1
|
Trevisan C, Fallas MEA, Maghin E, Franzin C, Pavan P, Caccin P, Chiavegato A, Carraro E, Boso D, Boldrin F, Caicci F, Bertin E, Urbani L, Milan A, Biz C, Lazzari L, De Coppi P, Pozzobon M, Piccoli M. Generation of a Functioning and Self-Renewing Diaphragmatic Muscle Construct. Stem Cells Transl Med 2019; 8:858-869. [PMID: 30972959 PMCID: PMC6646700 DOI: 10.1002/sctm.18-0206] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Surgical repair of large muscular defects requires the use of autologous graft transfer or prosthetic material. Naturally derived matrices are biocompatible materials obtained by tissue decellularization and are commonly used in clinical practice. Despite promising applications described in the literature, the use of acellular matrices to repair large defects has been only partially successful, highlighting the need for more efficient constructs. Scaffold recellularization by means of tissue engineering may improve not only the structure of the matrix, but also its ability to functionally interact with the host. The development of such a complex construct is challenging, due to the complexity of the native organ architecture and the difficulties in recreating the cellular niche with both proliferative and differentiating potential during growth or after damage. In this study, we tested a mouse decellularized diaphragmatic extracellular matrix (ECM) previously described by our group, for the generation of a cellular skeletal muscle construct with functional features. The decellularized matrix was stored using different conditions to mimic the off‐the‐shelf clinical need. Pediatric human muscle precursors were seeded into the decellularized scaffold, demonstrating proliferation and differentiation capability, giving rise to a functioning three‐dimensional skeletal muscle structure. Furthermore, we exposed the engineered construct to cardiotoxin injury and demonstrated its ability to activate a regenerative response in vitro promoting cell self‐renewal and a positive ECM remodeling. Functional reconstruction of an engineered skeletal muscle with maintenance of a stem cell pool makes this a promising tool toward future clinical applications in diaphragmatic regeneration. stem cells translational medicine2019;8:858&869
Collapse
Affiliation(s)
- Caterina Trevisan
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy.,Department of Women and Children Health, University of Padova, Padova, Italy
| | - Mario Enrique Alvrez Fallas
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy.,Department of Women and Children Health, University of Padova, Padova, Italy
| | - Edoardo Maghin
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy.,Department of Women and Children Health, University of Padova, Padova, Italy
| | - Chiara Franzin
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Piero Pavan
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy.,Department of Industrial Engineering, University of Padova, Padova, Italy.,Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Paola Caccin
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Angela Chiavegato
- Department of Biomedical Sciences, University of Padova, Padova, Italy.,CNR Institute for Neuroscience, Padova, Italy
| | - Eugenia Carraro
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Daniele Boso
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | | | | | - Enrica Bertin
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Luca Urbani
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Institute of Hepatology, The Foundation for Liver Research, London, United Kingdom.,Faculty of Life Sciences & Medicine, King's College, London, United Kingdom
| | - Anna Milan
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy.,Department of Women and Children Health, University of Padova, Padova, Italy
| | - Carlo Biz
- Department of Surgery, Oncology, and Gastroenterology DiSCOG, Orthopaedic Clinic, University of Padova, Padua, Italy
| | - Lorenza Lazzari
- Laboratory of Regenerative Medicine - Cell Factory, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Paolo De Coppi
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Specialist Neonatal and Paediatric Surgery, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Michela Pozzobon
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy.,Department of Women and Children Health, University of Padova, Padova, Italy
| | - Martina Piccoli
- Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy.,Department of Biomedical Sciences, University of Padova, Padova, Italy
| |
Collapse
|
2
|
Diaphragmatic hernia repair using a rectus abdominis muscle pedicle flap in three dogs. Vet Comp Orthop Traumatol 2017; 26:135-9. [DOI: 10.3415/vcot-12-02-0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 09/11/2012] [Indexed: 11/17/2022]
Abstract
SummaryObjective: To report the clinical use of a pedicle flap from the rectus abdominis muscle to repair extensive diaphragmatic tears in dogs with diaphragmatic hernia.Materials and methods: Three dogs with a combination of radial and circumferential diaphragmatic tears were studied. The circumferential tear was repaired by suturing the wound edge with the edge at the abdominal wall. A pedicle flap of the rectus abdominis muscle was used for repairing the radial tear. The dogs were examined radiographically for lung and diaphragm appearance and evidence of reherniation at 10 days, and at one, two, and four months after surgery, and fluoroscopically for paradoxical motion of the diaphragm at one and four months.Results: The rectus abdominis muscle pedicle flap was successfully used in all three dogs. The animals recovered uneventfully without evidence of reherniation during the four follow-up months. Fluoroscopic examination revealed no paradoxical motion of the diaphragm.Clinical significance: A rectus abdominis muscle pedicle flap can be used for repairing large diaphragmatic defects in dogs.
