Chitosan-Based Gel Found to Lower Risk of Wound Infection, Synechia After Nasal Polyps Surgery

Use of a chitosan-based gel dressing after endoscopic sinus surgery (ESS) for nasal polyps was found to reduce risk of wound infection and synechia in patients, according to study findings published in International Wound Journal.

For patients with chronic rhinosinusitis, septal deviation, or inferior turbinate hypertrophy, ESS has emerged as an effective therapeutic option to address persistent nasal obstruction when standard-of-care intranasal and systemic corticosteroids prove unsuccessful. However, certain limitations regarding the formation of postoperative bleeding and synechia have been knowm to impair recovery and potentially cause reobstruction of the ostiomeatal complex.

“Nasal packing was described to be one common method to stop postoperative bleeding and endorse wound healing.…Although, conventional removable nasal packing was restricted by some inadequacies, for example, nasal airway blockage; bleeding because of extramucosal disorders; headache and pressure; painful mouth, pharynx dryness, and tremendous anxiety,” said the study authors.

Prior studies have found conflicting evidence on the use of chitosan-based gel dressing, formed by cross-linking chitosan and dextran derivatives gel, to address postoperative symptoms of ESS for nasal polyps. Acquired by alkaline deacetylation of natural chitins, chitosan has been considered to be an effective hemostatic agent, with a significant capability to quickly clot blood, hypoallergenicity, and antimicrobial influence.

Researchers conducted a meta-analysis of randomized controlled trials to further evaluate the effect of chitosan-based gel dressing on wound infection, synechia, and granulations after ESS of nasal polyps. A total of 6 studies reported between 2010 and 2022 comprising 386 patients who underwent ESS for nasal polyps were included for the analysis, of whom 187 were using chitosan-based gel dressing and 199 were control subjects.

Statistical tools like the dichotomous method were used within a random or fixed-influence model to evaluate the influence of chitosan-based gel dressing on risk of wound infection, synechia, and granulations after ESS of nasal polyps.

Findings indicated that chitosan-based gel dressing significantly lowered risk of postoperative wound infection and synechia by 52% and 75%, respectively (wound infection: odds ratio [OR], 0.48; 95% CI, 0.25-0.92; P = .03; synechia: OR, 0.25; 95% CI, 0.13-0.50; P < .001), compared with the control group. Conversely, no significant difference was observed in granulations between patients given chitosan-based gel dressing and the control group (OR, 1.57; 95% CI, 0.49-5.00; P = .45).

Discussing limitations of the analysis, researchers noted that the pooled data did not consider elements such as group age, ethnicity, and gender because of the lack of data on these variables. They added that further analysis is warranted to confirm findings due to the low number of selected studies and the low sample size of all of the selected studies found for the meta-analysis.

“This study exhibited a correlation between the effects of chitosan-based gel dressing on wound infection, synechia, and granulations after ESS of nasal polyps,” they concluded. “However, more trials are still required to explain the exact clinical difference in the results and closeness.”

Reference

Liu R, Gong Z. Effect of chitosan-based gel dressing on wound infection, synechia, and granulations after endoscopic sinus surgery of nasal polyps: a meta-analysis. Int Wound J. Published online May 7, 2022. doi:10.1111/iwj.13820