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Cited by 20Intestinal and Peritoneal AdhesionsSurgical Sutures and AdhesivesTissue Engineering and Regenerative Medicine

Biomaterials in Postoperative Adhesion Barriers and Uterine Tissue Engineering

Open access
Fazel Anvari-Yazdi, Abbas, Badea, Ildiko, Chen, Xiongbiao·2025·Gels
DOI 10.3390/gels11060441PMC PMC12191503
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Abstract

Postoperative adhesions (POAs) are a common and often serious complication following abdominal and gynecologic surgeries, leading to infertility, chronic pain, and bowel obstruction. To address these outcomes, the development of anti-adhesion barriers using biocompatible materials has emerged as a key area of biomedical research. This article presents a comprehensive overview of clinically relevant natural and synthetic biomaterials explored for POA prevention, emphasizing their degradation behavior, barrier integrity, and translational progress. Natural biopolymers—such as collagen, gelatin, fibrin, silk fibroin, and decellularized extracellular matrices—are discussed alongside polysaccharides, including alginate, chitosan, and carboxymethyl cellulose, focusing on their structural features and biological functionality. Synthetic polymers, including polycaprolactone (PCL), polyethylene glycol (PEG), and poly(lactic-co-glycolic acid) (PLGA), are also examined for their tunable degradation profiles (spanning days to months), mechanical robustness, and capacity for drug incorporation. Recent innovations, such as bioprinted and electrospun dual-layer membranes, are highlighted for their enhanced anti-fibrotic performance in preclinical studies. By consolidating current material strategies and fabrication techniques, this work aims to support informed material selection while also identifying key knowledge gaps—particularly the limited comparative data on degradation kinetics, inconsistent definitions of ideal mechanical properties, and the need for more research into cell-responsive barrier systems.

AI snapshot

Written from the paper’s full text.

TL;DR

This review consolidates natural and synthetic biomaterials used for postoperative adhesion barriers and uterine tissue engineering, emphasizing degradation behavior, barrier integrity, and translational progress. It highlights preclinical and clinical examples while identifying gaps in comparative degradation data, mechanical-property definitions, and cell-responsive barrier design.

Key findings

  • Postoperative adhesions develop in 50–95% of patients after abdominal or pelvic operations, and anti-adhesion barriers are designed to separate injured tissues during the critical first 3–7 days of healing.
  • In a rat intrauterine adhesion model, a collagen scaffold loaded with human umbilical-cord mesenchymal stem cells increased endometrial thickness to 610 ± 30 µm at 60 days vs. 220 ± 20 µm for scaffold alone and 170 ± 20 µm for no repair, reduced collagen deposition to 41 ± 2% vs. 74 ± 2% and 75 ± 2%, and achieved a 45.0% pregnancy rate and 30.3% embryo implantation rate vs. no pregnancies in the no-repair group and 5.0% in the scaffold-only group.
  • A gelatin sponge reduced adhesion formation by 91% vs. untreated controls in a rat intra-abdominal model, while a punctate gelatin film reduced adhesion extent and severity to 0.71 ± 1.50 and 0.43 ± 0.79 vs. 3.88 ± 0.35 and 3.63 ± 0.74 for controls.
  • In clinical/preclinical examples, TachoSil showed adhesions in 2/22 patients (9%) vs. 13/23 controls (57%, p < 0.01); CMC–pullulan barriers prevented adhesions in 100% of treated rats vs. ~42% for Medicurtain; and a meta-analysis of 12 trials found HA gel reduced moderate/severe adhesions (p = 0.0010).

Methods

  • Narrative/comprehensive review of clinically relevant natural and synthetic biomaterials for postoperative adhesion prevention and uterine scaffolds, including collagen, gelatin, fibrin, silk fibroin, dECM, polysaccharides, PCL, PEG, PLGA, ePTFE, and polypropylene.
  • Synthesizes material properties, degradation behavior, fabrication techniques (gas foaming, freeze drying, porogen leaching, phase separation, melt molding, electrospinning, melt electrowriting, 3D bioprinting, layer-by-layer assembly), and elimination/excretion routes.
  • No primary experimental design, systematic search strategy, or quantitative meta-analysis is reported; evidence is drawn from cited preclinical and clinical studies.

Limitations

  • The paper states key knowledge gaps: limited comparative data on degradation kinetics, inconsistent definitions of ideal mechanical properties, and the need for more research into cell-responsive barrier systems.
  • The paper notes limitations of included studies, including short-term rodent outcomes, small clinical samples, incomplete anti-adhesion effects, missing functional fertility data, and the need for large-animal and clinical validation before translation.
  • Evident from the text: as a narrative review, it does not report a systematic search, inclusion/exclusion criteria, risk-of-bias assessment, or quantitative synthesis.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/gels11060441

Cites

271 of 271 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

73 of 272 cited sources checked · 27 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    A significant impediment to the broad adoption of fibrin-based barriers is the considerable challenges and expenses inherent in their large-scale manufacturing, considering the fibrin molecule's origin in blood plasma.

    “Consequently, a significant impediment to the broad adoption of fibrin-based barriers stems from the considerable challenges and expenses inherent in their large-scale manufacturing, considering the fibrin molecule’s origin in blood plasma [78,79].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [78] Hense, D., and Strube, O.I. (2023). Thrombin-Free Fibrillogenesis and Gelation of Fibrinogen Triggered by Magnesium Sulfate. Gels, 9. source

      The Introduction identifies cost as a downside of fibrin and discusses inexpensive thrombin-free alternatives. It does not attribute that cost to fibrinogen’s origin in blood plasma or discuss large-scale manufacturing; instead, it calls isolation of fibrinogen and thrombin comparatively uncomplicated. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [79] Li, 2024, Developing fibrin-based biomaterials/scaffolds in tissue engineering, Bioact. Mater. source

      The Fibrin glue section (page not provided) says fibrinogen can be obtained from plasma and that preparing autologous fibrin glue is relatively complex; it also mentions newer, more cost-effective production methods. It does not establish that large-scale manufacturing costs impede broad adoption of fibrin-based barriers. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
  • Premisecitation

    One primary goal of anti-adhesion materials is to avoid fibrin bridges forming, as these bridges serve as precursors to adhesions by providing a scaffold for fibroblast proliferation and collagen deposition.

    “One of the primary goals of these materials is to avoid fibrin bridges forming, as these bridges serve as precursors to adhesions by providing a scaffold for fibroblast proliferation and collagen deposition [15].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] Liao, 2023, Prevention strategies of postoperative adhesion in soft tissues by applying biomaterials: Based on the mechanisms of occurrence and development of adhesions, Bioact. Mater. source
  • Interpretationcitation

    PU GF has potential as a practical, bioactive, and re-attachable anti-adhesion barrier suited for laparoscopic applications.

    “Together, these findings highlight PU GF’s potential as a practical, bioactive, and re-attachable anti-adhesion barrier suited for laparoscopic applications (Figure 2(E1–E13)).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [49] Ozamoto, Y., Horii, T., Morita, S., Tsujimoto, H., Oe, Y., Minato, H., Ueda, J., Ichikawa, H., Kawauchi, A., and Hagiwara, A. (2025). Physical and biological properties of a novel anti-adhesive punctate uneven gelatin film. PLoS ONE, 20. source
  • Premisecitation

    PRF-treated rats showed a significant increase in fertility, with pregnancy rates increasing from 16.7% in the untreated IUA group to 75% in the PRF-treated group.

    “In addition to other improvements, the rats treated with PRF also showed a significant increase in fertility, as evidenced by the increase in pregnancy rates from 16.7% in the untreated IUA group to 75% in the PRF-treated group.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [68] Mao, 2023, Platelet-rich fibrin improves repair and regeneration of damaged endometrium in rats, Front. Endocrinol. source

      The Results (Evaluation of regenerative endometrium, Figure 6G) report a higher pregnancy rate in PRF-treated rats than in untreated IUA rats, and the figure caption includes significance markers. The reported rates, however, are 44.44% (4/9) and 10% (1/10), not 75% and 16.7%. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
  • Premisecitation

    In a randomized, controlled laparoscopic rat model, TachoSil® significantly reduced postoperative adhesion formation.

    “In a randomized, controlled laparoscopic rat model, TachoSil®, a fibrinogen- and thrombin-coated collagen sponge, significantly reduced postoperative adhesion formation [67].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [67] Nohuz, 2009, Efficiency of TachoSil® to prevent postsurgical adhesion development on laparoscopic rat model, Gynecol. Surg. source
  • May combine two claims. 159
  • Classified as probably not a substantial claim. 45
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    CMC combined with HA, as in Seprafilm®, improves mechanical stability and prolongs retention time at the surgical site.

    “Often combined with HA, as in Seprafilm®, CMC improves mechanical stability and prolongs retention time at the surgical site [136].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [136] Mayes, 2020, Polysaccharide-based films for the prevention of unwanted postoperative adhesions at biological interfaces, Acta Biomater. source

      The Introduction identifies Seprafilm® as a CMC–HA membrane, but says its dry form is brittle and its wet form has poor mechanical integrity. The Results and Discussion (In vivo validation studies) describe the authors’ alginate/GMHA film—not Seprafilm—as mechanically robust and potentially longer-lasting. The paper does not attribute improved stability or prolonged surgical-site retention to adding CMC to HA. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Silk fibroin has excellent biocompatibility; it has been approved by the FDA for medical applications, including sutures, since 1993.

    “Silk fibroin has been approved by the FDA for medical applications, including sutures, since 1993 [92,93].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [92] Cao, 2017, Drug release from core-shell PVA/silk fibroin nanoparticles fabricated by one-step electrospraying, Sci. Rep. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [93] Park, 2015, Tri-layered silk fibroin and poly-ɛ-caprolactone small diameter vascular grafts tested in vitro and in vivo, Macromol. Res. source

  • May combine two claims.

    Premisecitation

    TachoSil® is a sponge-like sheet composed of equine collagen coated with human fibrinogen and bovine thrombin; when moistened, the coated side forms a fibrin barrier at the application site, enabling effective hemostasis while acting as a physical barrier to prevent postoperative adhesions.

    “One of the earliest clinically evaluated hemostatic and anti-adhesion barriers was TachoSil®, a sponge-like sheet composed of equine collagen coated with human fibrinogen and bovine thrombin (Figure 3B). When moistened with saline, the coated side formed a fibrin barrier at the application site, enabling effective hemostasis while acting as a physical barrier to prevent postoperative adhesions.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [74] Osada, 1999, Clinical Evaluation of a Haemostatic and Anti-Adhesion Preparation Used to Prevent Post-Surgical Adhesion, J. Int. Med. Res. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Natural polymers often exhibit weaker mechanical properties, batch-to-batch variability, and scalability challenges.

    “However, they often exhibit weaker mechanical properties, batch-to-batch variability, and scalability challenges [17,18].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [17] Akhlaghi, 2023, Recent advances in the preventative strategies for postoperative adhesions using biomaterial-based membranes and micro/nano-drug delivery systems, J. Drug Deliv. Sci. Technol. source
    • cites [18] Tavakoli, 2023, Natural polymers in wound healing: From academic studies to commercial products, J. Appl. Polym. Sci. source

      The Introduction says natural polymers can vary from batch to batch and that environmentally dependent production may be slow, supporting the variability and production-challenge parts of the claim. Section 4.1.4 identifies poor mechanical properties in sericin specifically; it does not establish that natural polymers generally have weaker mechanical properties. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In another clinical setting, TachoSil® significantly reduced postoperative adhesion formation, with one referenced trial showing that only 2 out of 22 patients (9%) treated with TachoSil had postoperative adhesions, compared to 13 out of 23 patients (57%) in the control group (p < 0.01).

    “In another clinical setting, TachoSil® significantly reduced postoperative adhesion formation, with one referenced trial showing that only 2 out of 22 patients (9%) treated with TachoSil had postoperative adhesions, compared to 13 out of 23 patients (57%) in the control group (p < 0.01) [75].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [75] Simo, 2012, Hemostatic Agents in Hepatobiliary and Pancreas Surgery: A Review of the Literature and Critical Evaluation of a Novel Carrier-Bound Fibrin Sealant (TachoSil), Int. Sch. Res. Not. source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Synthetic polymers offer greater versatility, enabling tunable biodegradation rates and superior mechanical stability.

    “In contrast, synthetic polymers offer greater versatility, enabling tunable biodegradation rates and superior mechanical stability [19].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [19] Satchanska, G., Davidova, S., and Petrov, P.D. (2024). Natural and Synthetic Polymers for Biomedical and Environmental Applications. Polymers, 16. source

  • May combine two claims.

    Premisecitation

    In a study involving 16 gynecological surgery patients, complete hemostasis was achieved in 87.5% of cases, and no de novo adhesions were observed at application sites upon second-look laparoscopy or laparotomy conducted up to 4 years post-operation.

    “In a study involving 16 gynecological surgery patients, complete hemostasis was achieved in 87.5% of cases, and no de novo adhesions were observed at application sites upon second-look laparoscopy or laparotomy conducted up to 4 years post-operation.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [74] Osada, 1999, Clinical Evaluation of a Haemostatic and Anti-Adhesion Preparation Used to Prevent Post-Surgical Adhesion, J. Int. Med. Res. source

  • May combine two claims.

    Premisecitation

    Collagen possesses properties suitable for anti-adhesion applications, including excellent biocompatibility, biodegradability, hydrophilicity, non-immunogenicity, and ability to act as a physical barrier against fibrin bridge formation.

    “Collagen possesses unique properties that make it highly suitable for anti-adhesion applications, including excellent biocompatibility, biodegradability, hydrophilicity, and non-immunogenicity, in addition to its ability to act as a physical barrier against fibrin bridge formation [20,21].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [20] Heino, 2007, The collagen family members as cell adhesion proteins, Bioessays source
    • cites [21] Wolf, K., Alexander, S., Schacht, V., Coussens, L.M., von Andrian, U.H., van Rheenen, J., Deryugina, E., and Friedl, P. (2009, January 23–27). Collagen-based cell migration models in vitro and in vivo. Proceedings of the Seminars in Cell & Developmental Biology, San Francisco, CA, USA. source

      The Introduction describes collagen as a mechanically stable tissue scaffold, and the Conclusions describe its fibre networks as barriers to cell movement. Neither section addresses anti-adhesion applications, the listed material properties, or prevention of fibrin bridge formation. Searches for those properties and for fibrin bridges found no relevant passage in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In a rat cecum abrasion model, PU GF significantly reduced adhesion extent and severity (0.71 ± 1.50 and 0.43 ± 0.79, respectively) compared to controls (3.88 ± 0.35 and 3.63 ± 0.74, p < 0.05), and maintained efficacy even after re-attachment.