Collapse
|
3
|
Eastwood MP, Joyeux L, Pranpanus S, Van der Merwe J, Verbeken E, De Vleeschauwer S, Gayan-Ramirez G, Deprest J. A growing animal model for neonatal repair of large diaphragmatic defects to evaluate patch function and outcome. PLoS One 2017; 12:e0174332. [PMID: 28358826 PMCID: PMC5373533 DOI: 10.1371/journal.pone.0174332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/07/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives We aimed to develop a more representative model for neonatal congenital diaphragmatic hernia repair in a large animal model, by creating a large defect in a fast-growing pup, using functional pulmonary and diaphragmatic read outs. Background Grafts are increasingly used to repair congenital diaphragmatic hernia with the risk of local complications. Growing animal models have been used to test novel materials. Methods 6-week-old rabbits underwent fiberoptic intubation, left subcostal laparotomy and hemi-diaphragmatic excision (either nearly complete (n = 13) or 3*3cm (n = 9)) and primary closure (Gore-Tex patch). Survival was further increased by moving to laryngeal mask airway ventilation (n = 15). Sham operated animals were used as controls (n = 6). Survivors (90 days) underwent chest X-Ray (scoliosis), measurements of maximum transdiaphragmatic pressure and breathing pattern (tidal volume, Pdi). Rates of herniation, lung histology and right hemi-diaphragmatic fiber cross-sectional area was measured. Results Rabbits surviving 90 days doubled their weight. Only one (8%) with a complete defect survived to 90 days. In the 3*3cm defect group all survived to 48 hours, however seven (78%) died later (16–49 days) from respiratory failure secondary to tracheal stricture formation. Use of a laryngeal mask airway doubled 90-day survival, one pup displaying herniation (17%). Cobb angel measurements, breathing pattern, and lung histology were comparable to sham. Under exertion, sham animals increased their maximum transdiaphragmatic pressure 134% compared to a 71% increase in patched animals (p<0.05). Patched animals had a compensatory increase in their right hemi-diaphragmatic fiber cross-sectional area (p<0.0001). Conclusions A primarily patched 3*3cm defect in growing rabbits, under laryngeal mask airway ventilation, enables adequate survival with normal lung function and reduced maximum transdiaphragmatic pressure compared to controls.
Collapse
Affiliation(s)
- Mary Patrice Eastwood
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Luc Joyeux
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Savitree Pranpanus
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Prince of Songkla University, Hat Yai, Thailand
| | - Johannes Van der Merwe
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Clinical department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Eric Verbeken
- Department of Pathology, Group Biomedical Sciences, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Jan Deprest
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Clinical department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- * E-mail:
| |
Collapse
|
4
|
Liang X, Zhang L, Lv Y. Treatment of total pelvic organ prolapse using a whole biological patch: A pilot study of 17 patients. J Obstet Gynaecol Res 2016; 43:164-172. [PMID: 27762472 DOI: 10.1111/jog.13155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Xianghua Liang
- Department of Obstetrics and Gynecology; Beijing Jishuital Hospital; Beijing China
| | - Lili Zhang
- Department of Obstetrics and Gynecology; Beijing Jishuital Hospital; Beijing China
| | - Yanwei Lv
- Department of Beijing Research Institute of Traumatology and Orthopaedics; Beijing Jishuitan Hospital; Beijing China
| |
Collapse
|
5
|
Orthotopic transplantation of a tissue engineered diaphragm in rats. Biomaterials 2015; 77:320-35. [PMID: 26618750 DOI: 10.1016/j.biomaterials.2015.11.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/01/2015] [Accepted: 11/06/2015] [Indexed: 01/25/2023]
Abstract
The currently available surgical options to repair the diaphragm are associated with significant risks of defect recurrence, lack of growth potential and restored functionality. A tissue engineered diaphragm has the potential to improve surgical outcomes for patients with congenital or acquired disorders. Here we show that decellularized diaphragmatic tissue reseeded with bone marrow mesenchymal stromal cells (BM-MSCs) facilitates in situ regeneration of functional tissue. A novel bioreactor, using simultaneous perfusion and agitation, was used to rapidly decellularize rat diaphragms. The scaffolds retained architecture and mechanical properties and supported cell adhesion, proliferation and differentiation. Biocompatibility was further confirmed in vitro and in vivo. We replaced 80% of the left hemidiaphragm with reseeded diaphragmatic scaffolds. After three weeks, transplanted animals gained 32% weight, showed myography, spirometry parameters, and histological evaluations similar to native rats. In conclusion, our study suggested that reseeded decellularized diaphragmatic tissue appears to be a promising option for patients in need of diaphragmatic reconstruction.
