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Karmakar D, Basu KS, Basu S, Chakrabarty S, Saha K, Ghosh D. Acellular Bovine Pericardial Patch for Difficult Abdominal Closure in the Pediatric Population: Our Experience with Review of Literature. J Indian Assoc Pediatr Surg 2024; 29:233-239. [PMID: 38912025 PMCID: PMC11192272 DOI: 10.4103/jiaps.jiaps_230_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/19/2023] [Accepted: 01/16/2024] [Indexed: 06/25/2024] Open
Abstract
Aims Closure of congenital body wall defects in children can be a challenging task for the pediatric Surgeon. Biological prosthesis has been increasingly used for high-risk wound closure in adult patients with excellent outcomes and use in the pediatric population has also been reported. Here, we aim to study the outcome of abdominal wound repair with a tissue-engineered acellular bovine pericardial patch. Methods Over a period of 21 months, a total of 15 children had undergone abdominal wound repair with bioprostheses, i.e., bovine pericardial patch at our institute. Patient demographics, cause of defect, an indication of patch use, rate of infection, postoperative recovery, recurrence, and outcome were studied. Results A total of 15 patients underwent abdominal wall closure with acellular bovine pericardial patch. Nine out of 15 patients were neonates, of whom five had gastroschisis, two had a congenital diaphragmatic hernia, and two had ruptured omphalocele major. Of the rest 6 patients, 2 were patients of bladder exstrophy, 2 were older children of congenital diaphragmatic hernia with incisional hernias, and 2 were older children with omphalocele major. Out of the five patients with gastroschisis, two died during the early postoperative period due to sepsis. The wound healed in the rest 13 patients with mild skin dehiscence in two patients. Only one child had a recurrence. Conclusion Reconstruction with acellular bovine pericardial patch is a viable option in children with high-risk abdominal wounds as it allows tensionless repair with excellent healing and minimal complications. Recurrence, if any, may disappear with time as remodeling of the prosthesis occurs along with the growth of the body wall of the child.
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Affiliation(s)
- Debalina Karmakar
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Kalyani Saha Basu
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Syamantak Basu
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Saikat Chakrabarty
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Koushik Saha
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Dipak Ghosh
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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de Haro Jorge I, Prat Ortells J, Martín-Solé O, Muñoz Fernandez E, Pertierra A, Martin-Lluis A, Tarrado X. Porcine dermal patches as a risk factor for recurrence after congenital diaphragmatic hernia repair. Pediatr Surg Int 2021; 37:59-65. [PMID: 33245446 DOI: 10.1007/s00383-020-04787-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Recurrence of congenital diaphragmatic hernia (CDH) is a treatment-related morbidity which can be preventable. There is no consensus about the ideal material for diaphragmatic substitution. The aim of our study is to identify if the use of porcine dermis patches increases the risk of CDH recurrence. METHODS Retrospective review of medical records of CDH patients treated between 2013 and 2017 in our center was carried out. Demographic, clinical and surgical variables were collected. Regression analysis was performed to identify which factors increase the risk of recurrence. RESULTS 50 patients entered the study. 94% of the patients had a left CDH, mean observed/expected lung-to-head ratio was 46%. 17 patients underwent a primary closure, the rest a patch closure: 25 Gore-Tex® and 8 porcine dermis patches were used. Seven patients presented recurrence (14%). Median follow-up time was 3.5 years (1.2-6.2). Univariate analysis revealed that the use of a porcine dermis patch (75%) increased the risk of recurrence compared with Gore-Tex® patch (4%) and primary closure (0%) p < 0.001 (HR 58.7; IC 95%: 6.9-501.2; p < 0.001). CONCLUSION The main risk factor for CDH recurrence is the use of a porcine dermis patch. We do not recommend the use of these patches for CDH repair.
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Affiliation(s)
- Irene de Haro Jorge
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain.