    “In a rat cecum abrasion model, PU GF significantly reduced adhesion extent and severity (0.71 ± 1.50 and 0.43 ± 0.79, respectively) compared to the controls (3.88 ± 0.35 and 3.63 ± 0.74, p < 0.05), and maintained efficacy even after re-attachment.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [49] Ozamoto, Y., Horii, T., Morita, S., Tsujimoto, H., Oe, Y., Minato, H., Ueda, J., Ichikawa, H., Kawauchi, A., and Hagiwara, A. (2025). Physical and biological properties of a novel anti-adhesive punctate uneven gelatin film. PLoS ONE, 20. source

  • May combine two claims.

    Findingcitation

    Despite improved histology, fertility outcomes remained suboptimal in the ADSC-seeded amnion rat model; high miscarriage rates persisted even with ADSC treatment.

    “Despite improved histology, fertility outcomes remained suboptimal in this model; high miscarriage rates persisted even with ADSC treatment, possibly due to residual uterine receptivity issues [116].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [116] Li, 2024, Transplantation of acellular amniotic membrane seeded with adipose-derived mesenchymal stem cells in a rat model of intrauterine adhesion, Ann. Med. Surg. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the body, HA interacts with proteins such as CD44 and RHAMM, which play roles in cell signaling, migration, and inflammation.

    “In the body, HA interacts with proteins, such as CD44 and Receptor for Hyaluronan Mediated Motility (RHAMM), which play roles in cell signaling, migration, and inflammation (Figure 6) [122,123].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [122] Jiang, 2007, Hyaluronan in tissue injury and repair, Annu. Rev. Cell Dev. Biol. source
    • cites [123] Jiang, 2011, Hyaluronan as an immune regulator in human diseases, Physiol. Rev. source

  • May combine two claims.

    Premisecitation

    In vitro and in vivo studies have shown that SF supports cell adhesion, proliferation, and differentiation, making it an ideal substrate for scar healing.

    “In vitro and in vivo studies have shown that SF supports cell adhesion, proliferation, and differentiation, making it an ideal substrate for scar healing.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [94] Ercan, 2015, Nanofeatured silk fibroin membranes for dermal wound healing applications, J. Biomed. Mater. Res. Part A source

      The study description in our copy (no section or page supplied) reports keratinocyte and fibroblast adhesion and proliferation on nanofeatured silk fibroin membranes, with greater cell density than on untreated membranes. It does not report cell differentiation, in vivo results, or scar healing; it describes the membranes as promising wound-dressing materials that warrant further study. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    ADSCs on the scaffold modulated the injury site immune environment by lowering pro-inflammatory TNF-α and IL-1β and increasing anti-inflammatory factors bFGF and IL-6, promoting a regenerative response.

    “Mechanistically, the ADSCs on the scaffold modulated the injury site immune environment—lowering pro-inflammatory TNF-α and IL-1β, and increasing anti-inflammatory factors (bFGF, IL-6)—promoting a regenerative response.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [116] Li, 2024, Transplantation of acellular amniotic membrane seeded with adipose-derived mesenchymal stem cells in a rat model of intrauterine adhesion, Ann. Med. Surg. source

  • May combine two claims.

    Premisecitation

    Established HA-based products Hyalobarrier (gel) and Seprafilm (sheet) have demonstrated clinical efficacy in reducing adhesion formation, particularly in gynecologic and colorectal surgeries, with acceptable safety profiles.

    “Established products like Hyalobarrier (gel) and Seprafilm (sheet) have demonstrated clinical efficacy in reducing adhesion formation—particularly in gynecologic and colorectal surgeries—with acceptable safety profiles [124].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [124] Siebert, 2024, Laparoscopic application of sodium hyaluronate–carboxymethylcellulose barrier in abdominopelvic surgery: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Systematic Review Protocols–compliant systematic review and meta-analysis, Surgery source

      The Discussion (page not available in our copy) reports that laparoscopically placed Seprafilm reduced postoperative bowel obstruction in colorectal surgery, using obstruction as a surrogate for adhesion formation; the Study limitations section reports no new safety signals or increase in adverse events. The paper does not address Hyalobarrier gel, and its colorectal result does not establish reduced adhesion formation for both products across gynecologic and colorectal surgery. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    The sHA/chitosan hydrogel forms a conformal gel film upon contact and modulates local inflammation by promoting an anti-inflammatory M2 macrophage phenotype.

    “This hydrogel, delivered via a dual-syringe sprayer, forms a conformal gel film upon contact and modulates local inflammation by promoting an anti-inflammatory (M2) macrophage phenotype.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [120] Song, 2024, Sprayable anti-adhesive hydrogel for peritoneal macrophage scavenging in post-surgical applications, Nat. Commun. source

  • May combine two claims.

    Premisecitation

    Chitosan is non-toxic, biodegradable, and exhibits minimal immune response when used in vivo.

    “Chitosan is non-toxic, biodegradable, and exhibits minimal immune response when used in vivo.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [144] Jiménez-Gómez, C.P., and Cecilia, J.A. (2020). Chitosan: A natural biopolymer with a wide and varied range of applications. Molecules, 25. source

      Section 3.1 describes chitosan as having low toxicity and being biodegradable; Section 2 also lists it as non-toxic and biodegradable. The copy does not establish that it produces a minimal immune response in vivo. Section 3.2 instead mentions immunostimulation, without quantifying the immune response. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    HA is non-immunogenic and has a capacity for modifying biological responses, positioning it as an ideal candidate for surgical applications, particularly prevention of post-surgical adhesions including those from peritoneal injury.

    “Its non-immunogenic nature and capacity for modifying biological responses have positioned it as an ideal candidate for surgical applications, particularly in the prevention of post-surgical adhesions, including those arising from peritoneal injury [117].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [117] Sionkowska, A., Gadomska, M., Musiał, K., and Piątek, J. (2020). Hyaluronic Acid as a Component of Natural Polymer Blends for Biomedical Applications: A Review. Molecules, 25. source

      The Introduction says HA can modify cellular behavior and is used for therapeutic purposes, supporting the claim about biological responses. The section on HA–collagen blends reports little inflammatory response to one hydrogel, but does not establish that HA itself is non-immunogenic. No passage found addresses prevention of post-surgical adhesions or those arising from peritoneal injury. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Hyalobarrier® had a moderate increase in extrusion force (20 N), indicating a trade-off between mechanical stability and ease of application.

    “However, this came with a moderate increase in extrusion force (20 N), indicating a trade-off between mechanical stability and ease of application.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [121] Torres-de la Roche, L.A., Bérard, V., de Wilde, M.S., Devassy, R., Wallwiener, M., and De Wilde, R.L. (2022). Chemically Modified Hyaluronic Acid for Prevention of Post-Surgical Adhesions: New Aspects of Gel Barriers Physical Profiles. J. Clin. Med., 11. source

      The Results (§3.2) identify Hyalobarrier® as polymer A and report its extrusion force as 20 N, compared with 17 N for polymer C and 28 N for polymer B. The Discussion (§4) suggests polymer A may be more likely to remain in place, but the paper does not establish a trade-off with ease of application; its Abstract says further clinical studies are needed to determine whether the measured differences affect application during surgery. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Chitosan's structure provides a cationic nature, making it unique among polysaccharides and capable of interacting with negatively charged biological molecules such as proteins and cell membranes, making it favorable for tissue engineering applications.

    “This structure provides chitosan with a cationic nature, making it unique among polysaccharides and capable of interacting with negatively charged biological molecules such as proteins and cell membranes, which makes it a favorable biopolymer for tissue engineering applications [144].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [144] Jiménez-Gómez, C.P., and Cecilia, J.A. (2020). Chitosan: A natural biopolymer with a wide and varied range of applications. Molecules, 25. source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    In a mouse study, a soluble PVP-alginate film completely prevented adhesions: no macroscopic adhesions formed and gene expression of pro-adhesion markers remained at baseline levels, similar to uninjured controls.

    “After creating standardized peritoneal injuries in mice, the soluble PVP–Alg film completely prevented adhesions: no macroscopic adhesions formed and the gene expression of pro-adhesion markers remained at baseline levels, similar to uninjured controls.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [191] Forysenkova, A.A., Konovalova, M.V., Fadeeva, I.V., Antonova, O.S., Kotsareva, O.D., Slonskaya, T.K., Rau, J.V., and Svirshchevskaya, E.V. (2023). Polyvinylpyrrolidone–Alginate Film Barriers for Abdominal Surgery: Anti-Adhesion Effect in Murine Model. Materials, 16. source

      Results §3.2 reports that PVP-Alg dry films completely prevented visible adhesions in the mouse model. But Results §3.3 reports residual adhesions on histology, and the Conclusions report increased expression of several genes in the PVP-Alg group compared with control animals. The claim that pro-adhesion gene expression remained at uninjured baseline levels is therefore not supported. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Chitosan promotes angiogenesis, granulation tissue formation, and re-epithelialization, aiding tissue recovery.

    “It promotes angiogenesis, granulation tissue formation, and re-epithelialization, aiding tissue recovery [169,170].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [169] Movaffagh, 2022, Evaluation of wound-healing efficiency of a functional Chitosan/Aloe vera hydrogel on the improvement of re-epithelialization in full thickness wound model of rat, J. Tissue Viability source
    • cites [170] Li, 2021, Core-shell chitosan microsphere with antimicrobial and vascularized functions for promoting skin wound healing, Mater. Des. source

      Section 3.8 (page unavailable) reports angiogenesis, faster epidermal reconstruction, and improved wound closure with chitosan microspheres containing bFGF and PonG1. It does not report granulation tissue formation, and the angiogenesis and epidermal findings concern the loaded microspheres rather than chitosan alone. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    The chitosan composite hydrogel outcomes indicate enhanced endometrial repair and a strong anti-adhesion effect.

    “These outcomes indicate enhanced endometrial repair and a strong anti-adhesion effect.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [171] Yu, Z., Min, Y., Ouyang, Q., Fu, Y., Mao, Y., Xiang, S., Hu, X., and Jiang, L. (2025). Study on an Injectable Chitosan–Lignin/Poloxamer Hydrogel Loaded with Platelet-Rich Plasma for Intrauterine Adhesion Treatment. Polymers, 17. source

  • May combine two claims.

    Findingcitation

    In the same mouse study, a Ca-crosslinked alginate film (not readily biodegradable) induced a robust foreign-body response-adhesion bands scored as severe (grade 5) and a 5-10× upregulation of adhesion-related genes occurred.

    “In contrast, the Ca-crosslinked alginate film (not readily biodegradable) induced a robust foreign-body response—adhesion bands scored as severe (grade 5) and a 5–10× upregulation of adhesion-related genes occurred.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [191] Forysenkova, A.A., Konovalova, M.V., Fadeeva, I.V., Antonova, O.S., Kotsareva, O.D., Slonskaya, T.K., Rau, J.V., and Svirshchevskaya, E.V. (2023). Polyvinylpyrrolidone–Alginate Film Barriers for Abdominal Surgery: Anti-Adhesion Effect in Murine Model. Materials, 16. source

  • May combine two claims.

    Findingcitation

    After 2 weeks, rats treated with the chitosan composite hydrogel showed an almost normal uterine cavity with regenerated endometrium, in contrast to untreated rats that had obliterated cavities and necrotic tissue.

    “After 2 weeks, rats treated with the chitosan composite hydrogel showed an almost normal uterine cavity with regenerated endometrium, in contrast to untreated rats that had obliterated cavities and necrotic tissue.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [171] Yu, Z., Min, Y., Ouyang, Q., Fu, Y., Mao, Y., Xiang, S., Hu, X., and Jiang, L. (2025). Study on an Injectable Chitosan–Lignin/Poloxamer Hydrogel Loaded with Platelet-Rich Plasma for Intrauterine Adhesion Treatment. Polymers, 17. source

  • May combine two claims.

    Premisecitation

    Ionic crosslinking with Ca2+ allows for rapid gelation and easy hydrogel formation.

    “While ionic crosslinking with Ca2+ allows for rapid gelation and easy hydrogel formation, incorporating multivalent ions such as Ba2+ or Sr2+ can enhance network stability, prolonging the material’s functional lifespan (Figure 9A) [187,188,189].”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [187] Vajda, 2023, Sr2+ vs. Ca2+ as post-processing ionic crosslinkers: Implications for 3D bioprinting of polysaccharide hydrogels in tissue engineering, J. Mater. Res. Technol. source
    • cites [188] Sarker, 2018, Influence of ionic crosslinkers (Ca2+/Ba2+/Zn2+) on the mechanical and biological properties of 3D Bioplotted Hydrogel Scaffolds, J. Biomater. Sci. Polym. Ed. source
    • cites [189] Malektaj, H., Drozdov, A.D., and deClaville Christiansen, J. (2023). Mechanical properties of alginate hydrogels cross-linked with multivalent cations. Polymers, 15. source

  • May combine two claims.

    Premisecitation

    PLGA can be formulated into injectable hydrogels, offering minimally invasive application and localized adhesion prevention, particularly in complex surgical sites.

    “Additionally, PLGA can be formulated into injectable hydrogels, which offer minimally invasive application and localized adhesion prevention, particularly in complex surgical sites [230].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [230] Gu, W., Fan, R., Quan, J., Cheng, Y., Wang, S., Zhang, H., Zheng, A., and Song, S. (2022). Intracranial In Situ Thermosensitive Hydrogel Delivery of Temozolomide Accomplished by PLGA–PEG–PLGA Triblock Copolymer Blending for GBM Treatment. Polymers, 14. source

      The Materials and Methods section (2.4) describes intracranial injection of a PLGA–PEG–PLGA hydrogel, supporting the injectable-hydrogel part of the claim. The paper studies local delivery for glioblastoma treatment, but the passages do not report adhesion prevention or establish a minimally invasive advantage in complex surgical sites. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    A non-crosslinked, fast-dissolving alginate barrier is effective, whereas a persistent alginate scaffold can trigger inflammation and adhesion formation.

    “These results underscore that a non-crosslinked, fast-dissolving alginate barrier is effective, whereas a persistent alginate scaffold can trigger inflammation and adhesion formation (Figure 9B) [191].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [191] Forysenkova, A.A., Konovalova, M.V., Fadeeva, I.V., Antonova, O.S., Kotsareva, O.D., Slonskaya, T.K., Rau, J.V., and Svirshchevskaya, E.V. (2023). Polyvinylpyrrolidone–Alginate Film Barriers for Abdominal Surgery: Anti-Adhesion Effect in Murine Model. Materials, 16. source

  • May combine two claims.

    Premisecitation

    Only low-molecular-weight HA fragments (<12 kDa) can pass the glomerular barrier; under normal physiology, only ~1-2% of HA is removed by the kidneys, limited to these small fragments.

    “Similarly, only low-molecular-weight HA fragments (<12 kDa) are able to pass the glomerular barrier—indeed, under normal physiology, only ~1–2% of HA is removed by the kidneys, limited to these small fragments [252].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [252] Jin, 2023, The role of hyaluronan in renal cell carcinoma, Front. Immunol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    PP is widely used in tissue engineering, particularly in surgical meshes for hernia repair, pelvic organ prolapse, and other soft tissue reinforcement procedures.

