BRUNEL UNIVERSITY Pathogenesis ofPost Surgical Adhesions

Post surgical adhesions (PSAs) are an inevitable outcome of surgery and their presence leads to pathogeneses and significant economic impact. The studies within this thesis utilised standard and reproducible abrasion models, in rabbits, pigs and rats, to investigate the formation and maturation of PSAs with strict quantitative analyses. These studies have shown that the development of PSAs is a series of complex, multi-factorial processes. PSA development can be classified into two stages: (i) PSA modelling occurring up to/including 16 hours post injury characterised by the inflammatory response and fibrin deposition and maturation; and (ii) PSA remodelling occurring from 16 hours onwards and characterised by tissue repair, collagen deposition and maturation and chemical mediation by TGF-P. Treatment with VivostatTm System Derived (novel) Fibrin Sealant significantly reduced the formation of PSAs with mean PSA reduction of 80 % for the rabbit uterine hom abrasion model, from 3 separate studies; 83 % for the pig stomach/colon/caecurn abrasion model, from 2 separate studies; 80 % for the rat caecum abrasion model. This i