Surgical Challenge

Soft Tissue Attachment (STA) is a post surgical condition of visceral tissue repair following surgical procedures. This postoperative fibrosis is associated by many complications which includes:

• Pelvic or Abdominal Pain
• Fertility Impairment in Women
• Bowel Obstruction
• Complication in Surgical Reentry

There is a substantially high risk for patients undergoing abdominal or pelvic re-operation as fibrous developments resulting from previous surgical procedures may complicate the reentry by:

• Extended operating time due to surgical difficulties
• Substantial blood loss
• Incidental/inadvertent enterotomies
• Entercutaneous fistulas
• Resection of damaged tissue

MAST Biosurgery's Polymer Sheet is:

• Made of 70:30 Poly (L-lactide-co-D, L-lactide)
• Synthetic match to the natural lactic acid
• Inert material
• Naturally resorbed through bulk hydrolysis

Product Packaging

• Check the Expiration Date
  (3 year shelf life for the device)
• Ensure Sterilization Square is RED
• The protective envelope provides detailed warnings, precautions, and storage and handling instructions
• The implant is delivered sterile in a multi-layered package starting with
  the envelope
• The envelope contains the Instructions-For-Use and a foil pouch.
• The foil pouch provides the first sterile barrier and contains a sterile Tyvek® pouch which contains the implant
• This is a resorbable Implant, no explant is required
• Implant Stickers for the patient’s chart are located on the foil pouch
• A non-sterile operator (circulator) opens the foil pouch to expose the Tyvek® pouch inside
• The Tyvek® pouch should then be received by a sterile operator and opened within the sterile field

Implant Delivery

• One corner of the Tyvek® pouch is tabbed to facilitate opening
• The SurgiWrap® Bioresorbable Protective Sheet is clear and can easily be misplaced.
  It is recommended to keep the
  sheet in the Tyvek® sleeve until
  ready to use.
• Remove the Tyvek® sleeve from the Tyvek® pouch
• The implant is located within this Tyvek® pouch, between a folded sleeve of white Tyvek® material
• Please note the difference between the folded white Tyvek® sleeve material (A) and the clear Bioresorbable sheet implant (B)
• No preparation is required for the implant
• The SurgiWrap® Bioresorbable Protective Sheet is removed and handed to the clinician

SurgiWrap® Bioresorbable Protective Sheet

SurgiWrap®  Bioresorbable Protective Sheet’s polymer material is fabricated from essentially the same lactic acid molecular building blocks that occur naturally in the human body. The polymers, which result from lactic acid derivatives, are generally referred to as PLA or polylactide. The SurgiWrap® Bioresorbable Protective Sheet is made from an amorphous bioresorbable copolymer of 70:30 Poly(L-lactide-co-D,L-lactide).

The degradation of polylactide polymer (PLA) occurs in two phases:

• Water penetrates the implant and severs the polymer chains into smaller units
• Individual lactide molecules are metabolized in the liver into CO₂ and H₂O and excreted or exhaled

The 0.02mm and 0.05mm sheet retain significant tensile strength (greater than 80% and 100%, respectively) for the initial 8 weeks, and decreases in a controlled fashion through 24 weeks of aging (see Figure 1). Independent laboratory testing determined that the SurgiWrap® Bioresorbable Protective Sheet was capable of maintaining an impermeable barrier throughout the critical healing period, which has been described as several hours for soft tissue attachments (1,2,3) and up to 8 weeks for reinforcing weak tissues. (4)

Features and Benefits

Packaging and Labels

Review the packaging warning symbols prior to use.