    “Polypropylene (PP) is another widely used polymer in tissue engineering, particularly in the fabrication of surgical meshes for hernia repair, pelvic organ prolapse, and other soft tissue reinforcement procedures [242].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [242] Seifalian, A., Basma, Z., Digesu, A., and Khullar, V. (2023). Polypropylene Pelvic Mesh: What Went Wrong and What Will Be of the Future?. Biomedicines, 11. source

  • May combine two claims.

    Premisecitation

    PEG-based films maintain structural integrity without causing additional mechanical irritation, making them suitable for minimally invasive adhesion prevention.

    “Unlike rigid or brittle polymers, PEG-based films maintain structural integrity without causing additional mechanical irritation, making them highly suitable for minimally invasive adhesion prevention strategies [217].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [217] Allègre, L., Le Teuff, I., Leprince, S., Warembourg, S., Taillades, H., Garric, X., Letouzey, V., and Huberlant, S. (2018). A new bioabsorbable polymer film to prevent peritoneal adhesions validated in a post-surgical animal model. PLoS ONE, 13. source

      The Discussion (page unavailable) describes the PLA-PEG-PLA film as malleable, easy to reposition, and seemingly better suited than Seprafilm for laparoscopy. It does not establish that the films maintain structural integrity or cause no mechanical irritation; its histological finding of no specific inflammatory response is not a test of mechanical irritation. Suitability for minimally invasive use is presented as a prospect, not demonstrated in the animal study. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In hernia repairs, ePTFE serves as a physical barrier that prevents post-surgical adhesions between organs and surrounding tissues, reducing complications such as bowel obstruction or chronic pain.

    “For instance, in hernia repairs, ePTFE serves as a physical barrier that prevents post-surgical adhesions between organs and surrounding tissues, thereby reducing complications such as bowel obstruction or chronic pain [241].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [241] Fatehi Hassanabad, A., Zarzycki, A.N., Jeon, K., Dundas, J.A., Vasanthan, V., Deniset, J.F., and Fedak, P.W. (2021). Prevention of post-operative adhesions: A comprehensive review of present and emerging strategies. Biomolecules, 11. source

      Section 4.1 describes ePTFE as a permanent physical barrier that can prevent adhesion formation, and the Introduction identifies chronic pain as a complication of adhesions. The copy does not establish that ePTFE prevents adhesions specifically in hernia repairs or that its use reduces bowel obstruction or chronic pain in those patients; the ePTFE evidence discussed concerns other surgical settings. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    PCL maintains structural integrity for weeks to months, making it highly suitable for adhesion-prevention applications.

    “PCL maintains structural integrity for weeks to months, making it highly suitable for adhesion-prevention applications [196].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [196] Ferrari, M., Cirisano, F., and Morán, M.C. (2019). Mammalian cell behavior on hydrophobic substrates: Influence of surface properties. Colloids Interfaces, 3. source

      The Case Studies section discusses anti-adhesive biomaterials and tissue-adhesion barriers generally, but does not establish this claim about PCL. Searches for “PCL,” “polycaprolactone,” and structural integrity over weeks or months found no passage addressing PCL’s durability or suitability for adhesion prevention. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    PLGA's ester bond linkages enable controlled hydrolysis, and its mechanical flexibility allows fabrication of thin, conformable films that adhere to tissue surfaces without causing irritation or excessive mechanical stress.

    “Its ester bond linkages enable controlled hydrolysis, while its mechanical flexibility allows for the fabrication of thin, conformable films that adhere to tissue surfaces without causing irritation or excessive mechanical stress (Figure 10C) [229].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [229] Robin, 2021, Tuning morphology of Pickering emulsions stabilised by biodegradable PLGA nanoparticles: How PLGA characteristics influence emulsion properties, J. Colloid Interface Sci. source

      The Introduction states that PLGA’s ester-linked units can be hydrolysed and that its degradation rate can be tuned. Sections 2.4.3 and 3.2.1 describe PLGA films used for wettability measurements, but do not support the claims that mechanical flexibility enables thin, tissue-conformable films or that such films adhere without irritation or excessive stress. No page numbers are available in our copy. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    A dual-surface membrane made by merging a CMC hydrogel layer with a collagen hydrogel layer through vitrification has a collagen-rich side that is slightly sticky and adheres to wet tissue, while the CMC side provides strong anti-adhesive properties, ensuring the barrier stays in place on the target organ while preventing adhesions on its outward-facing surface.

    “For example, a recent “dual-surface” membrane was made by merging a carboxymethyl cellulose (CMC) hydrogel layer with a collagen hydrogel layer through a vitrification process [276]. The resulting dry film (termed Bi-C-CVM) has a collagen-rich side that is slightly sticky, adhering to wet tissue, while the CMC side provides strong anti-adhesive properties.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [276] Wang, 2018, Layer-by-layer Polyelectrolytes Coating of Alginate Microgels for Sustained Release of Sodium Benzoate and Zosteric Acid, J. Drug Deliv. Sci. Technol. source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Electrospun anti-adhesion films can be made from biodegradable polymers and can incorporate drugs by techniques like coaxial (core-shell) electrospinning.

    “Electrospun anti-adhesion films can be made from biodegradable polymers and even incorporate drugs by techniques like coaxial (core–shell) electrospinning [12,271].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [12] Park, H., Baek, S., Kang, H., and Lee, D. (2020). Biomaterials to Prevent Post-Operative Adhesion. Materials, 13. source

      Section 2.2.3 (page unavailable) says biodegradable PCL is made into electrospun anti-adhesion barriers and can be combined with a natural polymer in a core–sheath structure. Section 2.1.5 also describes drug-loaded anti-adhesion barriers made by electrospinning. The copy does not establish that drugs are incorporated specifically by coaxial or core–shell electrospinning. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [271] Nadri, 2022, Prevention of peritoneal adhesions formation by core-shell electrospun ibuprofen-loaded PEG/silk fibrous membrane, Artif. Cells Nanomed. Biotechnol. source

  • May combine two claims.

    Premisecitation

    When implanted in a rat abdominal injury model, a mesothelial-cell-seeded MEW mesh acted as a functional anti-adhesion barrier by physically blocking pro-adhesive cells like macrophages from infiltrating the injured site and actively participating in regenerating the damaged peritoneum.

    “When implanted in a rat abdominal injury model, a mesothelial-cell-seeded MEW mesh acted as a functional anti-adhesion barrier: it physically blocked pro-adhesive cells (like macrophages) from infiltrating the injured site and actively participated in regenerating the damaged peritoneum [274].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [274] Li, 2023, Melt electrowriting-printed peritoneal scaffold prevents peritoneal adhesion and facilitates peritoneal repair, Int. J. Bioprint source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Three-dimensional bioprinting builds constructs layer-by-layer using bioinks, typically hydrogels that can include living cells or therapeutic agents, enabling custom-shaped barriers and incorporation of biological components to aid healing.

    “Three-dimensional bioprinting (an additive manufacturing technique) builds constructs layer-by-layer using bioinks—typically hydrogels that can include living cells or therapeutic agents. This technique enables custom-shaped barriers and the incorporation of biological components to aid healing [22].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [22] Chen, 2023, Biomaterials/bioinks and extrusion bioprinting, Bioact. Mater. source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    A composite hydrogel of GelMA and collagen methacrylate bioprinted with encapsulated human amniotic mesenchymal stem cells and crosslinked by blue light successfully prevented uterine cavity adhesions in a rat model of intrauterine adhesions, demonstrating excellent biocompatibility and anti-adhesion efficacy.

    “For instance, a composite hydrogel of gelatin methacrylate (GelMA) and collagen methacrylate was bioprinted with encapsulated human amniotic mesenchymal stem cells (hAMSCs) and crosslinked by blue light. In a rat model of intrauterine adhesions, this cell-laden printed hydrogel successfully prevented uterine cavity adhesions, demonstrating excellent biocompatibility and anti-adhesion efficacy [275”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [275] Feng, 2021, Bioprinting of a Blue Light-Cross-Linked Biodegradable Hydrogel Encapsulating Amniotic Mesenchymal Stem Cells for Intrauterine Adhesion Prevention, ACS Omega source

  • May combine two claims.

    Findingcitation

    In a rat laparotomy model, CMC-pullulan barriers showed excellent biocompatibility (no toxicity or inflammation) and impressive efficacy.

    “In a rat laparotomy model, the CMC–pullulan barriers showed excellent biocompatibility (no toxicity or inflammation) and impressive efficacy.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [142] An, 2021, Carboxymethyl Cellulose, Pluronic, and Pullulan-Based Compositions Efficiently Enhance Antiadhesion and Tissue Regeneration Properties without Using Any Drug Molecules, ACS Appl. Mater. Interfaces source

  • May combine two claims.

    Findingcitation

    In a randomized clinical trial involving 192 women undergoing hysteroscopic surgery, ABT13107 was non-inferior to Hyalobarrier in reducing intrauterine adhesions, with no serious adverse events reported.

    “In a randomized clinical trial involving 192 women undergoing hysteroscopic surgery, ABT13107 was shown to be non-inferior to Hyalobarrier in reducing intrauterine adhesions, with no serious adverse events reported.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [125] Lee, 2020, A New Thermo-Responsive Hyaluronic Acid Sol-Gel to Prevent Intrauterine Adhesions after Hysteroscopic Surgery: A Randomized, Non-Inferiority Trial, Yonsei Med. J. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Findingcitation

    Rats receiving ADSC-seeded amnion grafts showed near-normal uterine recovery: by 14 days post-surgery, endometrial thickness, gland count, and fibrosis scores approached those of uninjured sham animals and were significantly better than AM alone.

    “Rats receiving ADSC-seeded amnion grafts showed near-normal uterine recovery: by 14 days post-surgery, endometrial thickness, gland count, and fibrosis scores in the ADSC + AM group approached those of uninjured sham animals and were significantly better than AM alone [116].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [116] Li, 2024, Transplantation of acellular amniotic membrane seeded with adipose-derived mesenchymal stem cells in a rat model of intrauterine adhesion, Ann. Med. Surg. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Findingcitation

    DL-AM alone did not fully restore normal endometrium; fibrotic markers remained above baseline and there was no significant regeneration of endometrial glands by 4 weeks.

    “However, DL-AM alone did not fully restore normal endometrium—fibrotic markers remained above baseline and there was no significant regeneration of endometrial glands by 4 weeks [103].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [103] Chen, 2021, Transplantation of decellularized and lyophilized amniotic membrane inhibits endometrial fibrosis by regulating connective tissue growth factor and tissue inhibitor of matrix metalloproteinase-2, Exp. Ther. Med. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Findingcitation

    The CMC component of CMC-gelatin hydrogels effectively reduced fibroblast adhesion, while gelatin supported the viability of limited attached cells.

    “The CMC component effectively reduced fibroblast adhesion, while gelatin supported the viability of limited attached cells.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [141] Swilem, 2022, Development of carboxymethyl cellulose/gelatin hybrid hydrogels via radiation-induced cross-linking as novel anti-adhesion barriers, Polym. Degrad. Stab. source

  • May combine two claims.

    Findingcitation

    Patients treated with HA had a notably lower rate of moderate or severe adhesions (p = 0.0010) and a significantly smaller proportion of adhesion-affected sites (p < 0.00001) compared to controls.

    “Patients treated with HA exhibited a notably lower rate of moderate or severe adhesions (p = 0.0010) and a significantly smaller proportion of adhesion-affected sites (p < 0.00001) compared to controls.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [126] Adamyan, 2024, Hyaluronic acid in the prevention of adhesions after gynecological surgery: Systematic review and meta-analysis, J. Endometr. Uterine Disord. source

  • May combine two claims.

    Findingcitation

    Medicurtain prevented postoperative adhesions in approximately 42% of animals, whereas new CMC-pullulan formulations prevented adhesions in 100% of treated rats.

    “Medicurtain prevented postoperative adhesions in ~42% of animals, whereas the new CMC–pullulan formulations prevented adhesions in 100% of the treated rats.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [142] An, 2021, Carboxymethyl Cellulose, Pluronic, and Pullulan-Based Compositions Efficiently Enhance Antiadhesion and Tissue Regeneration Properties without Using Any Drug Molecules, ACS Appl. Mater. Interfaces source

  • May combine two claims.

    Findingcitation

    CMC-gelatin hydrogels showed reduced foreign body response and strong anti-adhesive properties.

    “These hydrogels also showed reduced foreign body response and strong anti-adhesive properties, highlighting their potential as biocompatible, tunable barrier materials for postoperative adhesion prevention (Figure 7B) [141].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [141] Swilem, 2022, Development of carboxymethyl cellulose/gelatin hybrid hydrogels via radiation-induced cross-linking as novel anti-adhesion barriers, Polym. Degrad. Stab. source

  • May combine two claims.

    Findingcitation

    The CMC-pullulan study noted enhanced tissue regeneration at the surgical site, suggesting the materials might actively support healing.

    “The study also noted enhanced tissue regeneration at the surgical site with these formulations, suggesting that the materials might actively support healing [142].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [142] An, 2021, Carboxymethyl Cellulose, Pluronic, and Pullulan-Based Compositions Efficiently Enhance Antiadhesion and Tissue Regeneration Properties without Using Any Drug Molecules, ACS Appl. Mater. Interfaces source

  • May combine two claims.

    Findingcitation

    All rats treated with optimized CMC-pullulan barriers had a completely adhesion-free recovery, a dramatic improvement over the control agent.

    “In other words, all rats treated with optimized CMC–pullulan barriers had a completely adhesion-free recovery, a dramatic improvement over the control agent.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [142] An, 2021, Carboxymethyl Cellulose, Pluronic, and Pullulan-Based Compositions Efficiently Enhance Antiadhesion and Tissue Regeneration Properties without Using Any Drug Molecules, ACS Appl. Mater. Interfaces source

  • May combine two claims.

    Findingcitation

    In a 2021 rodent study, rats treated with a decellularized, lyophilized human amnion patch showed attenuated fibrosis, with significantly lower connective tissue growth factor levels and higher MMP-2 levels in scarred uteri than untreated injured uteri.

    “Rats treated with the DL-AM showed attenuated fibrosis: connective tissue growth factor (CTGF) levels in scarred uteri were significantly lower, and MMP-2 (matrix-degrading enzyme) higher, than in untreated injured uteri.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [103] Chen, 2021, Transplantation of decellularized and lyophilized amniotic membrane inhibits endometrial fibrosis by regulating connective tissue growth factor and tissue inhibitor of matrix metalloproteinase-2, Exp. Ther. Med. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Findingcitation

    No notable toxicity or inflammation was observed with the chitosan-PRP hydrogel, indicating good biocompatibility.

