Clinical Application and Effects of Sodium Hyaluronate-Carboxymethylcellulose (Guardix®) in Surgery of Ankle Fractures / 대한족부족관절학회지

PURPOSE: Reducing tenderness or pain on the ankle joint and improving the range of motion are thought to be possible using hyaluronate-based anti-adhesive agents. On the other hand, there are more aspects to be studied regarding the incidence of complications, such as resting pain, tenderness, and stiffness, after surgery. Therefore, the aim of this study was to prove the effectiveness of the agents after ankle fracture surgery. MATERIALS AND METHODS: Patients, who underwent open reduction and internal fixation surgery due to ankle joint fractures from June 2015 to May 2016, were studied prospectively. Thirty patients of them received a Guardix® injection during their surgeries and were included in the injection group. The other 30 patients were included in the control group. Postoperatively, tenderness on the scar, a delay in wound healing, and the active range of motion were evaluated at 2, 6, and 12 weeks after surgery. RESULTS: A significant difference in tenderness on the scar was observed 2 weeks after surgery. On the other hand, there was no significant difference at 6 and 12 weeks after the surgery. The agent-using group showed a 6.7% delay in wound healing and a 93.3% non-delaying. In the non-using group, the delay was 63.3%, while non-delay was 36.7% (p < 0.001). The group that underwent Guardix® usage showed an effective result in the visual analogue scale, which was statistically significant (p < 0.001). The result at 6 and 12 weeks after surgery showed a significant difference. CONCLUSION: Improvement was observed in the patients who underwent a Guardix® injection, regarding the range of motion, visual analog scale, and healing of the wound postoperatively.

Clinical Effect of the Mixed Solution of Sodium Hyaluronate and Sodium Carboxymethylcellulose After Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the effects of a mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol(R)) for reducing postoperative adhesion after endonasal dacryocystorhinostomy. METHODS: Endonasal dacryocystorhinostomy was performed on 58 patients with obstructions of the nasolacrimal system. We divided the 58 patients into two groups. At the completion of endonasal dacryocystorhinostomy, HACMC was applied to the operative site in the experimental group (n=26) and normal saline was applied in the control group (n=32). For the evaluation of clinical effectsand postoperative adhesion, subjective symptom score evaluations, lacrimal irrigation tests, fluorescein disappearance tests, and endoscopic examinations were performed at 1 week, 1 month, 3 months, and 6 months postoperatively. RESULTS: The HACMC-treated patients showed better results than the control patients for subjective symptom scores, lacrimal irrigation tests, and fluorescein disappearance tests, but these differences were not statistically significant. Upon endoscopic examination, the HACMC group revealed lower incidence of adhesion at 1 week after surgery and lower severity of adhesion throughout the period of observation (p<0.05). CONCLUSIONS: The application of a mixed solution of HACMC may effectively reduce postoperative adhesion after endonasal dacryocystorhinostomy.

The Efficacy and Safety of Guardix-SG® in Patients Who Are Undergoing Thyroid Surgery: A Randomized, Prospective, Double-blinded Study / 대한내분비외과학회지

PURPOSE: Postoperative adhesion of the surgical field seems to be troublesome not only to the patients, but also to the surgeons. Guardix-SG® is a poloxamer/alginate mixture that reduced the incidence of postoperative adhesions when it is added to the abdominal surgery in animal models and also in clinical trials. This study was a randomized, prospective, double-blinded study to evaluate the antiadhesive efficacy and safety of Guardix-SG® after total thyroidectomy. METHODS: A total of 89 patients who underwent total thyroidectomy between July 2008 and February 2009 in Severance Hospital and Gang-Nam Severance Hospital were randomized to either the Guardix-SG® treatment group (n=45) or the non-treatmentcontrol group (n=44). The patients were asked about their clinical symptoms (hypesthesia or paresthesia on the operative site (SN) and swallowing discomfort (SW)) by using a questionnaire, and the swallowing function was evaluated using Marshmallow Esophagography by one physician. The clinical symptoms and Marshmallow Esophagography were scored according to the results of assessment. The most severe state was scored as 0 and normal was scored as 3. RESULTS: The scores of the clinical symptoms (SN and SW) were 2.67 and 2.49 in the treatment group, and 2.09 and 1.80 in the control group, respectively, at the postoperative 6th week (P=0.001, <0.001). The scores of the Marshmallow Esophagography were 2.93 in the treatment group and 2.73 in the control group (P=0.033). Abnormal findings were seen in 2 patients (4.4%) in the treatment group and in 10 patients (22.7%) in the control group (P=0.014). CONCLUSION: Guardix-SG® seems to be effective in preventing adhesion after thyroidectomy. Further studies involving a larger number of subjects will be needed to make an application guideline.