Collapse
|
6
|
Mayer S, Decaluwe H, Ruol M, Manodoro S, Kramer M, Till H, Deprest J. Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model. PLoS One 2015; 10:e0132021. [PMID: 26147985 PMCID: PMC4493058 DOI: 10.1371/journal.pone.0132021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 06/09/2015] [Indexed: 12/02/2022] Open
Abstract
Background Neonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes. Materials and Methods 2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue. Results Overall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p<0.0001). Tensiometry revealed a reduced bursting strength but normal compliance for SIS. Compliance was reduced in Matricel and Gore-Tex (p<0.01). Inflammatory response was characterized by a more polymorphonuclear cell (SIS) resp. macrophage (Matricel) type of infiltrate (p<0.05). Fibrosis was similar for all groups, except there was less mature collagen deposited to Gore-Tex implants (p<0.05). Conclusions Matricel induced a macrophage-dominated inflammatory response, more adhesions, had appropriate strength but a lesser compliance compared to native tissue. The herein investigated ACM is not a viable option for CDH repair.
Collapse
Affiliation(s)
- Steffi Mayer
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Michele Ruol
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Pediatric Surgery, University Hospital Padua, Padua, Italy
| | - Stefano Manodoro
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Monza, Monza, Italy
| | - Manuel Kramer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Holger Till
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Jan Deprest
- Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
- * E-mail:
| |
Collapse
|
7
|
de Battisti A, Polton G, de Vries M, Friend E. Chest wall reconstruction with latissimus dorsi and an autologous thoracolumbar fascia graft in a dog. J Small Anim Pract 2014; 56:218-22. [DOI: 10.1111/jsap.12270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 05/27/2014] [Accepted: 07/08/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. de Battisti
- Langford Veterinary Services, Department of Clinical Veterinary Science; University of Bristol, Langford House; Langford Bristol BS40 5DU
| | - G. Polton
- North Downs Specialist Referrals; The Friesian Buildings 3 & 4, The Brewerstreet Dairy Business Park, Brewer Street Bletchingley Surrey RH1 4QP
| | - M. de Vries
- Animal Health Trust; Lanwades Park Kentford; Newmarket Suffolk CB8 7UU
| | - E. Friend
- Langford Veterinary Services, Department of Clinical Veterinary Science; University of Bristol, Langford House; Langford Bristol BS40 5DU
| |
Collapse
|
8
|
Lim ML, Jungebluth P, Ajalloueian F, Friedrich LH, Gilevich I, Grinnemo KH, Gubareva E, Haag JC, Lemon G, Sjöqvist S, Caplan AL, Macchiarini P. Whole organ and tissue reconstruction in thoracic regenerative surgery. Mayo Clin Proc 2013; 88:1151-66. [PMID: 24079685 DOI: 10.1016/j.mayocp.2013.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/09/2013] [Accepted: 03/15/2013] [Indexed: 12/25/2022]
Abstract
Development of novel prognostic, diagnostic, and treatment options will provide major benefits for millions of patients with acute or chronic respiratory dysfunction, cardiac-related disorders, esophageal problems, or other diseases in the thorax. Allogeneic organ transplant is currently available. However, it remains a trap because of its dependency on a very limited supply of donated organs, which may be needed for both initial and subsequent transplants. Furthermore, it requires lifelong treatment with immunosuppressants, which are associated with adverse effects. Despite early clinical applications of bioengineered organs and tissues, routine implementation is still far off. For this review, we searched the PubMed, MEDLINE, and Ovid databases for the following keywords for each tissue or organ: tissue engineering, biological and synthetic scaffold/graft, acellular and decelluar(ized), reseeding, bioreactor, tissue replacement, and transplantation. We identified the current state-of-the-art practices in tissue engineering with a focus on advances during the past 5 years. We discuss advantages and disadvantages of biological and synthetic solutions and introduce novel strategies and technologies for the field. The ethical challenges of innovation in this area are also reviewed.