    “No notable toxicity or inflammation was observed, indicating good biocompatibility (Figure 8B) [150].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [150] Lv, 2024, Injectable, degradable, and mechanically adaptive hydrogel induced by L-serine and allyl-functionalized chitosan with platelet-rich plasma for treating intrauterine adhesions, Acta Biomater. source

  • May combine two claims.

    Findingcitation

    Treated rats had significantly less collagen scar deposition and increased endometrial cell proliferation, leading to near-normal endometrial architecture.

    “Treated rats had significantly less collagen scar deposition and increased endometrial cell proliferation, leading to near-normal endometrial architecture.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [150] Lv, 2024, Injectable, degradable, and mechanically adaptive hydrogel induced by L-serine and allyl-functionalized chitosan with platelet-rich plasma for treating intrauterine adhesions, Acta Biomater. source

  • The quote only partly states this claim.

    Findingcitation

    In vivo imaging confirmed prolonged retention of the tChi/tHA hydrogel components in the uterine cavity for up to 14 days.

    “In vivo imaging confirmed prolonged retention of the hydrogel components in the uterine cavity for up to 14 days.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [151] Zheng, 2025, Injectable antioxidant hyaluronan/chitosan hydrogel as a platelet-rich plasma and stem cell carrier to promote endometrial regeneration and fertility restoration, Acta Biomater. source

  • May combine two claims. The quote only partly states this claim.

    Findingcitation

    In a rat model of IUA, tChi/tHA hydrogel-treated animals showed significantly improved endometrial regeneration, with greater endometrial thickness, increased gland numbers, and reduced fibrosis compared to untreated controls (p < 0.01).

    “In a rat model of IUA, hydrogel-treated animals showed significantly improved endometrial regeneration, with greater endometrial thickness, increased gland numbers, and reduced fibrosis compared to untreated controls (p < 0.01).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [151] Zheng, 2025, Injectable antioxidant hyaluronan/chitosan hydrogel as a platelet-rich plasma and stem cell carrier to promote endometrial regeneration and fertility restoration, Acta Biomater. source

  • May combine two claims.

    Findingcitation

    The disulfide-crosslinked tChi/tHA hydrogel exhibited rapid sol-gel transition, self-healing, and excellent injectability.

    “This disulfide-crosslinked system exhibited favorable properties, including rapid sol–gel transition, self-healing, and excellent injectability.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [151] Zheng, 2025, Injectable antioxidant hyaluronan/chitosan hydrogel as a platelet-rich plasma and stem cell carrier to promote endometrial regeneration and fertility restoration, Acta Biomater. source

  • May combine two claims.

    Findingcitation

    Fertility was restored in treated rats (evidenced by successful pregnancies in the IUA model), whereas untreated rats remained infertile.

    “Importantly, fertility was restored in treated rats (evidenced by successful pregnancies in the IUA model), whereas untreated rats remained infertile.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [150] Lv, 2024, Injectable, degradable, and mechanically adaptive hydrogel induced by L-serine and allyl-functionalized chitosan with platelet-rich plasma for treating intrauterine adhesions, Acta Biomater. source

  • May combine two claims.

    Findingcitation

    The chitosan composite hydrogel proved safe in vivo, with no significant inflammatory reaction, and is fully biodegradable.

    “The material proved safe in vivo, with no significant inflammatory reaction, and is fully biodegradable [171].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [171] Yu, Z., Min, Y., Ouyang, Q., Fu, Y., Mao, Y., Xiang, S., Hu, X., and Jiang, L. (2025). Study on an Injectable Chitosan–Lignin/Poloxamer Hydrogel Loaded with Platelet-Rich Plasma for Intrauterine Adhesion Treatment. Polymers, 17. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Findingcitation

    PLA-PCL nanofibrous blends have shown enhanced support for fibroblast proliferation and the osteogenic differentiation of stem cells.

    “Similarly, PLA–PCL nanofibrous blends have shown enhanced support for fibroblast proliferation and the osteogenic differentiation of stem cells, confirming the favorable cell–material interactions resulting from such modifications [200].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [200] Shahverdi, 2022, Melt electrowriting of PLA, PCL, and composite PLA/PCL scaffolds for tissue engineering application, Sci. Rep. source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Synthetic polymers such as PCL, PEG, and PLGA allow for fine-tuning of mechanical strength and degradation kinetics.

    “Synthetic polymers such as polycaprolactone (PCL), polyethylene glycol (PEG), and poly(lactic-co-glycolic acid) (PLGA) allow for the fine-tuning of mechanical strength and degradation kinetics [9,10].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9] Patel, 2024, Nanocellulose in targeted drug delivery: A review of modifications and synergistic applications, Int. J. Biol. Macromol. source
    • cites [10] Naik, 2024, Unleashing the power of polymeric nanoparticles—Creative triumph against antibiotic resistance: A review, Int. J. Biol. Macromol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Collagen is the most abundant protein, making up about 20-30% of the total protein in the human body, and plays a crucial role in the structural integrity of various tissues.

    “Collagen is the most abundant protein, making up about 20–30% of the total protein in the human body, and plays a crucial role in the structural integrity of various tissues.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Tahermanesh, 2024, Comparative analysis of porcine-uterine decellularization for bioactive-molecule preservation and DNA removal, Front. Bioeng. Biotechnol. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    At 60 days post-transplantation, endometrial thickness in the CS/UC-MSC group reached 610 ± 30 μm, markedly greater than that in the CS (220 ± 20 μm) and NR (170 ± 20 μm) groups (p < 0.01).

    “At 60 days post-transplantation, the endometrial thickness in the CS/UC-MSC group reached 610 ± 30 µm, markedly greater than that in the CS (220 ± 20 µm) and NR (170 ± 20 µm) groups (p < 0.01).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Xin, 2019, A collagen scaffold loaded with human umbilical cord-derived mesenchymal stem cells facilitates endometrial regeneration and restores fertility, Acta Biomater. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Polysaccharides like cellulose, chitosan, and alginate contribute useful properties such as gelation, antimicrobial activity, and ease of modification.

    “Polysaccharides like cellulose, chitosan, and alginate contribute useful properties such as gelation, antimicrobial activity, and ease of modification [7,8].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Lv, 2019, Influence of chitosan oligosaccharide on the gelling and wound healing properties of injectable hydrogels based on carboxymethyl chitosan/alginate polyelectrolyte complexes, Carbohydr. Polym. source
    • cites [8] Alavi, 2020, An overview on antimicrobial and wound healing properties of ZnO nanobiofilms, hydrogels, and bionanocomposites based on cellulose, chitosan, and alginate polymers, Carbohydr. Polym. source

  • May combine two claims.

    Interpretationcitation

    The collagen gel's efficacy was comparable to the standard HA/CMC treatment, suggesting that it can be effectively used to minimize adhesions in reproductive surgery.

    “The collagen gel’s efficacy was comparable to the standard treatment, suggesting that it can be effectively used to minimize adhesions in reproductive surgery.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In a 2023 rat model of intrauterine adhesion, platelet-rich fibrin (PRF) transplantation resulted in a significant improvement in endometrial regeneration while concurrently decreasing the fibrotic area from approximately 25% to approximately 6%.

    “A 2023 study conducted by Mao et al. using a rat model of intrauterine adhesion demonstrated that platelet-rich fibrin (PRF) transplantation resulted in a significant improvement in endometrial regeneration while concurrently decreasing the fibrotic area from approximately 25% to approximately 6%.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] Mao, 2023, Platelet-rich fibrin improves repair and regeneration of damaged endometrium in rats, Front. Endocrinol. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    Histological and histochemical analyses revealed significantly decreased inflammatory cell infiltration, neovascularization, and collagen fiber deposition in the gelatin group (p < 0.001).

    “Histological and histochemical analyses revealed significantly decreased inflammatory cell infiltration, neovascularization, and collagen fiber deposition in the gelatin group (p < 0.001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Ibrahim, 2022, Efficacy of gelatin sponge in the prevention of post-surgical intra-abdominal adhesion in a rat model, Res. Vet. Sci. source

  • May combine two claims.

    Interpretationcitation

    The CS/UC-MSCs system supports structural regeneration of the endometrium and restores its functional competence, offering a potent strategy for treating IUA and promoting fertility restoration.

    “These findings demonstrate that the CS/UC-MSCs system not only supports the structural regeneration of the endometrium, but also restores its functional competence, offering a potent strategy for treating IUA and promoting fertility restoration (Figure 1(C1–C12, D1–D7)) [35].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Xin, 2019, A collagen scaffold loaded with human umbilical cord-derived mesenchymal stem cells facilitates endometrial regeneration and restores fertility, Acta Biomater. source

  • May combine two claims.

    Premisecitation

    Gelatin has weaker mechanical strength and is much more thermosensitive, losing its structural integrity at body temperature unless chemically modified or crosslinked.

    “However, due to the denaturation process, gelatin has weaker mechanical strength and is much more thermosensitive, meaning it loses its structural integrity at body temperature unless chemically modified or crosslinked [51,52].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [51] Salahuddin, 2021, Hybrid gelatin hydrogels in nanomedicine applications, ACS Appl. Bio Mater. source
    • cites [52] Horii, 2018, Physical and biological properties of a novel anti-adhesion material made of thermally cross-linked gelatin film: Investigation of the usefulness as anti-adhesion material, J. Biomed. Mater. Res. Part B Appl. Biomater. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Non-degradable polymers like ePTFE and polypropylene are less commonly used today due to their permanence, but are still applied in cases requiring permanent structural reinforcement.

    “Non-degradable polymers like ePTFE and polypropylene, while less commonly used today due to their permanence, have played a key role in the history of surgical biomaterials and are still applied in cases requiring permanent structural reinforcement [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Subramaniam, A., and Sethuraman, S. (2014). Biomedical applications of nondegradable polymers. Natural and Synthetic Biomedical Polymers, Elsevier. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Postoperative adhesions (POAs) are a common and often serious complication following abdominal and gynecologic surgeries, leading to infertility, chronic pain, and bowel obstruction.

    “Postoperative adhesions (POAs) are a common and often serious complication following abdominal and gynecologic surgeries, leading to infertility, chronic pain, and bowel obstruction.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] Weibel, 1973, Peritoneal adhesions and their relation to abdominal surgery: A postmortem study, Am. J. Surg. source
    • cites [2] Lauder, 2010, Abdominal adhesion prevention: Still a sticky subject, Dig. Surg. source
    • cites [3] Schaefer, 2024, Prevention of peritoneal adhesions after gynecological surgery: A systematic review, Arch. Gynecol. Obstet. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Interpretationcitation

    Absorbable gelatin sponges are safe, bioactive physical barriers capable of modulating the postoperative healing environment to prevent intra-abdominal adhesions.

    “These findings support the use of absorbable gelatin sponges as safe, bioactive physical barriers capable of modulating the postoperative healing environment to prevent intra-abdominal adhesions (Figure 2(D1–D5)) [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Ibrahim, 2022, Efficacy of gelatin sponge in the prevention of post-surgical intra-abdominal adhesion in a rat model, Res. Vet. Sci. source

  • May combine two claims.

    Premisecitation

    Plant-derived rhCollagen has shown no antigenic or immunogenic responses in human CD4+ T cells, in contrast to bovine collagen, which is known to trigger immune reactions.

    “Notably, plant-derived rhCollagen has shown no antigenic or immunogenic responses in human CD4+ T cells, in contrast to bovine collagen, which is known to trigger immune reactions [40].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Shilo, 2013, Cutaneous wound healing after treatment with plant-derived human recombinant collagen flowable gel, Tissue Eng. Part A source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    Collagen deposition was significantly reduced to 41 ± 2% in the CS/UC-MSC group, comparable to the sham group (41 ± 3%) and far lower than in the CS (74 ± 2%) and NR (75 ± 2%) groups (p < 0.01).

    “Collagen deposition was also significantly reduced to 41 ± 2%, comparable to the sham group (41 ± 3%) and far lower than in the CS (74 ± 2%) and NR (75 ± 2%) groups (p < 0.01).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Xin, 2019, A collagen scaffold loaded with human umbilical cord-derived mesenchymal stem cells facilitates endometrial regeneration and restores fertility, Acta Biomater. source

  • May combine two claims.

    Interpretationcitation

    Unlike the conventional film, which completely inhibited fibroblast proliferation, PU GF supported moderate, non-cytotoxic cell growth, suggesting a safer mechanism of adhesion prevention via controlled degradation rather than cytotoxicity.

    “Unlike the conventional film, which completely inhibited fibroblast proliferation, PU GF supported moderate, non-cytotoxic cell growth, suggesting a safer mechanism of adhesion prevention via controlled degradation rather than cytotoxicity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Ozamoto, Y., Horii, T., Morita, S., Tsujimoto, H., Oe, Y., Minato, H., Ueda, J., Ichikawa, H., Kawauchi, A., and Hagiwara, A. (2025). Physical and biological properties of a novel anti-adhesive punctate uneven gelatin film. PLoS ONE, 20. source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Adhesions still develop in 50-95% of patients after abdominal or pelvic operations despite advances in surgical technique.

    “Despite advances in surgical technique, adhesions still develop in 50–95% of patients after abdominal or pelvic operations [1,2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Weibel, 1973, Peritoneal adhesions and their relation to abdominal surgery: A postmortem study, Am. J. Surg. source
    • cites [2] Lauder, 2010, Abdominal adhesion prevention: Still a sticky subject, Dig. Surg. source

  • May combine two claims.

    Premisecitation

    In a rat model of severe intrauterine adhesion, application of a collagen scaffold loaded with human umbilical-cord-derived mesenchymal stem cells significantly promoted endometrial regeneration and reduced adhesion recurrence.

    “In a rat model of severe intrauterine adhesion (IUA), the application of a collagen scaffold (CS) loaded with human umbilical-cord-derived mesenchymal stem cells (UC-MSCs) significantly promoted endometrial regeneration and reduced adhesion recurrence [35].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Xin, 2019, A collagen scaffold loaded with human umbilical cord-derived mesenchymal stem cells facilitates endometrial regeneration and restores fertility, Acta Biomater. source

  • May combine two claims.

    Interpretationreasoning

    rhCollagen is particularly suitable for patients sensitive to traditional collagen sources or those at higher risk of foreign body reactions.

    “This makes rhCollagen particularly suitable for patients sensitive to traditional collagen sources or those at higher risk of foreign body reactions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Natural biopolymers such as collagen, gelatin, fibrin, silk fibroin, and decellularized extracellular matrix offer high biocompatibility and bioactivity.

    “Natural biopolymers such as collagen, gelatin, fibrin, silk fibroin, and decellularized extracellular matrix (dECM) offer high biocompatibility and bioactivity [5,6].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Xu, 2021, A biological functional hybrid scaffold based on decellularized extracellular matrix/gelatin/chitosan with high biocompatibility and antibacterial activity for skin tissue engineering, Int. J. Biol. Macromol. source
    • cites [6] Tahermanesh, 2024, Comparative analysis of porcine-uterine decellularization for bioactive-molecule preservation and DNA removal, Front. Bioeng. Biotechnol. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    PU GF exhibited enhanced mechanical properties, including high tensile strength (73.83 ± 13.35 MPa) and ductility (fracture strain 7.27 ± 2.5%), and superior adhesion to tissue (4.0 ± 0.76 MPa) while minimizing undesirable self-adhesion and silicon adherence.