	Avoid extreme heat. Do not expose above 120°F (49°C).		Do not re-use. For single use only. Do not resterilize.
	Do not use after the expiration date		Use only if sterilization indicator SQUARE is RED
	Attention, see Instructions for use		Do not use if temperature indicator DOT is BLACK
	Keep package dry

Label Nomenclature

Contraindications

• Where permanent implants are needed
• Active infection
• Patient conditions including blood supply limitations, or latent infection

Open Surgery Procedure

Intraoperative Placement
Before fascial closure begins, sterile scissors can be used to customize the sheet to any desired shape or configuration as needed. The SurgiWrap® Bioresorbable Protective Sheet is placed between the omentum (or underlying abdominal contents) and peritoneum. The edges of the SurgiWrap®  sheet should extend beyond both ends of the wound. The SurgiWrap® sheet can be easily repositioned intraoperatively.

Fascial Closure
To prevent postoperative migration of the sheet, it is recommended that the sheet be held in place. During the facial closure, loop one of the first and one of the last sutures of either an interrupted or continuous series through the sheet. The SurgiWrap® Bioresorbable Protective Sheet is transparent, and allows direct surgical visualization of underlying abdominal contents for simplified suture placement.

Laparoscopy/ Closed Procedure

Preparation and Delivery
Sterile scissors may be used to customize the sheet to any desired shape or configuration. The SurgiWrap® Bioresorbable Protective Sheet is loosely rolled lengthwise and held, at a slight angle at one end, by the laparoscopic graspers. The SurgiWrap® sheet is then easily delivered through a trocar 10mm or larger and released into the operative site.

Intraoperative Placement
Once released into the operative site, the sheet will unroll to the extent allowed by the surrounding soft tissue. The SurgiWrap® Bioresorbable Protective Sheet can be anchored in place with one or two fine sutures or clips and may be further secured on the pelvic sidewall merely by the weight of the adnexa. The SurgiWrap® sheet can be repositioned intraoperatively with graspers while its transparent nature allows for direct surgical visualization of underlying anatomy to facilitate placement.

Literature

SurgiWrap® OB/GYN Laparoscopic Placement Surgical Technique
Download PDF (952Kb)

SurgiWrap® General Abdominal Closure Surgical Technique
Download PDF (243Kb)

Controlling Soft-Tissue Attachments
Download PDF (153Kb)

SurgiWrap® Bioresorbable Protective Sheet Product  Brochure
Download PDF (435Kb)

SurgiWrap® Bioresorbable Protective Sheet – Colorectal Surgery
Download PDF (100Kb)

SurgiWrap® Bioresorbable Protective Sheet – Gynecologic Surgery
Download PDF (164Kb)

SurgiWrap® Bioresorbable Protective Sheet – Abdominal Surgery
Download PDF (205Kb)

Prevention of Tissue Attachment Through the Use of SurgiWrap® Surgical Film
by Noel N. Williams, MD, MCh, FRCSI, FRCS (Gen)
Download PDF (412Kb)

SurgiWrap® Bioresorbable Protective Sheet – In-Service Guide
Download PDF (412Kb)

SurgiWrap® Surgical Products Product Ordering Information
Download PDF (625Kb)

References

1. Okuyama N, Wang CY, Rose EA, Rodgers KE, Pines E, diZerega GS, Oz MC: Reduction of retrosternal and pericardial adhesions with rapidly resorbable polymer films. Ann Thorac Surg 68: 913-918, 1999

2. Rodgers K, Cohn D, Hotovely A, Pines E, Diamond MP, diZerega G: Evaluation of polyethylene glycol / polylactic acid films in the prevention of adhesions in the rabbit adhesion formation and reformation sidewall models. Fertility and Sterility 69: 403-408, 1998

3. Yamaoka T, Takahashi Y, Fujisato T, Lee CW, Tsuji T, Ohta T, Murakami A, Kimura, Y: Novel adhesion prevention membrane based on a bioresorbable copoly(ester-ether) comprised of Poly-L-lactide and Pluronic: in vitro and in vivo evaluations. J Biomed Mater Res 54: 470-479, 2001

4. Cuono C: Scars and keloids: Plastic Surgery Principles and Practice. St. Louis: Mosby 1411-1428, 1990

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