Collapse
Affiliation(s)
- Mei Ling Lim
- Advanced Center for Translational Regenerative Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Lee AJ, Lee SH, Chung WH, Kim DH, Chung DJ, Do SH, Kim HY. Evaluation of a canine small intestinal submucosal xenograft and polypropylene mesh as bioscaffolds in an abdominal full-thickness resection model of growing rats. J Vet Sci 2013; 14:175-84. [PMID: 23628657 PMCID: PMC3694189 DOI: 10.4142/jvs.2013.14.2.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 04/04/2012] [Indexed: 01/09/2023] Open
Abstract
We evaluated the biological scaffold properties of canine small intestinal submucosa (SIS) compared to a those of polypropylene mesh in growing rats with full-thickness abdominal defects. SIS is used to repair musculoskeletal tissue while promoting cell migration and supporting tissue regeneration. Polypropylene mesh is a non-resorbable synthetic material that can endure mechanical tension. Canine SIS was obtained from donor German shepherds, and its porous collagen fiber structure was identified using scanning electron microscopy (SEM). A 2.50-cm2 section of canine SIS (SIS group) or mesh (mesh group) was implanted in Sprague-Dawley rats. At 1, 2, 4, 12, and 24 weeks after surgery, the implants were histopathologically examined and tensile load was tested. One month after surgery, CD68+ macrophage numbers in the SIS group were increased, but the number of CD8+ T cells in this group declined more rapidly than that in rats treated with the mesh. In the SIS group, few adhesions and well-developed autologous abdominal muscle infiltration into the SIS collagen fibers were observed. No significant differences in the tensile load test results were found between the SIS and mesh groups at 24 weeks. Canine SIS may therefore be a suitable replacement for artificial biological scaffolds in small animals.
Collapse
Affiliation(s)
- A-Jin Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul 143-701, Korea
| | | | | | | | | | | | | |
Collapse
|
10
|
Brouwer KM, Hoogenkamp HR, Daamen WF, van Kuppevelt TH. Regenerative medicine for the respiratory system: distant future or tomorrow's treatment? Am J Respir Crit Care Med 2012; 187:468-75. [PMID: 23220914 DOI: 10.1164/rccm.201208-1558pp] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Regenerative medicine (RM) is a new field of biomedical science that focuses on the regeneration of tissues and organs and the restoration of organ function. Although regeneration of organ systems such as bone, cartilage, and heart has attracted intense scientific research over recent decades, RM research regarding the respiratory system, including the trachea, the lung proper, and the diaphragm, has lagged behind. However, the last 5 years have witnessed novel approaches and initial clinical applications of tissue-engineered constructs to restore organ structure and function. In this regard, this article briefly addresses the basics of RM and introduces the key elements necessary for tissue regeneration, including (stem) cells, biomaterials, and extracellular matrices. In addition, the current status of the (clinical) application of RM to the respiratory system is discussed, and bottlenecks and recent approaches are identified. For the trachea, several initial clinical studies have been reported and have used various combinations of cells and scaffolds. Although promising, the methods used in these studies require optimization and standardization. For the lung proper, only (stem) cell-based approaches have been probed clinically, but it is becoming apparent that combinations of cells and scaffolds are required to successfully restore the lung's architecture and function. In the case of the diaphragm, clinical applications have focused on the use of decellularized scaffolds, but novel scaffolds, with or without cells, are clearly needed for true regeneration of diaphragmatic tissue. We conclude that respiratory treatment with RM will not be realized tomorrow, but its future looks promising.