    “PU GF also exhibited enhanced mechanical properties, including high tensile strength (73.83 ± 13.35 MPa) and ductility (fracture strain 7.27 ± 2.5%), and superior adhesion to tissue (4.0 ± 0.76 MPa) while minimizing undesirable self-adhesion and silicon adherence.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Ozamoto, Y., Horii, T., Morita, S., Tsujimoto, H., Oe, Y., Minato, H., Ueda, J., Ichikawa, H., Kawauchi, A., and Hagiwara, A. (2025). Physical and biological properties of a novel anti-adhesive punctate uneven gelatin film. PLoS ONE, 20. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    In gynecological surgery, adhesion formation often leads to chronic pelvic pain, bowel obstruction, and infertility.

    “In gynecological surgery, adhesion formation is of particular concern, as it often leads to chronic pelvic pain, bowel obstruction, and infertility [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Schaefer, 2024, Prevention of peritoneal adhesions after gynecological surgery: A systematic review, Arch. Gynecol. Obstet. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Interpretationcitation

    Immunohistochemical staining showed a marked increase in MMP-9 expression and a decrease in macrophage marker (MAC387), suggesting enhanced fibrinolytic activity and suppression of inflammation as key mechanisms.

    “Importantly, immunohistochemical staining showed a marked increase in matrix metalloproteinase-9 (MMP-9) expression and a decrease in macrophage marker (MAC387), suggesting enhanced fibrinolytic activity and the suppression of inflammation as key mechanisms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Ibrahim, 2022, Efficacy of gelatin sponge in the prevention of post-surgical intra-abdominal adhesion in a rat model, Res. Vet. Sci. source

  • May combine two claims.

    Premisecitation

    Anti-adhesion biomaterials must prevent inflammatory responses, as prolonged inflammation can exacerbate adhesion formation.

    “They must also work to prevent inflammatory responses, as prolonged inflammation can exacerbate adhesion formation [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Kavic, 2002, Adhesions and adhesiolysis: The role of laparoscopy, JSLS

  • May combine two claims.

    Interpretationcitation

    The higher viscosity, elasticity, and peel strength of Hyalobarrier® suggest a stronger capacity to remain in place and resist deformation post-application, potentially enhancing its anti-adhesion efficacy.

    “These properties suggest a stronger capacity to remain in place and resist deformation post-application, potentially enhancing the gel′s anti-adhesion efficacy.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [121] Torres-de la Roche, L.A., Bérard, V., de Wilde, M.S., Devassy, R., Wallwiener, M., and De Wilde, R.L. (2022). Chemically Modified Hyaluronic Acid for Prevention of Post-Surgical Adhesions: New Aspects of Gel Barriers Physical Profiles. J. Clin. Med., 11. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    Seprafilm (hyaluronic acid/carboxymethylcellulose film) is FDA-approved and widely used as a physical barrier to reduce intra-abdominal and pelvic adhesions following surgery.

    “A well-known example of its clinical use is Seprafilm® (hyaluronic acid/carboxymethylcellulose film), which is FDA-approved and widely used as a physical barrier to reduce intra-abdominal and pelvic adhesions following surgery [118].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [118] Diamond, 2012, Seprafilm® adhesion barrier: (1) a review of preclinical, animal, and human investigational studies, Gynecol. Surg. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    Chemical modification of cellulose with carboxymethyl substitutions imparts hydrophilicity and biocompatibility, making CMC an excellent anti-adhesion barrier material.

    “This chemical modification imparts hydrophilicity and biocompatibility, making CMC an excellent anti-adhesion barrier material [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Patel, 2024, Nanocellulose in targeted drug delivery: A review of modifications and synergistic applications, Int. J. Biol. Macromol. source

  • May combine two claims.

    Premisecitation

    An alkaline-treated low-molecular-weight silk fibroin hydrogel, with reduced β-sheet crystallinity, fully biodegraded within ~2 weeks and significantly lowered adhesion severity scores vs. untreated rats.

    “By contrast, an alkaline-treated low-molecular-weight (LMW) silk fibroin hydrogel, with reduced β-sheet crystallinity, fully biodegraded within ~2 weeks and significantly lowered adhesion severity scores vs. untreated rats.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89] Kambe, 2024, Enhanced Biodegradation of Silk Fibroin Hydrogel for Preventing Postoperative Adhesion, ACS Biomater. Sci. Eng. source

  • May combine two claims.

    Premisecitation

    CMC degrades naturally into non-toxic byproducts, but its rapid degradation and tendency for excessive swelling can limit barrier effectiveness.

    “Furthermore, CMC degrades naturally into non-toxic byproducts; however, its rapid degradation and tendency for excessive swelling can limit barrier effectiveness [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Patel, 2024, Nanocellulose in targeted drug delivery: A review of modifications and synergistic applications, Int. J. Biol. Macromol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    After cellulose, chitosan is the second most abundant biopolymer found in living organisms.

    “After cellulose, chitosan is the second most abundant biopolymer found in living organisms [144].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [144] Jiménez-Gómez, C.P., and Cecilia, J.A. (2020). Chitosan: A natural biopolymer with a wide and varied range of applications. Molecules, 25. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    Crosslinking strategies have been used to extend retention and reduce hydrogel expansion of CMC.

    “Crosslinking strategies have been used to mitigate these issues by extending retention and reducing hydrogel expansion [139].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [139] Kurhade, 2024, Advancements in carboxymethyl cellulose (CMC) modifications and their diverse biomedical applications: A comprehensive review, Int. J. Polym. Mater. Polym. Biomater. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    HA molecular weight can vary significantly, ranging from 20 kDa to several million Daltons.

    “HA’s molecular weight can vary significantly, ranging from 20 kDa to several million Daltons (Figure 6A) [119].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [119] Zhang, 2023, High density cellulose nanofibril assembly leads to upgraded enzymatic and chemical catalysis of fermentable sugars, cellulose nanocrystals and cellulase production by precisely engineering cellulose synthase complexes, Green Chem. source

  • May combine two claims.

    Interpretationcitation

    The LMW silk's faster bioresorption was key: it elicited less fibrous encapsulation, lower plasma protein/fibroblast attachment, and was gone by the time healing occurred.

    “The LMW silk’s faster bioresorption was key: it elicited less fibrous encapsulation, lower plasma protein/fibroblast attachment, and was gone by the time healing occurred (Figure 4(B1–B11)) [89].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89] Kambe, 2024, Enhanced Biodegradation of Silk Fibroin Hydrogel for Preventing Postoperative Adhesion, ACS Biomater. Sci. Eng. source

  • May combine two claims.

    Study design and conductreasoning

    The anti-adhesion effect of DL-AM was not complete, which affected the reliability of the results.

    “A key limitation of the current study lies in the fact that the anti-adhesion effect was not complete, thereby affecting the reliability of the results obtained.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    CMC absorbs water and swells, forming a hydrogel-like layer that physically separates tissues during healing, preventing direct tissue contact and reducing adhesion formation.

    “CMC absorbs water and swells, forming a hydrogel-like layer that physically separates tissues during healing, preventing direct tissue contact and reducing adhesion formation [135].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [135] Pourshahrestani, 2020, Polymeric hydrogel systems as emerging biomaterial platforms to enable hemostasis and wound healing, Adv. Healthc. Mater. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Study design and conductreasoning

    The DL-AM study had an insufficient follow-up period and missing functional fertility data.

    “Given the insufficient follow-up period and the missing functional fertility data in this study, more research is needed to find the best ways to use dECM to treat women with Asherman’s syndrome (Figure 5B).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In a rat cecal abrasion model, a high-molecular-weight silk film remained in the abdomen and did not reduce adhesions (adhesion severity equal to untreated controls).

    “High-molecular-weight (HMW) silk hydrogels degrade slowly in vivo, and in a rat cecal abrasion model, a HMW silk film remained in the abdomen and did not reduce adhesions (adhesion severity equal to untreated controls).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [89] Kambe, 2024, Enhanced Biodegradation of Silk Fibroin Hydrogel for Preventing Postoperative Adhesion, ACS Biomater. Sci. Eng. source

  • May combine two claims.

    Interpretationreasoning

    The dECM's slow degradation provides a sustained barrier during the critical healing phase, reducing adhesion risks.

    “Its slow degradation provides a sustained barrier during the critical healing phase, reducing adhesion risks.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    CMC-pullulan composite barriers are biodegradable over approximately 30 days and were designed to promote tissue healing while blocking adhesions.

    “These materials are biodegradable over ~30 days and were designed to promote tissue healing while blocking adhesions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [142] An, 2021, Carboxymethyl Cellulose, Pluronic, and Pullulan-Based Compositions Efficiently Enhance Antiadhesion and Tissue Regeneration Properties without Using Any Drug Molecules, ACS Appl. Mater. Interfaces source

  • May combine two claims.

    Premisecitation

    SF is compatible with blood, and scaffolds made from SF exhibit minimal immune response after implantation.

    “Additionally, SF has been shown to be compatible with blood, and scaffolds made from SF exhibit minimal immune response after implantation [95].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [95] Kaushik, 2020, Silk Fibroin: An Emerging Biocompatible Material for Application of Enzymes and Whole Cells in Bioelectronics and Bioanalytical Sciences, ACS Biomater. Sci. Eng. source

  • May combine two claims.

    Premisecitation

    The decellularized extracellular matrix (dECM) helps prevent adhesions by acting as a biocompatible physical barrier between healing tissues, minimizing direct contact and reducing fibroblast proliferation.

    “The decellularized extracellular matrix (dECM) helps prevent adhesions by acting as a biocompatible physical barrier between healing tissues, minimizing direct contact and reducing fibroblast proliferation [101].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [101] Luo, 2023, Tailoring the multiscale mechanics of tunable decellularized extracellular matrix (dECM) for wound healing through immunomodulation, Bioact. Mater. source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Carboxymethyl cellulose is derived from cellulose, the most abundant biopolymer on Earth, primarily found in plant cell walls and produced by certain bacteria.

    “Carboxymethyl cellulose (CMC) is derived from cellulose, the most abundant biopolymer on Earth, primarily found in plant cell walls and produced by certain bacteria [127].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [127] Heinze, 1999, Studies on the synthesis and characterization of carboxymethylcellulose, Die Angew. Makromol. Chem. source

  • May combine two claims.

    Premisecitation

    The degree of deacetylation determines the proportion of free amine groups in chitosan, which influences its solubility and reactivity.

    “The degree of deacetylation (DD) determines the proportion of free amine groups (-NH2) in the structure, which influences its solubility and reactivity (Figure 8A) [148].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [148] Yadav, M., Goswami, P., Paritosh, K., Kumar, M., Pareek, N., and Vivekanand, V. (2019). Seafood waste: A source for preparation of commercially employable chitin/chitosan materials. Bioresour. Bioprocess., 6. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    In vivo studies have shown that SF scaffolds can degrade entirely within 18 to 36 months, depending on their morphology, with nanofibers degrading as quickly as 8 weeks.

    “In vivo studies have shown that SF scaffolds can degrade entirely within 18 to 36 months, depending on their morphology, with nanofibers degrading as quickly as 8 weeks [94,96].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [94] Ercan, 2015, Nanofeatured silk fibroin membranes for dermal wound healing applications, J. Biomed. Mater. Res. Part A source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [96] Kim, 2012, Preparation and in vivo degradation of controlled biodegradability of electrospun silk fibroin nanofiber mats, J. Biomed. Mater. Res. Part A source

  • May combine two claims.

    Premisecitation

    Bacterial cellulose synthesized by Gluconacetobacter xylinus features a highly pure nanofibrillar structure, offering high porosity, elasticity, and crystallinity.

    “In contrast, bacterial cellulose (BC), synthesized by Gluconacetobacter xylinus, features a highly pure nanofibrillar structure, offering high porosity, elasticity, and crystallinity (Figure 7A) [129,130].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [129] Lima, 2024, Bacterial cellulose in cosmetic innovation: A review, Int. J. Biol. Macromol. source
    • cites [130] Urbina, 2021, A review of bacterial cellulose: Sustainable production from agricultural waste and applications in various fields, Cellulose source

  • May combine two claims.

    Interpretationreasoning

    Fine-tuning the M/G ratio enables customization of mechanical properties and degradation profiles to match surgical site requirements and improve clinical outcomes.

    “Fine-tuning the M/G ratio enables the customization of mechanical properties and degradation profiles to match surgical site requirements and improve clinical outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    γ-Chitosan is known for having enhanced water solubility while maintaining reasonable mechanical properties.

    “γ-chitosan is known for having enhanced water solubility while maintaining reasonable mechanical properties [158].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [158] Ma, 2020, Functional chitosan-based materials for biological applications, Curr. Med. Chem. source

  • May combine two claims.

    Premisecitation

    Practical limitations of chitosan include variability in molecular weight and degree of deacetylation due to natural sourcing from shellfish, as well as regulatory hurdles.

    “However, practical limitations include variability in molecular weight and degree of deacetylation due to its natural sourcing from shellfish, as well as regulatory hurdles.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [149] Kean, 2010, Biodegradation, biodistribution and toxicity of chitosan, Adv. Drug Deliv. Rev. source

  • May combine two claims.

    Premisecitation

    Alginate-chitosan hybrids improve mechanical stability and prolong degradation, ensuring the barrier remains intact for an extended period.

    “Similarly, alginate–chitosan hybrids improve mechanical stability and prolong degradation, ensuring the barrier remains intact for an extended period [179].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [179] Jing, 2022, Facile synthesis of pH-responsive sodium alginate/carboxymethyl chitosan hydrogel beads promoted by hydrogen bond, Carbohydr. Polym. source

  • May combine two claims.

    Premisecitation

    β-Chitosan, found in squid pens, has a parallel chain structure, leading to lower crystallinity, higher solubility, and flexibility.

    “β-Chitosan, found in squid pens, has a parallel chain structure, leading to lower crystallinity, higher solubility, and flexibility (Figure 8) [157,159].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [157] Pohling, 2022, Comprehensive review on pre-treatment of native, crystalline chitin using non-toxic and mechanical processes in preparation for biomaterial applications, Green Chem. source
    • cites [159] Raihan, M.J. (2020). Exploring the Properties of Chitin for Promoting Tissue Engineering and Repair, South Dakota State University.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    β-Chitosan's swelling and higher water absorption helps maintain a hydrated environment, reducing fibrin bridge formation, a key factor in adhesion development.

