on day x (%) = (a − b)/a × 100.

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  Fig. 3 Comparison based on gross visualization of complete wound healing. Hyaluronic acid (HA) film and HA gel groups showed complete wound healing on day 14 (yellow arrows indicate the wound or the scar).

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  Fig. 4 The wound healing rate in each group per day up to day 14. The wound healing rate on day 11 was 53.2% in the control group, 80.2% in the hyaluronic acid (HA) film group, and 61.9% in the HA gel group. The dark line shows the mean rate per day with standard deviation, and the lighter lines show the rate per individual in each group.

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  Fig. 5 Representative H&E-stained images from the control, hyaluronic acid (HA) film, and HA gel groups. On day 2, all 3 groups displayed wound-induced epithelial defects and neutrophilic exudate. On day 6, only the HA film and HA gel groups showed reepithelialization.

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  Fig. 6 Representative Masson's trichrome-stained images from the control, hyaluronic acid (HA) film, and HA gel groups. On day 6, only HA film and HA gel groups show a progression of fibrosis.

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