Collapse
Affiliation(s)
- Katrien M Brouwer
- Department of Biochemistry, Nijmegen Centre for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | | |
Collapse
|
11
|
Aikawa M, Miyazawa M, Okamoto K, Toshimitsu Y, Okada K, Akimoto N, Ueno Y, Koyama I, Ikada Y. Newly designed bioabsorbable substitute for the treatment of diaphragmatic defects. Surg Today 2012; 43:1298-304. [PMID: 23161480 DOI: 10.1007/s00595-012-0414-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 08/05/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Earlier studies have investigated the suitability of various materials and autologous grafts for the repair of diaphragmatic defects. Our group investigated the feasibility of using an artificial diaphragm (AD) to repair wide diaphragmatic defects. METHODS Twelve pigs were laparotomized and, in each pig, a defect was fashioned by resecting a round 8-cm diameter hole in the left diaphragm. Next, the defect was repaired by implanting an AD. The animals were relaparotomized 8 or 24 weeks after implantation for gross, histological and radiological observation of the implanted sites. RESULTS All recipient animals survived until killing for evaluation. Chest X-ray examinations showed no differences between the preoperative diaphragms and the grafted diaphragms at 8 and 24 weeks after implantation. At 8 weeks after implantation, the implanted sites exhibited fibrous adhesions to the liver and lungs without deformities or penetrations. Parts of the surface tissue at the graft sites had a varnished appearance similar to those of the native diaphragm. Histology performed at 8 weeks detected no trace of the ADs in the graft sites; however, numerous inflammatory cells and profuse fibrous connective tissue were observed. At 24 weeks after implantation, no differences were found in the thorax between the areas with the grafts and the unaffected areas. Histology of the graft sites in the thorax confirmed growth of mesothelial cells similar to that observed in the native diaphragm. CONCLUSIONS Artificial diaphragms can be a novel substitute for diaphragmatic repair.
Collapse
Affiliation(s)
- Masayasu Aikawa
- Department of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Tsao K, Lally KP. Innovations in the surgical management of congenital diaphragmatic hernia. Clin Perinatol 2012; 39:363-74. [PMID: 22682385 DOI: 10.1016/j.clp.2012.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Surgical management of congenital diaphragmatic hernia (CDH) remains a challenge for all clinicians. While the treatment strategies for CDH have evolved from emergent surgical intervention to initial hemodynamic stabilization with delayed surgical repair, surgical innovations have remained limited in the last 20 years. Advances in surgical approaches, such as minimally invasive surgery and alternatives to diaphragmatic replacement, have focused on improvements in surgical morbidity.
Collapse
Affiliation(s)
- KuoJen Tsao
- Department of Pediatric Surgery, The University of Texas School of Medicine at Houston, Houston, TX 77030, USA.
| | | |
Collapse
|
13
|
Brouwer KM, Daamen WF, Reijnen D, Verstegen RH, Lammers G, Hafmans TG, Wismans RG, van Kuppevelt TH, Wijnen RM. Repair of surgically created diaphragmatic defect in rat with use of a crosslinked porous collagen scaffold. J Tissue Eng Regen Med 2012; 7:552-61. [DOI: 10.1002/term.549] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 10/07/2011] [Accepted: 11/15/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Katrien M. Brouwer
- Dept. of Biochemistry 280, NCMLS; Radboud University Nijmegen Medical Centre; P.O. Box 9101; 6500 HB; Nijmegen; The Netherlands
| | - Willeke F. Daamen
- Dept. of Biochemistry 280, NCMLS; Radboud University Nijmegen Medical Centre; P.O. Box 9101; 6500 HB; Nijmegen; The Netherlands
| | - Daphne Reijnen
- Central Animal Facility 231; Radboud University Nijmegen Medical Centre; Geert Grooteplein Noord 29; 6525 EZ; Nijmegen; The Netherlands
| | - Ruud H. Verstegen
- Dept. of Surgery; Radboud University Nijmegen Medical Centre; P.O. Box 9101; 6500 HB; Nijmegen; The Netherlands
| | - Gerwen Lammers
- Dept. of Biochemistry 280, NCMLS; Radboud University Nijmegen Medical Centre; P.O. Box 9101; 6500 HB; Nijmegen; The Netherlands
| | - Theo G. Hafmans
- Dept. of Biochemistry 280, NCMLS; Radboud University Nijmegen Medical Centre; P.O. Box 9101; 6500 HB; Nijmegen; The Netherlands
| | - Ronnie G. Wismans
- Dept. of Biochemistry 280, NCMLS; Radboud University Nijmegen Medical Centre; P.O. Box 9101; 6500 HB; Nijmegen; The Netherlands
| | - Toin H. van Kuppevelt
- Dept. of Biochemistry 280, NCMLS; Radboud University Nijmegen Medical Centre; P.O. Box 9101; 6500 HB; Nijmegen; The Netherlands
| | - René M. Wijnen
- Dept. of Surgery; Radboud University Nijmegen Medical Centre; P.O. Box 9101; 6500 HB; Nijmegen; The Netherlands
| |
Collapse
|
14
|
Kesieme EB, Kesieme CN. Congenital diaphragmatic hernia: review of current concept in surgical management. ISRN SURGERY 2011; 2011:974041. [PMID: 22229104 PMCID: PMC3251163 DOI: 10.5402/2011/974041] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/26/2011] [Indexed: 11/23/2022]
Abstract
CONGENITAL DIAPHRAGMATIC HERNIAS (CDHS) OCCUR MAINLY IN TWO LOCATIONS: the foramen of Morgagni and the more common type involving the foramen of Bochdalek. Hiatal hernia and paraesophageal hernia have also been described as other forms of CDH. Pulmonary hypertension and pulmonary hypoplasia have been recognized as the two most important factors in the pathophysiology of congenital diaphragmatic hernia. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, introduction of fetal intervention due to improved prenatal diagnosis, the introduction of minimal invasive surgery, in addition to the standard open repair, and the use of improved prosthetic devices for closure.