    “Its swelling and higher water absorption helps maintain a hydrated environment, reducing fibrin bridge formation, a key factor in adhesion development [162,163].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [162] Gupta, 2000, An overview on chitin and chitosan applications with an emphasis on controlled drug release formulations, J. Macromol. Sci. Part C Polym. Rev. source
    • cites [163] Li, 2019, Review on adaptation between biomaterials function of chitosan and its structure, Med. Res. source

  • May combine two claims.

    Interpretationcitation

    The tChi/tHA hydrogel has a dual role as both a physical barrier and an active modulator of inflammation, offering a promising strategy for effective adhesion prevention.

    “These results highlight the hydrogel’s dual role as both a physical barrier and an active modulator of inflammation, offering a promising strategy for effective adhesion prevention (Figure 8C) [151].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [151] Zheng, 2025, Injectable antioxidant hyaluronan/chitosan hydrogel as a platelet-rich plasma and stem cell carrier to promote endometrial regeneration and fertility restoration, Acta Biomater. source

  • May combine two claims.

    Premisecitation

    Bacterial-derived alginates, such as those produced by Pseudomonas aeruginosa and Azotobacter vinelandii, typically have higher M-block content, resulting in softer, more elastic gels that degrade quickly and may lack sufficient mechanical strength for long-term barrier use.

    “Bacterial-derived alginates, such as those produced by Pseudomonas aeruginosa and Azotobacter vinelandii, typically have higher M-block content, resulting in softer, more elastic gels that degrade quickly and may lack sufficient mechanical strength for long-term barrier use [183,184].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [183] Wang, 2023, Alginate: Microbial production, functionalization, and biomedical applications, Int. J. Biol. Macromol. source
    • cites [184] Clementi, 1997, Alginate production by Azotobacter vinelandii, Crit. Rev. Biotechnol. source

  • May combine two claims.

    Premisecitation

    High-M alginates yield softer, more elastic gels that degrade more rapidly, making them more adaptable to dynamic tissue environments but less suitable for long-term adhesion prevention.

    “In contrast, high-M alginates yield softer, more elastic gels that degrade more rapidly, making them more adaptable to dynamic tissue environments but less suitable for long-term adhesion prevention [186].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [186] Smith, 2021, Alginate hydrogels with tuneable properties, Tunable Hydrogels Smart Mater. Biomed. Appl. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Alginate has been widely explored in biomedical applications due to its excellent biocompatibility, non-toxicity, and ability to form hydrogels.

    “Alginate has been widely explored in biomedical applications due to its excellent biocompatibility, non-toxicity, and ability to form hydrogels.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Chen, 2023, Biomaterials/bioinks and extrusion bioprinting, Bioact. Mater. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    Although chitosan is classified as Generally Recognized as Safe by the U.S. FDA for certain food applications, its medical-grade use requires rigorous purification to meet endotoxin, sterility, and biocompatibility standards, which can complicate clinical translation.

    “Although chitosan is classified as Generally Recognized as Safe (GRAS) by the U.S. FDA for certain food applications, its medical-grade use—especially in injectable or implantable products—requires rigorous purification to meet endotoxin, sterility, and biocompatibility standards, which can complicate its clinical translation [149].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [149] Kean, 2010, Biodegradation, biodistribution and toxicity of chitosan, Adv. Drug Deliv. Rev. source

  • May combine two claims.

    Premisecitation

    α-Chitosan, derived from crustacean shells, has an anti-parallel polymer arrangement, resulting in high crystallinity and mechanical strength.

    “α-Chitosan, derived from crustacean shells, has an anti-parallel polymer arrangement, resulting in high crystallinity and mechanical strength [154,155].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [154] Blackwell, 1969, Structure of β-chitin or parallel chain systems of poly-β-(1→4)-N-acetyl-D-glucosamine, Biopolym. Orig. Res. Biomol. source
    • cites [155] Jafari, 2020, Chitooligosaccharides for wound healing biomaterials engineering, Mater. Sci. Eng. C source

  • May combine two claims.

    Premisecitation

    γ-Chitosan has better flexibility than α-chitosan but is less soluble than β-chitosan.

    “It has better flexibility than α-chitosan but is less soluble than β-chitosan [164].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [164] Hasan, S., Boddu, V.M., Viswanath, D.S., and Ghosh, T.K. (2022). The Structural Difference Between Chitin and Chitosan. Chitin and Chitosan: Science and Engineering, Springer International Publishing. source

  • May combine two claims.

    Premisecitation

    γ-Chitosan offers a sustained anti-adhesion effect while allowing controlled degradation to support wound healing and tissue regeneration.

    “It also offers a sustained anti-adhesion effect while allowing controlled degradation to support wound healing and tissue regeneration [165].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [165] Hamedi, 2022, Chitosan based bioadhesives for biomedical applications: A review, Carbohydr. Polym. source

  • May combine two claims.

    Premisecitation

    High-G alginates form stiffer, more stable hydrogels due to enhanced ionic crosslinking, making them better suited for prolonged adhesion prevention.

    “In contrast, high-G alginates form stiffer, more stable hydrogels due to enhanced ionic crosslinking, making them better suited for prolonged adhesion prevention [153,154].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [153] Gopi, S., Thomas, S., and Pius, A. (2020). Chapter 1—Chitin and chitosan: Origin, properties, and applications. Handbook of Chitin and Chitosan, Elsevier. source
    • cites [154] Blackwell, 1969, Structure of β-chitin or parallel chain systems of poly-β-(1→4)-N-acetyl-D-glucosamine, Biopolym. Orig. Res. Biomol. source

  • May combine two claims.

    Premisecitation

    An injectable, in situ gelling hydrogel using allyl-functionalized chitosan combined with L-serine and loaded with platelet-rich plasma is mechanically adaptive, conforming to the uterus shape, and degrades over time.

    “Recently, researchers developed an injectable, in situ gelling hydrogel using allyl-functionalized chitosan (a chemically modified chitosan) combined with L-serine as a trigger and loaded with platelet-rich plasma. This hydrogel is mechanically adaptive, conforming to the uterus shape, and degrades over time [150].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [150] Lv, 2024, Injectable, degradable, and mechanically adaptive hydrogel induced by L-serine and allyl-functionalized chitosan with platelet-rich plasma for treating intrauterine adhesions, Acta Biomater. source

  • May combine two claims.

    Premisecitation

    Alginate-collagen composites provide enhanced bioactivity, mimicking the extracellular matrix while promoting cellular interactions and tissue integration.

    “For example, alginate–collagen composites provide enhanced bioactivity, mimicking the extracellular matrix while promoting cellular interactions and tissue integration [178].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [178] Azarpira, 2021, Incorporation of VEGF-and bFGF-loaded alginate oxide particles in acellular collagen-alginate composite hydrogel to promote angiogenesis, Tissue Cell source

  • May combine two claims.

    Premisecitation

    α-Chitosan's low solubility limits its direct use as an injectable or hydrogel-based barrier, but crosslinked α-chitosan films can provide durable physical barriers that prevent tissue adhesion.

    “While its low solubility limits its direct use as an injectable or hydrogel-based barrier, crosslinked α-chitosan films can provide durable physical barriers that prevent tissue adhesion [156].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [156] Chen, 1994, Effects of pH, ionic strength, and type of anion on the rheological properties of chitosan solutions, Acta Polym. source

  • May combine two claims.

    Premisecitation

    High-G alginates form stronger, more rigid gels due to enhanced ionic crosslinking, making them suitable for applications requiring prolonged barrier function.

    “High-G alginates form stronger, more rigid gels due to enhanced ionic crosslinking, making them suitable for applications requiring prolonged barrier function [185].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [185] Aravamudhan, A., Ramos, D.M., Nada, A.A., and Kumbar, S.G. (2014). Natural polymers: Polysaccharides and their derivatives for biomedical applications. Natural and Synthetic Biomedical Polymers, Elsevier. source

  • May combine two claims.

    Premisecitation

    PEG remains biologically passive and ensures minimal immune activation, unlike hydrophobic polymers that may promote localized inflammatory responses.

    “Unlike hydrophobic polymers, which may unintentionally promote localized inflammatory responses, PEG remains biologically passive, ensuring minimal immune activation [211].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [211] Shi, 2022, To PEGylate or not to PEGylate: Immunological properties of nanomedicine’s most popular component, polyethylene glycol and its alternatives, Adv. Drug Deliv. Rev. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    After a barrier degrades in the peritoneal cavity, its remnants are cleared via one or more excretion routes: renal, hepatic/biliary, or respiratory, sometimes with intermediate lymphatic transport.

    “After a barrier degrades in the peritoneal cavity, its remnants are cleared via one or more excretion routes: renal (urinary) excretion, hepatic/biliary excretion, or respiratory excretion (as metabolized CO2), sometimes with intermediate steps like lymphatic transport (Figure 11).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Biomaterials used in adhesion barriers must be safely eliminated from the body.

  • May combine two claims.

    Premisecitation

    The FDA has raised concerns about the safety and effectiveness of PP meshes, leading to reclassification as high-risk Class III and withdrawal of certain products from the market.

    “Notably, the U.S. Food and Drug Administration (FDA) has raised concerns regarding the safety and effectiveness of PP meshes, leading to the reclassification of these devices as high-risk (Class III) and the subsequent withdrawal of certain products from the market [249,250].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [249] Shoureshi, 2021, Media coverage of the 2019 United States Food and Drug Administration ordered withdrawal of vaginal mesh products for pelvic organ prolapse, Int. Urogynecology J. source
    • cites [250] U.S. Food and Drug Administration (2019, June 17). Urogynecologic Surgical Mesh Implants, Available online: https://www.fda.gov/medical-devices/implants-and-prosthetics/urogynecologic-surgical-mesh-implants.

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Blending PCL with hydrophilic or bioactive polymers reduces surface hydrophobicity and enhances wettability, leading to better cell adhesion and viability.

    “Blending PCL with hydrophilic or bioactive polymers reduces surface hydrophobicity and enhances wettability, leading to better cell adhesion and viability.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    PEG is a highly effective biomaterial for anti-adhesion barrier films, offering exceptional biocompatibility, non-fouling surface properties, and adaptability in formulation, but optimizing its degradation rate remains a key challenge because excessively rapid resorption may compromise long-term efficacy.

    “Overall, PEG is a highly effective biomaterial for anti-adhesion barrier films, offering exceptional biocompatibility, non-fouling surface properties, and adaptability in formulation. However, optimizing its degradation rate remains a key challenge, as excessively rapid resorption may compromise long-term efficacy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    PP's non-degradable nature can trigger a chronic inflammatory response, which may lead to mesh encapsulation or fibrosis.

    “While it provides excellent mechanical support, its presence in the body can trigger a chronic inflammatory response, which may lead to mesh encapsulation or fibrosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    PP's popularity stems from its excellent mechanical properties, such as high tensile strength and durability.

    “Its popularity stems from its excellent mechanical properties, such as high tensile strength and durability.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    ePTFE's microporous structure allows selective tissue integration while preventing excessive tissue adhesion, making it suitable for abdominal and pelvic surgeries.

    “The material’s microporous structure allows selective tissue integration while preventing excessive tissue adhesion, making it suitable for use in abdominal and pelvic surgeries.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    Post-surgical adhesion barriers are typically made of biodegradable biopolymers (natural or synthetic), obviating the need for surgical removal.

    “They are typically made of biodegradable biopolymers (natural or synthetic), obviating the need for surgical removal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Post-surgical adhesion barriers are thin films, gels, or membranes placed in the peritoneal cavity to prevent tissues from sticking together during healing.

    “Post-surgical adhesion barriers are thin films, gels, or membranes placed in the peritoneal cavity to prevent tissues from sticking together during healing.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    PEG can be engineered into hydrogels that form a soft, flexible, water-retentive barrier mimicking natural tissue environments and helping maintain tissue separation during critical healing phases.

    “Furthermore, PEG can be engineered into hydrogels, forming a soft, flexible, and water-retentive barrier that closely mimics natural tissue environments, helping to maintain tissue separation during critical healing phases [212].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [212] Tan, 2010, Novel multiarm PEG-based hydrogels for tissue engineering, J. Biomed. Mater. Res. A source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Interpretationreasoning

    PLGA remains a cornerstone biomaterial for postoperative adhesion barriers, offering customizable degradation rates, excellent biocompatibility, and adaptable mechanical properties.

    “Despite these challenges, PLGA remains a cornerstone biomaterial for postoperative adhesion barriers, offering customizable degradation rates, excellent biocompatibility, and adaptable mechanical properties.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A 50:50 LA:GA ratio results in a faster-degrading, more amorphous structure suitable for short-term barrier applications, while a higher lactic acid content (e.g., 85:15 LA:GA) increases crystallinity and hydrophobicity, leading to slower degradation and prolonged tissue separation.

    “A 50:50 ratio results in a faster-degrading, more amorphous structure, suitable for short-term barrier applications, while a higher lactic acid content (e.g., 85:15 LA:GA) increases crystallinity and hydrophobicity, leading to slower degradation and prolonged tissue separation [226,227,228].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [226] Vlachopoulos, A., Karlioti, G., Balla, E., Daniilidis, V., Kalamas, T., Stefanidou, M., Bikiaris, N.D., Christodoulou, E., Koumentakou, I., and Karavas, E. (2022). Poly (lactic acid)-based microparticles for drug delivery applications: An overview of recent advances. Pharmaceutics, 14. source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [227] Jin, 2021, Recent advances in PLGA-based biomaterials for bone tissue regeneration, Acta Biomater. source
    • cites [228] Kırımlıoğlu, G.Y. (2023). History, introduction, and properties of PLGA as a drug delivery carrier. Poly (Lactic-Co-Glycolic Acid)(PLGA) Nanoparticles for Drug Delivery, Elsevier. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    ePTFE is manufactured through a specialized expansion process that results in a microporous structure.

    “ePTFE is manufactured through a specialized process that expands the material, resulting in a microporous structure [238].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [238] Roina, 2022, ePTFE-based biomedical devices: An overview of surgical efficiency, J. Biomed. Mater. Res. Part B Appl. Biomater. source

  • May combine two claims.

    Premisecitation

    Seprafilm breaks down into soluble fragments that are excreted primarily through the kidneys; radiolabel studies showed Seprafilm is completely cleared from the body within 28 days, mostly via urine.

    “For instance, the absorbable HA/CMC barrier Seprafilm breaks down into soluble fragments that are excreted primarily through the kidneys. Radiolabel studies showed that Seprafilm is completely cleared from the body within 28 days, mostly via urine [251].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [251] Burns, 1997, Preclinical evaluation of Seprafilm bioresorbable membrane, Eur. J. Surg. Suppl.

  • May combine two claims.

    Interpretationreasoning

    PCL is an effective, long-lasting synthetic biomaterial for postoperative anti-adhesion barrier films, providing sustained protection against tissue adhesions while degrading in a controlled manner.