| | - Jordi Prat Ortells
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Oriol Martín-Solé
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Elena Muñoz Fernandez
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Africa Pertierra
- Department of Neonatology, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Alba Martin-Lluis
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Xavier Tarrado
- Department of Pediatric Surgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain
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Talon I, Schneider A, Ball V, Hemmerle J. Polydopamine Functionalization: A Smart and Efficient Way to Improve Host Responses to e-PTFE Implants. Front Chem 2019; 7:482. [PMID: 31338362 PMCID: PMC6629787 DOI: 10.3389/fchem.2019.00482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022] Open
Abstract
Among the different materials used as protheses for the treatment of Congenital Diaphragmatic Hernia, expanded polytetrafluoroethylene (e-PTFE) plays a leading role owing to its mechanical properties as explained in the first part of this review. However, this material is poorly cell adhesive, which is expected for its contact on the abdominal face, but should display specific tissue adhesion on its thoracic exposed faced. A side specific functionalization method is hence required. The deposition of a nanosized polydopamine film on PTFE is known to be possible but immersion of the e-PTFE membrane in an aerated dopamine solution leads to a functionalization not only on both faces of the membrane but also in its porous volume. The fact that polydopamine also forms at the water/air interface has allowed to transfer a polydopamine film on only one face of the e-PTFE membrane. The deposition method and applications of such Janus like membranes are reviewed in the second part of the review.
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Affiliation(s)
- Isabelle Talon
- Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
| | - Anne Schneider
- Service de Chirurgie Pédiatrique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
| | - Vincent Ball
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - Joseph Hemmerle
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1121, Strasbourg, France
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Abstract
Omphalocele is an abdominal wall defect involving the umbilical ring which results in visceral herniation of small and large intestine, liver, spleen and sometimes gonads. The covering of the herniated viscera by a fused membrane consisting of peritoneum, Wharton's jelly and amnion projects viscera from mechanical injury and exposure to chemical irritants in amniotic fluid. Omphalocele is usually diagnosed before birth, is variable in size, and is frequently associated with chromosomal and somatic anomalies, syndromes, and variable degrees of pulmonary hypoplasia which can be lethal. In this article we examine surgical closure options for omphaloceles ranging from early primary fascial repair for small omphaloceles to a staged repair, often facilitated by an amnion preserving silo, which may be necessary for giant omphaloceles that cannot be closed primarily. We also review some of the adjuncts to abdominal wall reconstruction including tissue expansion and mesh. Conservative management (paint and wait) of giant omphaloceles is described elsewhere.
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Affiliation(s)
- Erik D Skarsgard
- British Columbia Children's Hospital, Department of Surgery, University of British Columbia, K0-110 ACB 4480 Oak Street, V6H 3V4 Vancouver, British Columbia, Canada.
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Terazawa T, Furukoshi M, Nakayama Y. One-year follow-up study of iBTA-induced allogenic biosheet for repair of abdominal wall defects in a beagle model: a pilot study. Hernia 2018; 23:149-155. [PMID: 30506241 DOI: 10.1007/s10029-018-1866-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 11/25/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE We evaluated the usefulness of biosheet, an in-body tissue-engineered collagenous membrane, as a novel repair material for abdominal wall defects in a beagle model. METHODS Biosheets were prepared by embedding molds into subcutaneous pouches in two beagle dogs for 2 months, with subsequent storage in 70% ethanol. The obtained biosheets (thickness 0.5 mm, size 25 cm2) were implanted to replace same-size defects in the abdominal wall of two beagles in an allogenic manner. RESULTS The biosheets were not stressed during suturing and did not split; moreover, patch implantation into the defective wound was easy. No complications such as anastomotic leaks or infections occurred during implantation. One year post-implantation, the thickness of the biosheet implantation section increased to approximately 2.5 mm, corresponding to approximately 70% of the native abdominal wall. A section of the abdominal wall muscle elongated from the periphery of the newly formed collagen layer, and the peritoneum was entirely formed on the peritoneal cavity surface, resulting in partial regeneration of the three-layered abdominal wall. The mechanical strength of the newly formed wall was approximately fivefold higher than the native wall. The elasticity of the biosheet in the low-strain region decreased to approximately 10% post-implantation, similar to the native wall. CONCLUSIONS This pilot study demonstrated that biosheet maintained the abdominal wall without any complications for 1 year post-implantation, and partial regeneration was observed. Although this experiment was limited to two cases, the results indicated that biosheet may serve as a reliable abdominal wall restorative material.
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Affiliation(s)
- T Terazawa
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan.,Division of Cell Engineering, Graduate School of Chemical Science and Engineering, Hokkaido University, Kita 13 Nishi 8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan.,Biotube Co., Ltd, 2-13-11 Shinkawa, Chuo, Tokyo, 104-0033, Japan
| | - M Furukoshi
- Department of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center Research Institute, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan.,Division of Cell Engineering, Graduate School of Chemical Science and Engineering, Hokkaido University, Kita 13 Nishi 8, Kita-ku, Sapporo, Hokkaido, 060-8628, Japan
| | - Y Nakayama
- Biotube Co., Ltd, 2-13-11 Shinkawa, Chuo, Tokyo, 104-0033, Japan.
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