Collapse
Affiliation(s)
- Emeka B. Kesieme
- Department of Surgery, Irrua Specialist Teaching Hospital, PMB 8, Edo State, Irrua, Nigeria
| | - Chinenye N. Kesieme
- Department of Paediatrics, Irrua Specialist Teaching Hospital, PMB 8, Edo State, Irrua, Nigeria
| |
Collapse
|
15
|
Paraesophageal hernia repair with biomesh does not increase postoperative dysphagia. J Gastrointest Surg 2011; 15:1743-9. [PMID: 21773871 DOI: 10.1007/s11605-011-1596-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 06/20/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Laparoscopic techniques have led to hiatal procedures being performed with less morbidity but higher failure rates. Biologic mesh (biomesh) has been proposed as an alternative to plastic mesh to achieve durable repairs while minimizing stricturing and erosion. This paper documents the lack of significant dysphagia after the placement of biomesh during hiatal hernia repair. METHODS A retrospective chart review of patients who underwent paraesophageal hiatal hernia repairs with and without biomesh was performed. Hernias were diagnosed with esophagogastroscopy and esophageal manometry. Demographic, procedural, and pre- and post-surgery symptom data were recorded. RESULTS Fifty-six patients underwent biomesh repair while 33 patients underwent non-mesh repairs. The procedure time for mesh repairs was significantly longer (p = 0.004). Hospital stays, resting lower esophageal sphincter pressure, and mean contraction amplitudes were similar between groups. Residual pressure was measured to be significantly higher in patients who had mesh repairs (p = 0.0001). Normal esophageal peristalsis was maintained in both groups. At first follow-up, mesh patients complained of more dysphagia and bloating, but non-mesh patients had more heartburn. At second follow-up, non-mesh patients had more symptom complaints than mesh patients. CONCLUSION The addition of biomesh for hiatal hernia repair does not result in significantly increased patient dysphagia rates postoperatively compared with patients who underwent primary repair.
Collapse
|
16
|
Gonzalez R, Hill SJ, Mattar SG, Lin E, Ramshaw BJ, Smith CD, Wulkan ML. Absorbable versus nonabsorbable mesh repair of congenital diaphragmatic hernias in a growing animal model. J Laparoendosc Adv Surg Tech A 2011; 21:449-54. [PMID: 21542768 DOI: 10.1089/lap.2010.0409] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The repair of large congenital diaphragmatic hernia frequently results in patch disruption and recurrence as patients grow in size. Absorbable meshes allow for ingrowth of endogenous tissue as they are degraded, providing a more natural and durable repair. The aim of this study was to compare the characteristics of the new diaphragmatic tissue between an absorbable biologic mesh and a nonabsorbable mesh for repairing diaphragmatic hernia in a growing animal model. METHODS The left hemi-diaphragm of twenty 2-month-old Yucatan pigs was nearly completely resected. Small intestinal submucosa (SIS; Cook Biotech, Lafayette, IN) and expanded polytetrafluoroethylene (ePTFE; W.L. Gore & Associates, Flagstaff, AZ) were randomly assigned to cover the defect in 10 animals each, and were survived for 6 months. During necropsy, newly formed diaphragmatic tissue was evaluated and compared between the two groups. RESULTS At necropsy, the animals had tripled their weight. Patch disruption and herniation occurred in 3 animals in the ePTFE group and none in the SIS group. The SIS mesh had better integration to the chest wall (2.8 ± 0.2 versus 1.3 ± 0.3), more muscle growth within the newly formed diaphragmatic tissue (1.9 ± 0.2 versus 0.4 ± 0.2), and less fibrotic tissue (2.1 ± 0.5 versus 3.4 ± 0.4) than ePTFE. There was no difference between SIS and ePTFE in terms of adhesion scores to the lung (2 ± 0.4 versus 2.4 ± 0.4) and liver (1.8 ± 0.3 versus 2.2 ± 0.5). CONCLUSION SIS allows for tissue ingrowth from surrounding tissue as it degrades, providing a more durable repair with 30% less incidence of herniation in a porcine model. As the diaphragm grows, SIS resulted in a more natural repair of the defect with more tissue growth, better tissue integration, and a comparable adhesion formation to ePTFE.
