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Chitogel improves wound healing through anti-inflammatory action and its ability to delay fibroblast migration.7 7Paramasivan S, Jones D, Baker L, Hanton L, Robinson S, Wormald PJ, Tan L. The Use of Chitosan-Dextran Gel Shows Anti-Flammatory, Antibiofilm, and Antiproliferative Properties in Fibroblast Cell Culture. Am J Rhinol Allergy. 2014 Sep-Oct;28(5):361-5.The dual effect of inhibiting inflammation and delaying fibroblast migration provides mechanisms for the anti-adhesion effect of Chitogel, as well as preserving the ostial patency of the sinus ostia.10 10Ha T, Valentine R, Moratti S, Robinson S, Hanton L, Wormald PJ. A blinded randomized controlled trial evaluating the efficacy of chitosan gel on ostial stenosis following endoscopic sinus surgery. Int Forum Allergy Rhinol. 2013 Jul;3(7):573-80.  

Chitogel also improves the speed of wound epithelialization, with studies showing that this epithelium recovers its ciliated surface, as shown on electron microscopy, significantly faster than where no gel has been used.2 2Athanasiadis T, Beule AG, Robinson BH, Robinson SR, Shi Z, Wormald PJ. Effects of a novel chitosan gel on mucosal wound healing following endoscopic sinus surgery in a sheep model of chronic rhinosinusitis. Larygoscope. 2008 Jun;118(6):1088-94.This indicates that Chitogel enhances epithelial migration and subsequent functionality, thereby improving the healing time and functioning of the mucosa and contributing to the increased ostial patency when using Chitogel.1 1Ha T, Valentine R, Moratti S, Hanton L, Robinson S, Wormald P-J. The efficacy of a novel budesonide chitosan gel on wound healing following endoscopic sinus surgery. Int Forum Allergy Rhinol. 2018 Mar;8(3):435-443.

Additionally, recent clinical research demonstrates that Chitogel significantly increases the abundance of commensal bacteria Corynebacterium accolens and Cutibacterium acnes forming the sinus microbiome, resulting in a healthier sinus environment.9 9Megow, A, Alsuliman Y, Bouras G, et al. Chitogel following endoscopic sinus surgery promotes a healthy microbiome and reduces postoperative infections. Int Forum Allergy Rhinol. 2022;1-15.

The importance of the microbiome in the sinonasal mucosal environment has been increasingly recognized, and is known to influence long-term sinus health and the need for revision surgery. A recent retrospective observational study demonstrated a significant reduction in revision surgeries among patients who underwent ESS with Chitogel, suggesting that use of Chitogel can improve long-term patient outcomes.16 16Barber JM, Bouras G, Robinson GS and Robinson SR. Chitogel improves long-term health economic outcomes following endoscopic sinus surgery in severe chronic rhinosinusitis patients. Front. Health Serv. 2024; 4:1196499. doi: 10.3389/frhs.2024.1196499.