    “Overall, PCL stands out as an effective, long-lasting synthetic biomaterial for postoperative anti-adhesion barrier films, providing sustained protection against tissue adhesions while degrading in a controlled manner.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    PLGA has been widely utilized in biomedical and pharmaceutical applications due to its biodegradability, biocompatibility, and tunable degradation rate.

    “Poly(lactic-co-glycolic acid) (PLGA) has been widely utilized in biomedical and pharmaceutical applications due to its biodegradability, biocompatibility, and tunable degradation rate [224].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [224] Nair, 2007, Biodegradable polymers as biomaterials, Progress Polym. Sci. source

  • May combine two claims.

    Premisecitation

    PCL-based films effectively serve as physical barriers, preventing the adhesion of healing tissues and reducing the risk of fibrotic scarring following surgical procedures.

    “PCL-based films effectively serve as physical barriers, preventing the adhesion of healing tissues and reducing the risk of fibrotic scarring following surgical procedures [193].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [193] Zimmerling, A., Yazdanpanah, Z., Cooper, D.M.L., Johnston, J.D., and Chen, X. (2021). 3D printing PCL/nHA bone scaffolds: Exploring the influence of material synthesis techniques. Biomater. Res., 25. source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Premisecitation

    Lightweight and large-pore PP meshes have been developed to reduce the amount of implanted material, thus lowering the inflammatory response and improving patient outcomes.

    “To address these issues, lightweight and large-pore PP meshes have been developed to reduce the overall amount of implanted material, thus lowering the inflammatory response and improving patient outcomes [247].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [247] Jacob, 2012, Comparison of a lightweight polypropylene mesh (Optilene® LP) and a large-pore knitted PTFE mesh (GORE® INFINIT® mesh)—Biocompatibility in a standardized endoscopic extraperitoneal hernia model, Langenbeck’s Arch. Surg. source

  • May combine two claims.

    Premisecitation

    Oxidative degradation driven by reactive oxygen species in inflamed tissues can compromise PEG's long-term stability in vivo and reduce its effectiveness in maintaining prolonged tissue separation.

    “In particular, oxidative degradation—driven by reactive oxygen species (ROS) in inflamed tissues—can compromise PEG’s long-term stability in vivo, reducing its effectiveness in maintaining prolonged tissue separation [219].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [219] Ulbricht, 2014, On the biodegradability of polyethylene glycol, polypeptoids and poly(2-oxazoline)s, Biomaterials source

  • May combine two claims.

    Premisecitation

    PCL's structure includes five methylene groups between the ester linkages, making it more hydrophobic compared to other polyesters like polylactic acid and polyglycolic acid.

    “Its structure includes five methylene groups between the ester linkages, making it more hydrophobic compared to other polyesters like polylactic acid (PLA) and polyglycolic acid (PGA) [194].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [194] Mudoi, M.P., and Sinha, S. (2022). Biodegradable polymer-based natural fiber composites. Natural Fiber Composites, CRC Press. source

  • May combine two claims.

    Premisecitation

    Glycolic acid from PLGA is excreted renally, while lactic acid enters the Krebs cycle and is metabolized to carbon dioxide and water.

    “These monomers are naturally eliminated: glycolic acid is excreted renally, while lactic acid enters the Krebs cycle and is metabolized to carbon dioxide and water [232].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [232] Ramchandani, 1997, The influence of manufacturing procedure on the degradation of poly(lactide-co-glycolide) 85:15 and 50:50 implants, J. Control. Release source

  • May combine two claims.

    Premisenone given

    The kidneys efficiently filter water-soluble molecules below a certain size, and small polymer fragments, oligomers, or monomers can pass through the glomerular filter and be excreted in urine.

    “The kidneys efficiently filter water-soluble molecules below a certain size. Small polymer fragments, oligomers, or monomers can pass through the glomerular filter and are excreted in urine.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The success of products like Seprafilm, Interceed, and newer hydrogel barriers showcases how leveraging physiological excretion routes can yield materials that are both efficacious in preventing adhesions and safe in the long term.

    “The success of products like Seprafilm®, Interceed®, and newer hydrogel barriers showcases how leveraging physiological excretion routes can yield materials that are both efficacious in preventing adhesions and safe in the long term.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Biomaterials used in adhesion barriers must be safely eliminated from the body.
    • Rests on an assumption: Improper elimination of anti-adhesion barrier materials can lead to foreign body reactions, organ accumulation, or toxicity.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    Conventional fabrication methods including gas foaming, freeze drying, porogen leaching, phase separation, and melt molding can create porous structures and are widely used in developing anti-adhesion barriers.

    “Conventional methods, including gas foaming, freeze drying, porogen leaching, phase separation, and melt molding, are able to create porous structures and thus widely used in developing anti-adhesion barriers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Recent research has broadened the biomaterials landscape with the incorporation of synthetic polymers, composite hydrogels, and bioengineered scaffolds.

    “Recent research has broadened the biomaterials landscape with the incorporation of synthetic polymers, composite hydrogels, and bioengineered scaffolds.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Oxidized cellulose degrades to glucose acid units that can be metabolized to CO2 and H2O, and collagen/gelatin break into amino acids that are reused or oxidized.

    “Other biopolymers that break down into sugars or other metabolic intermediates follow a similar fate—e.g., oxidized cellulose degrades to glucose acid units that can be metabolized to CO2 and H2O, and collagen/gelatin break into amino acids that are reused or oxidized.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Electrospinning uses a high-voltage electric field to draw polymer solutions into ultrafine fibers that solidify into a non-woven fabric-like film, producing nanofibrous mats with high surface area and porosity suitable as physical barriers.

    “Electrospinning uses a high-voltage electric field to draw polymer solutions into ultrafine fibers, which then solidify into a non-woven fabric-like film. This technique can produce nanofibrous mats with high surface area and porosity, suitable as physical barriers.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Customized anti-adhesion membranes or patches ensure better conformity and reduce complications associated with improper barrier placement.

    “With advances in 3D printing and imaging technologies, it is increasingly feasible to fabricate anti-adhesion membranes or patches customized to individual anatomical defects, ensuring better conformity and reducing complications associated with improper barrier placement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Icodextrin is too large for direct absorption into blood capillaries; when 4% icodextrin is left in the peritoneum, it is slowly transferred into systemic circulation by peritoneal lymphatic drainage.

    “For example, icodextrin (a starch-based polymer used in Adept® adhesion reduction solution) is too large for direct absorption into blood capillaries. Instead, when 4% icodextrin is left in the peritoneum, it is slowly transferred into systemic circulation by peritoneal lymphatic drainage [256].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [256] Verco, 2002, A randomized, controlled pilot study of the safety and efficacy of 4% icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery, Human Reprod. source

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The limitations of current clinically approved barriers highlight the need for further innovation.

    “While these materials have demonstrated efficacy, their limitations—including poor mechanical strength, rapid degradation, and difficulty conforming to irregular anatomical sites—highlight the need for further innovation.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Current clinically approved barriers have poor mechanical strength.
    • Rests on an assumption: Current clinically approved barriers have rapid degradation.
    • Rests on an assumption: Current clinically approved barriers have difficulty conforming to irregular anatomical sites.

  • May combine two claims.

    Premisenone given

    Bioprinting is technically complex and time-consuming, requiring specialized equipment and bioink formulations; current 3D-printed anti-adhesion films are mostly preclinical, with challenges in scaling up, sterilization, and regulatory approval for clinical use.

    “Limitations: Bioprinting is technically complex and time-consuming, requiring specialized equipment and bioink formulations. Current 3D-printed anti-adhesion films are mostly in preclinical stages, and challenges remain in scaling up, sterilization, and regulatory approval for clinical use.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Phase separation creates tissue engineering scaffolds with tailored mechanical properties and controlled pore sizes by dissolving biodegradable polymers, inducing phase separation, solidifying the polymer-rich phase into interconnected pores, washing residual solvents, and seeding cells.

    “Phase separation is a technique used in tissue engineering to create scaffolds with tailored mechanical properties and controlled pore sizes. This technique in tissue engineering involves several key steps to develop scaffolds with tailored properties. Initially, suitable biodegradable polymers (either natural or synthetic) are selected and dissolved in a solvent to form a homogeneous solution.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [269] Chen, D.X.B. (2019). Extrusion Bioprinting of Scaffolds. Extrusion Bioprinting of Scaffolds for Tissue Engineering Applications, Springer International Publishing. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Such films can be highly conformable.

    “Such films can be highly conformable and tailored to various surgical scenarios.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Gas foaming is a cost-effective tissue engineering technique that can achieve porosity up to 90% by nucleation and growth of gas bubbles within a polymer.

    “Gas foaming is a technique used in tissue engineering to create porous structures, especially in hydrogels. This method is cost-effective and can achieve high porosity levels up to 90%. It involves the nucleation and growth of gas bubbles within a polymer, which forms an internal phase where porosity is introduced.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [269] Chen, D.X.B. (2019). Extrusion Bioprinting of Scaffolds. Extrusion Bioprinting of Scaffolds for Tissue Engineering Applications, Springer International Publishing. source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    It is increasingly feasible to fabricate anti-adhesion membranes or patches customized to individual anatomical defects with advances in 3D printing and imaging technologies.

    “With advances in 3D printing and imaging technologies, it is increasingly feasible to fabricate anti-adhesion membranes or patches customized to individual anatomical defects, ensuring better conformity and reducing complications associated with improper barrier placement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Freeze drying (lyophilization) is a tissue engineering technique involving freezing, primary drying (sublimation), and secondary drying (desorption) to create scaffolds with specific geometries, particularly useful for organ-specific scaffolds.

    “Freeze drying, also known as lyophilization, is a technique used in tissue engineering to create scaffolds with specific geometries. It involves three main stages: freezing, primary drying (sublimation), and secondary drying (desorption). This method is particularly useful for generating organ-specific scaffolds that can support tissue development and repair (Figure 12B) [269].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [269] Chen, D.X.B. (2019). Extrusion Bioprinting of Scaffolds. Extrusion Bioprinting of Scaffolds for Tissue Engineering Applications, Springer International Publishing. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    The degradation products of adhesion barriers-sugars, acids, or polymer fragments-are eliminated through the body's excretory routes.

    “The degradation products—whether they are sugars, acids, or polymer fragments—are then eliminated through the body’s excretory routes.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Biomaterials used in adhesion barriers must be safely eliminated from the body.

  • May combine two claims.

    Interpretationreasoning

    A well-designed barrier will maintain an effective presence during the risk period for adhesion formation, then biodegrade into biocompatible units that are efficiently eliminated via renal, hepatic, and metabolic pathways.

    “A well-designed barrier will maintain an effective presence during the risk period for adhesion formation, then biodegrade into biocompatible units that are efficiently eliminated via renal, hepatic, and metabolic pathways.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Biomaterials used in adhesion barriers must be safely eliminated from the body.
    • Rests on an assumption: Improper elimination of anti-adhesion barrier materials can lead to foreign body reactions, organ accumulation, or toxicity.

  • May combine two claims.

    Premisecitation

    An ideal gas foaming method avoids surfactants and organic solvents, making it suitable for biomedical applications.

    “Importantly, an ideal gas foaming method avoids the use of surfactants and organic solvents, making it suitable for biomedical applications (Figure 12A) [269].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [269] Chen, D.X.B. (2019). Extrusion Bioprinting of Scaffolds. Extrusion Bioprinting of Scaffolds for Tissue Engineering Applications, Springer International Publishing. source

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Regulatory pathways for multifunctional or living biomaterials will require robust preclinical validation.

    “Regulatory pathways for multifunctional or living biomaterials are complex and will require robust preclinical validation.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Regulatory pathways for multifunctional or living biomaterials are complex.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Such films can be tailored to various surgical scenarios.

    “Such films can be highly conformable and tailored to various surgical scenarios.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Integrating conventional and advanced fabrication techniques would allow overcoming limitations of individual methods and shows promise for next-generation anti-adhesion barriers with improved performance.

    “Furthermore, research has shown that integrating conventional and advanced fabrication techniques would allow for overcoming the limitations of individual methods, with this approach showing promise for the development of next-generation anti-adhesion barriers with improved performance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Layer-by-layer assembly involves depositing alternating layers of materials, often oppositely charged polymers or biomolecules, to build a film with nanometer-scale control over thickness and composition.

    “Layer-by-layer (LbL) assembly involves depositing alternating layers of materials—often oppositely charged polymers or biomolecules—to build up a film with nanometer-scale control over thickness and composition.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Molecular weight plays a pivotal role in the fate of anti-adhesion barrier materials: small breakdown products flow to urine, very large ones require capture and processing by the liver or immune cells, and many polymer metabolites are breathed out as carbon dioxide.

    “Molecular weight plays a pivotal role: small breakdown products flow to the urine, very large ones require capture and processing by the liver or immune cells, and many polymer metabolites are simply breathed out as carbon dioxide.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The majority of high-molecular-weight HA produced in the body is captured and metabolized by the liver, with liver sinusoidal endothelium and Kupffer cells clearing most circulating HA each day.

    “Natural macromolecules illustrate this route: the majority of high-molecular-weight HA produced in the body is captured and metabolized by the liver, with the liver sinusoidal endothelium and Kupffer cells clearing most circulating HA each day [252].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [252] Jin, 2023, The role of hyaluronan in renal cell carcinoma, Front. Immunol. source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Novel fabrication strategies such as electrospinning, 3D bioprinting, melt electrowriting, and layer-by-layer assembly have enabled the creation of anti-adhesion films with tunable porosity, degradation kinetics, and mechanical properties.

    “Novel fabrication strategies such as electrospinning, 3D bioprinting, melt electrowriting, and layer-by-layer assembly have enabled the creation of anti-adhesion films with tunable porosity, degradation kinetics, and mechanical properties.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    SprayGel/SprayShield (PEG hydrogel) is a sprayable PEG-based synthetic gel that polymerizes on tissues and remains for ~5-7 days before degrading and absorbing.

    “SprayGel®/SprayShield®(Radio Systems Corporation, Knoxville, TN, USA) (PEG hydrogel)—a sprayable PEG-based synthetic gel that polymerizes on tissues and remains for ~5–7 days before degrading and absorbing [266].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [266] Ferland, 2009, Pre-clinical evaluation of a next-generation spray adhesion barrier for multiple site adhesion protection, Surg. Technol. Int.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Studies using recombinant collagen, silk fibroin composites, decellularized extracellular matrices (dECM), and advanced alginate-based hydrogels have opened new avenues for developing biologically instructive anti-adhesion systems.

    “Studies using recombinant collagen, silk fibroin composites, decellularized extracellular matrices (dECM), and advanced alginate-based hydrogels have opened new avenues for developing biologically instructive anti-adhesion systems.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    For PEG, larger chains (~50 kDa and above) show increased uptake by Kupffer cells and higher biliary excretion.