Collapse
|
17
|
Andreoni AA, Voss K. Reconstruction of a large diaphragmatic defect in a kitten using small intestinal submucosa (SIS). J Feline Med Surg 2009; 11:1019-22. [PMID: 19699669 PMCID: PMC11318770 DOI: 10.1016/j.jfms.2009.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2009] [Indexed: 11/19/2022]
Abstract
A double-layer sheet of small intestinal submucosa (SIS) was used to reconstruct a large chronic diaphragmatic defect in a 4-month-old kitten. The SIS graft was easy to use, postoperative recovery was uneventful, no side effects of the SIS implant were observed, and the SIS graft resulted in restoration of normal clinical function while allowing growth of the kitten without restriction of chest wall development. Herniation of fat through the caval hiatus was diagnosed 29 months postoperatively on a CT scan. The cat was free of clinical signs.
Collapse
Affiliation(s)
- Angelo A Andreoni
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8053 Zurich, Switzerland.
| | | |
Collapse
|
18
|
Evaluation of diaphragmatic hernia repair using PLGA mesh-collagen sponge hybrid scaffold: an experimental study in a rat model. Pediatr Surg Int 2008; 24:1041-5. [PMID: 18668247 DOI: 10.1007/s00383-008-2212-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2008] [Indexed: 10/21/2022]
Abstract
Patch closure is necessary to achieve tension-free repair in large congenital diaphragmatic hernia. However, the use of prosthetic material may lead to granulation, allergic reaction, infection, recurrence of hernia, and thoracic deformity. Tissue engineering may become an alternative treatment strategy for diaphragmatic hernia repair, since the regenerated autologous tissue is expected to grow potentially without rejection or infection. We evaluated the efficacy of diaphragmatic hernia repair in a rat model using a poly-lactic-co-glycolic acid (PLGA) mesh-collagen sponge hybrid scaffold, designed for in situ tissue engineering. Twenty-four F344 female rats were used. Oval-shaped defects were surgically created in the left diaphragm and repaired with three different grafts, including PLGA mesh in group 1 (n = 7), PLGA mesh-collagen sponge hybrid scaffold in group 2 (n = 7), and PLGA mesh-collagen sponge hybrid scaffold seeded with bone marrow-derived mesenchymal stem cells (MSCs) in group 3 (n = 10). The animals were killed at 1, 2, and 3 months after operation. The specimens were examined macroscopically and microscopically. No recurrence or eventration was observed. In all animals, autologous fibrous tissue with vascularization was generated at the graft site. Although no muscular tissue was detected, scattered desmin-positive cells were observed in groups 2 and 3. The 'neodiaphragm' in groups 2 and 3 was significantly thicker compared with that in group 1. There was no significant difference in the 'neodiaphragm' between groups 2 and 3. The PLGA mesh-collagen sponge hybrid scaffold provided better promotion of autologous in situ tissue regeneration in the diaphragm, suggesting its potential application to diaphragmatic repair in place of other prosthetic patches.
