Anti-Adhesion Spraying

Abstract

Dry powders containing bioresorbable hyaluraonic acid (“HA”) are applied directly to a desired location in a patient wound to reduce adhesions, without first forming a hydrated gel. HA includes hyaluronic acid that has been modified, cross-linked or combined with other substances. it is important to control the size of the particles in the powder. The powder is essentially dry and blowable powder. At least 90% of powder particles have a maximum dimension between 30 μm and 1 mm.

1 . (canceled) 
   
   
       2 . (canceled) 
   
   
       3 . (canceled) 
   
   
       4 . (canceled) 
   
   
       5 . (canceled) 
   
   
       6 . (canceled) 
   
   
       7 . A method of reducing undesirable adhesions during wound healing, comprising applying an essentially dry blowable powder comprising bioresorbable HA into a location in a wound where adhesion reduction is desired, said powder being applied to be present in a mass per area sufficient to reduce adhesions as the wound heals. 
   
   
       8 . (canceled) 
   
   
       9 . The method of  claim 7  in which said mass/area is greater than 2 mg/cm2. 
   
   
       10 . The method of  claim 7  in which said wound is a surgical wound. 
   
   
       11 . The method of  claim 7  in which said powder is applied directly to an open wound. 
   
   
       12 . The method of  claim 11  in which said powder is applied to said wound from a shaker comprising a powder reservoir and orifices sized to release powder when the shaker is agitated. 
   
   
       13 . The method of  claim 10  in which said surgical wound is produced by a laparoscopic procedure on a patient, and said powder is applied to said wound via a conduit communicating from a first location outside the patient's body to a second location within the patient's body for delivery to said location in said wound. 
   
   
       14 . The method of  claim 13  further comprising,
 a. delivering a mesh material to said wound via a laparoscopic device; and   b. then applying said powder to a surface of said mesh via said exit conduit.   
   
   
       15 . The method of  claim 7  in which said location is on a surface of a tissue prosthesis. 
   
   
       16 . The method of  claim 7  in which said location includes the edges of said prosthesis. 
   
   
       17 . The method of  claim 7  comprising
 a. providing airflow through a chamber containing said powder to entrain said powder in said airflow; and   b. directing the airflow with entrained powder to said location.   
   
   
       18 . The method of  claim 17  in which said airflow is provided by a hand powered air pump or a squeeze bulb. 
   
   
       19 . The method of  claim 18  in which said airflow is provided by a source of pressurized gas in a hospital operating room. 
   
   
       20 . The method of  claim 7  in which said powder is provided via a tubular conduit positioned to carry said powder from said reservoir to said location in said wound. 
   
   
       21 . The method of  claim 20  in which said conduit includes an airflow modifier. 
   
   
       22 . The method of  claim 21  in which said airflow modifier comprises a swirl inducer positioned in said conduit to impart a radial component to said airflow. 
   
   
       23 . The method of  claim 7  comprising irrigating the location prior to applying the powder. 
   
   
       24 . The method of  claim 15  comprising saturating said prosthesis with an aqueous solution prior to introducing the powder. 
   
   
       25 . Apparatus for delivering powder to a wound, said apparatus comprising a powder reservoir connected to an incoming airflow conduit and an exiting airflow conduit, said conduits being connected to said reservoir to entrain powder in airflow that enters through said incoming conduit and exits through said exiting airflow conduit, said reservoir comprising an essentially dry blowable powder comprising bioresorbable HA. 
   
   
       26 . The apparatus of  claim 25  in which said incoming airflow conduit is connected to a squeeze bulb. 
   
   
       27 . The apparatus of  claim 26  comprising a handgrip, said squeeze bulb being positioned within said grip so as to permit the user to hold the apparatus in one hand and, while holding it, to squeeze the bulb and deliver power from the exiting airflow conduit. 
   
   
       28 . The apparatus of  claim 25  in which said incoming airflow conduit includes a connector for attachment to a hospital operating room gas supply. 
   
   
       29 . The apparatus of  claim 25  in which the exit conduit comprises a swirl inducer adding a radial component to airflow velocity. 
   
   
       30 . The apparatus of  claim 25  in which the reservoir is removable, so that after use, the spent reservoir can be replaced with a reservoir comprising a new powder charge. 
   
   
       31 . The apparatus of  claim 25  in which at least the exit conduit is hydrophobic. 
   
   
       32 . The apparatus of  claim 31  in which the exit conduit is coated with a hydrophobic material. 
   
   
       33 . The apparatus of  claim 31  in which the exit conduit is made of a hydrophobic material. 
   
   
       34 . The apparatus of  claim 32  or  claim 33  in which the hydrophobic material is a hydrophobic plastic. 
   
   
       35 . Apparatus comprising a dry, blowable powder to be introduced into a location in said wound where adhesion reduction is desired, said powder comprising HA, said apparatus further comprising a reservoir to contain said powder and exit orifices to apply the powder to said location. 
   
   
       36 . A method of making an essentially dry blowable powder comprising bioresorbable HA comprising, in any sequence,
 providing a solid material comprising HA, milling solid material comprising HA, and sieving solid material comprising HA to select material characterized in that at least 90% of powder particles have a maximum dimension between 5 μm and 1 mm.   
   
   
       37 . The method of  claim 7  in which said powder is characterized in that at least 90% of powder particles have a maximum dimension between 5 μm and 1 mm. 
   
   
       38 . The method of  claim 7  in which said powder further comprises CMC. 
   
   
       39 . The powder of  claim 7  or  claim 38  in which said HA or CMC or both is modified to reduce solubility or to enhance anti-adhesive properties of said powder or both. 
   
   
       40 . The powder of  claim 39  in which said powder comprises the reaction product of HA or CMC, or both, with a carbodiimide. 
   
   
       41 . The powder of  claim 39  in which said powder comprises the reaction product of HA with a divinylsulfone or a diepoxide. 
   
   
       42 . The powder of  claim 7  in which said powder is characterized in that at least 90% of the powder particles have a maximum dimension between 70 μm and 600 μm.