    “for PEG, studies have shown a shift toward hepatobiliary clearance for larger chains—PEG ~50 kDa and above results in increased uptake by Kupffer cells and higher biliary excretion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Synthetic polymers such as PLA, PLGA, PEG-based hydrogels, and other absorbable polymers are widely utilized, typically formulated into absorbable films or gels applied over injured peritoneal surfaces to prevent adhesion formation.

    “Synthetic polymers—such as polyesters like polylactic acid (PLA), its copolymer PLGA, polyethylene glycol (PEG)-based hydrogels, and other absorbable polymers—are also widely utilized. These materials are typically formulated into absorbable films or gels designed to be applied over injured peritoneal surfaces to prevent adhesion formation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Conventional fabrication techniques often have limitations in precise structural control, mechanical tunability, and surface functionalization.

    “Notably, conventional techniques often have limitations in terms of precise structural control, mechanical tunability, and surface functionalization.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Natural biopolymers including hyaluronic acid, cellulose derivatives, collagen/gelatin, chitosan, alginate, and starch-based materials have shown considerable promise and are traditionally used in anti-adhesion barrier films.

    “Natural biopolymers—including hyaluronic acid, cellulose derivatives, collagen/gelatin, chitosan, alginate, and starch-based materials—have shown considerable promise. These are traditionally used in the formulation of anti-adhesion barrier films.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    An in situ, spray-fabricated, double-layer hydrogel with an inner healing-promotive alginate-gelatin layer topped with an anti-adhesive alginate-CMC layer significantly reduced post-hepatectomy adhesion severity in rats, whereas either single layer alone was ineffective.

    “Researchers reported that an in situ, spray-fabricated, double-layer hydrogel (an inner healing-promotive alginate–gelatin layer topped with an anti-adhesive alginate–CMC layer) significantly reduced post-hepatectomy adhesion severity in rats, whereas either single layer alone was ineffective [277].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [277] Qi, 2019, In Situ Fabrication of Double-Layered Hydrogels via Spray Processes to Prevent Postoperative Peritoneal Adhesion, ACS Biomater. Sci. Eng. source

  • May combine two claims.

    Premisenone given

    Electrospun films can be mechanically delicate and may require careful handling or fixation, and achieving uniform thickness and ensuring the barrier stays in place during healing can be challenging in vivo.

    “Limitations: The resulting films can be mechanically delicate and may require careful handling or fixation. Additionally, achieving uniform thickness and ensuring the barrier stays in place during healing can be challenging in vivo.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Larger polymer fragments that cannot be filtered by the kidney often require clearance via the liver, potentially taken up by hepatic Kupffer cells or the mononuclear phagocyte system in the liver and spleen, then excreted in bile into the feces.

    “Larger polymer fragments that cannot be filtered by the kidney often require clearance via the liver. These may be taken up by hepatic Kupffer cells or by the mononuclear phagocyte system (MPS) in the liver and spleen, then excreted in bile into the feces.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Melt molding has drawbacks including potential residual porogen and high processing temperatures, which limit incorporation of bioactive molecules.

    “However, there are some drawbacks, such as the potential presence of residual porogen and high processing temperatures, which limit the incorporation of bioactive molecules.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Melt molding with porogen leaching is a nonsolvent fabrication method that allows independent control over scaffold morphology and shape.

    “Melt molding with porogen leaching is a nonsolvent fabrication method that allows for independent control over the scaffold’s morphology and shape [269].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [269] Chen, D.X.B. (2019). Extrusion Bioprinting of Scaffolds. Extrusion Bioprinting of Scaffolds for Tissue Engineering Applications, Springer International Publishing. source

  • May combine two claims.

    Premisecitation

    Increasing the number of bilayers on drug-loaded particles extended drug release from about 1 day to up to 5 days, which could help modulate inflammation and fibrosis during early healing.

    “Increasing the number of bilayers on the drug-loaded particles extended drug release from about 1 day to up to 5 days, which could help modulate inflammation and fibrosis during early healing.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The integration of bioactive agents into barrier systems is actively being explored to create multifunctional barriers.

    “Moreover, the integration of bioactive agents—such as anti-inflammatory drugs, growth factors, and stem cells—into barrier systems is actively being explored to create multifunctional barriers that not only prevent adhesions, but also promote tissue regeneration and reduce inflammatory cascades.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Interceed (ORC) is an oxidized regenerated cellulose fabric that becomes gel-like and is absorbed over ~2-4 weeks, depending on the application site.

    “Interceed® (ORC)—an oxidized regenerated cellulose fabric; becomes gel-like and is absorbed over ~2–4 weeks, depending on the application site [265].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [265] Linsky, 1987, Adhesion reduction in the rabbit uterine horn model using an absorbable barrier, TC-7, J. Reprod. Med.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Melt electrowriting (MEW) is an emerging high-resolution additive manufacturing technique that uses an electrostatic field to extrude and precisely deposit microscale polymer fibers from a molten polymer feed, creating highly structured porous meshes with controlled fiber alignment and spacing.

    “Melt electrowriting (MEW) is an emerging high-resolution additive manufacturing technique that uses an electrostatic field to extrude and precisely deposit microscale polymer fibers from a molten polymer feed. This method creates highly structured porous meshes with controlled fiber alignment and spacing—effectively a microscale 3D-printed fiber scaffold [273].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [273] Vakilian, 2024, Avastin-Loaded 3D-Printed Alginate Scaffold as an Effective Antiadhesive Barrier to Prevent Postsurgical Adhesion Bands Formation, Macromol. Biosci. source

  • May combine two claims.

    Premisecitation

    Once in the bloodstream, α-amylase rapidly depolymerizes icodextrin into smaller oligosaccharides, which are eliminated via the kidneys.

    “Once in the bloodstream, enzymes (α-amylase) rapidly depolymerize icodextrin into smaller oligosaccharides, which are then eliminated via the kidneys.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Cell-laden and tissue-engineered barriers are particularly relevant for complex injuries where simple mechanical separation is insufficient.

    “In parallel, cell-laden and tissue-engineered barriers—such as mesothelial cell-seeded scaffolds—represent an exciting frontier, particularly for complex injuries where simple mechanical separation is insufficient.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    MEW offers exceptional control over scaffold microstructure, enabling tunable pore sizes and alignment to promote healing and integration, and resulting microfiber films are typically stronger and more dimensionally stable than solution-electrospun mats, easing handling and placement.

    “Advantages: MEW offers exceptional control over scaffold microstructure, enabling tunable pore sizes and alignment to promote healing and integration (for example, by supporting a protective cell layer). The resulting microfiber films are typically stronger and more dimensionally stable than solution-electrospun mats, easing handling and placement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Seprafilm (HA/CMC) is a film of hyaluronic acid and carboxymethylcellulose that hydrates into a gel within hours and is fully resorbed in about a week.

    “Seprafilm® (HA/CMC)—a film of hyaluronic acid (HA) and carboxymethylcellulose; hydrates into a gel within hours and is fully resorbed in about a week [251].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [251] Burns, 1997, Preclinical evaluation of Seprafilm bioresorbable membrane, Eur. J. Surg. Suppl.

  • May combine two claims.

    Premisecitation

    A 3D-printed alginate scaffold loaded with bevacizumab significantly diminished the extent and strength of peritoneal adhesion bands in rats, reducing fibrosis and inflammation at the injury site by sustained local release of the drug, which lowered pro-angiogenic and pro-inflammatory signals (VEGF, IL-6) involved in adhesion formation.

    “In another study, a 3D-printed alginate scaffold loaded with the anti-VEGF drug bevacizumab (Avastin) significantly diminished the extent and strength of peritoneal adhesion bands in rats. The printed alginate/Avastin barrier reduced fibrosis and inflammation at the injury site by sustained local release of the drug, which lowered the pro-angiogenic and pro-inflammatory signals (VEGF, IL-6)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [273] Vakilian, 2024, Avastin-Loaded 3D-Printed Alginate Scaffold as an Effective Antiadhesive Barrier to Prevent Postsurgical Adhesion Bands Formation, Macromol. Biosci. source

  • May combine two claims.

    Interpretationreasoning

    Electrospinning is relatively simple and allows fine control of fiber diameter and composition, and barriers can be imbued with anti-inflammatory or anti-fibrotic agents for added efficacy.

    “Advantages: Electrospinning is relatively simple and allows fine control of fiber diameter and composition; barriers can be imbued with anti-inflammatory or anti-fibrotic agents for added efficacy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    An ibuprofen-loaded PEG/silk fibroin core-shell nanofiber membrane placed between injured peritoneal surfaces lightened adhesion bands and caused only a low-grade inflammatory reaction in rats.

    “Similarly, an ibuprofen-loaded PEG/silk fibroin core–shell nanofiber membrane, placed between injured peritoneal surfaces, lightened adhesion bands and caused only a low-grade inflammatory reaction in rats [271].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [271] Nadri, 2022, Prevention of peritoneal adhesions formation by core-shell electrospun ibuprofen-loaded PEG/silk fibrous membrane, Artif. Cells Nanomed. Biotechnol. source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Ensuring the uniformity of ultra-thin multilayers can be difficult.

    “Ensuring the uniformity and sufficient mechanical strength of ultra-thin multilayers can be difficult.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Emerging biomaterials that combine physical, biological, and therapeutic functions have the potential to dramatically improve patient outcomes after surgery.

    “Emerging biomaterials that combine physical, biological, and therapeutic functions have the potential to dramatically improve patient outcomes after surgery.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    MEW is limited to thermally processable polymers such as PCL and PLA and is a relatively slow fabrication process; the need for seeding patient-derived cells adds complexity, and without cells the scaffolds are purely passive barriers.

    “Limitations: MEW is limited to thermally processable polymers (e.g., PCL and PLA) and is a relatively slow fabrication process. The need for seeding patient-derived cells (to fully realize its benefits) adds complexity, and without cells the scaffolds are purely passive barriers.”
    Quote in the paperNot a substantial claim
192 of 192

  • The paper relies on this without support.

    Postoperative adhesions are inevitable after surgery despite advances in surgical technique.

    “Postoperative adhesions (POAs)—fibrous bands of scar tissue forming between organs after surgery—are a prevalent and serious complication across nearly all surgical fields and are inevitable.”

  • The paper relies on this without support.

    Decellularized ECM can be derived from a wide range of tissues and species—both allogeneic and xenogeneic—without requiring species specificity to the recipient.

    “Importantly, decellularized ECM can be derived from a wide range of tissues and species—both allogeneic and xenogeneic—without requiring species specificity to the recipient.”

  • The authors state this as an assumption.

    Biomaterials used in adhesion barriers must be safely eliminated from the body.

    “In biomaterial design, what goes in must safely come out.”

  • The paper relies on this without support.

    Improper elimination of anti-adhesion barrier materials can lead to foreign body reactions, organ accumulation, or toxicity.

    “Improper elimination can lead to foreign body reactions, organ accumulation, or toxicity, whereas optimal elimination ensures the barrier does its job and then leaves no harmful trace.”

  • The paper relies on this without support.

    Postoperative adhesions remain a significant cause of morbidity following gynecologic and abdominal surgeries.

    “Postoperative adhesions remain a significant cause of morbidity following gynecologic and abdominal surgeries, despite advancements in surgical techniques.”

  • The paper relies on this without support.

    Current clinically approved barriers have poor mechanical strength.

    “While these materials have demonstrated efficacy, their limitations—including poor mechanical strength, rapid degradation, and difficulty conforming to irregular anatomical sites—highlight the need for further innovation.”

  • The paper relies on this without support.

    Current clinically approved barriers have rapid degradation.

    “While these materials have demonstrated efficacy, their limitations—including poor mechanical strength, rapid degradation, and difficulty conforming to irregular anatomical sites—highlight the need for further innovation.”

  • The paper relies on this without support.

    Current clinically approved barriers have difficulty conforming to irregular anatomical sites.

    “While these materials have demonstrated efficacy, their limitations—including poor mechanical strength, rapid degradation, and difficulty conforming to irregular anatomical sites—highlight the need for further innovation.”

  • The paper relies on this without support.

    Regulatory pathways for multifunctional or living biomaterials are complex.

    “Regulatory pathways for multifunctional or living biomaterials are complex and will require robust preclinical validation.”
9 of 9

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Collagen-gel study is described as randomized but cited as retrospective

    Minor

    The text calls the study a multicenter, randomized study, whereas its cited reference identifies it as a multicenter retrospective study.

  • Cellulose is assigned two different constituent sugar units

    Minor

    The CMC section describes cellulose as made of D-glucose units, while the chitosan section assigns it 2-deoxy-D-glucopyranose units.

  • Two incompatible serine percentages are given for the silk fibroin heavy chain

    Minor

    Consecutive statements assign serine 5.3% and 12% of the silk fibroin heavy chain's amino acid composition.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Butnariu, 2022, General information about cellulose, J. Biotechnol. Bioprocess., 3, 1
  2. Roberts, 2007, The Road is long, Adv. Chitin Sci., 10, 3
  3. Park, J.-Y. (2018). Functional Nanofiber and Nanocoating for Biological Application. [Ph.D. Thesis, Keio University].
  4. Browning, 2014, Determination of the in vivo degradation mechanism of PEGDA hydrogels, J. Biomed. Mater. Res. A, 102, 4244
  5. Tekade, R.K. (2019). Chapter 2—Current Developments in Excipient Science: Implication of Quantitative Selection of Each Excipient in Product Development. Basic Fundamentals of Drug Delivery, Academic Press.

Cited by

Sorted by citations

Related

Authors
Fazel Anvari-Yazdi, A., Badea, I., & Chen, X.
Affiliations
  • Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Dr, Saskatoon, SK S7K 5A9, Canada
  • College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
ORCID
Venue
Gels
Publisher
MDPI AG
Published
2025-06-09
Volume
11
Issue
6
Pages
441
ISSN
2310-2861 (ISSN-L)
DOI
10.3390/gels11060441
PMC
PMC12191503
OpenAlex
W4411152325
Cited by
20
References
271
Citations by year
2026: 9 · 2025: 11
FWCI
4.33
Type
journal article
Language
en
Open access
Licence
Locations
  • Gels (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • HARVEST (University of Saskatchewan) (acceptedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Natural Sciences and Engineering Research Council (NSERC) of Canada (RGPIN 06369-2019, 2020-05315)
  • University of Saskatchewan’s Devolved Scholarship (RGPIN 06369-2019, 2020-05315)
Topics
  • Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
  • Health Sciences › Medicine › Surgery › Surgical Sutures and Adhesives
  • Health Sciences › Medicine › Surgery › Tissue Engineering and Regenerative Medicine
Keywords
postoperative adhesions, anti-adhesion barrier, biomaterials, natural biopolymers, synthetic polymers, collagen, gelatin, fibrin, silk fibroin, decellularized extracellular matrix, alginate, chitosan, carboxymethyl cellulose, polycaprolactone, polyethylene glycol, PLGA, biodegradation, electrospun membranes, gynecologic surgery

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-11-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-11-05.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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