Collapse
|
19
|
Rauth TP, Poulose BK, Nanney LB, Holzman MD. A Comparative Analysis of Expanded Polytetrafluoroethylene and Small Intestinal Submucosa—Implications for Patch Repair in Ventral Herniorrhaphy. J Surg Res 2007; 143:43-9. [DOI: 10.1016/j.jss.2007.03.079] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 03/19/2007] [Accepted: 03/26/2007] [Indexed: 10/22/2022]
|
20
|
Dasgupta R, Wales PW, Zuker RM, Fisher DM, Langer JC. The use of Surgisis for abdominal wall reconstruction in the separation of omphalopagus conjoined twins. Pediatr Surg Int 2007; 23:923-6. [PMID: 17437118 DOI: 10.1007/s00383-007-1909-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
Abdominal wall reconstruction in omphalopagus twins poses a difficult reconstructive challenge, as separation often results in a large abdominal wall defect. A number of options are available for closure, including tissue flaps, expanders and patches made of foreign material. Surgisis is a new biodegradable small intestine scaffolding substrate that permits tissue in-growth and results in a permanent durable scar. We describe its use in abdominal wall reconstruction after separation of a set of conjoined twins. A set of omphalopagus conjoined twins shared liver and abdominal wall. After separation at 6 months of age, Twin A's abdomen could be closed primarily, but Twin B could not. A 4-ply Surgisis mesh was used in the upper abdominal closure, and a skin flap was created, to completely cover the patch. Both twins survived the operation. A small portion of the skin flap over the Surgisis broke down, healing by secondary intention. In follow up of over 18 months post procedure, there have been no wound infections and the abdominal wall is intact with no evidence of a hernia. Surgisis can be successfully used for the reconstruction of complex abdominal wall defects in the pediatric patient, including reconstruction after separation of conjoined twins.
Collapse
Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General Surgery, Hospital for Sick Children, Toronto, ON, Canada.
| | | | | | | | | |
Collapse
|
21
|
Kling DE, Schnitzer JJ. Vitamin A deficiency (VAD), teratogenic, and surgical models of congenital diaphragmatic hernia (CDH). AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2007; 145C:139-57. [PMID: 17436305 DOI: 10.1002/ajmg.c.30129] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Congenital diaphragmatic hernia (CDH) is a congenital malformation that occurs with a frequency of 0.08 to 0.45 per 1,000 births. Children with CDH are born with the abdominal contents herniated through the diaphragm and exhibit an associated pulmonary hypoplasia which is frequently accompanied by severe morbidity and mortality. Although the etiology of CDH is largely unknown, considerable progress has been made in understanding its molecular mechanisms through the usage of genetic, teratogenic, and surgical models. The following review focuses on the teratogenic and surgical models of CDH and the possible molecular mechanisms of nitrofen (a diphenyl ether, formerly used as an herbicide) in both induction of CDH and pulmonary hypoplasia. In addition, the mechanisms of other compounds including several anti-inflammatory agents that have been linked to CDH will be discussed. Furthermore, this review will also explore the importance of vitamin A in lung and diaphragm development and the possible mechanisms of teratogen interference in vitamin A homeostasis. Continued exploration of these models will bring forth a clearer understanding of CDH and its molecular underpinnings, which will ultimately facilitate development of therapeutic strategies.
Collapse
Affiliation(s)
- David E Kling
- Massachusetts General Hospital, Department of Pediatric Surgery, Boston, MA 02114, USA.
| | | |
Collapse
|
22
|
Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 2006; 244:481-90. [PMID: 16998356 PMCID: PMC1856552 DOI: 10.1097/01.sla.0000237759.42831.03] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Laparoscopic paraesophageal hernia repair (LPEHR) is associated with a high recurrence rate. Repair with synthetic mesh lowers recurrence but can cause dysphagia and visceral erosions. This trial was designed to study the value of a biologic prosthesis, small intestinal submucosa (SIS), in LPEHR. METHODS Patients undergoing LPEHR (n = 108) at 4 institutions were randomized to primary repair -1 degrees (n = 57) or primary repair buttressed with SIS (n = 51) using a standardized technique. The primary outcome measure was evidence of recurrent hernia (> or =2 cm) on UGI, read by a study radiologist blinded to the randomization status, 6 months after operation. RESULTS At 6 months, 99 (93%) patients completed clinical symptomatic follow-up and 95 (90%) patients had an UGI. The groups had similar clinical presentations (symptom profile, quality of life, type and size of hernia, esophageal length, and BMI). Operative times (SIS 202 minutes vs. 1 degrees 183 minutes, P = 0.15) and perioperative complications did not differ. There were no operations for recurrent hernia nor mesh-related complications. At 6 months, 4 patients (9%) developed a recurrent hernia >2 cm in the SIS group and 12 patients (24%) in the 1 degrees group (P = 0.04). Both groups experienced a significant reduction in all measured symptoms (heartburn, regurgitation, dysphagia, chest pain, early satiety, and postprandial pain) and improved QOL (SF-36) after operation. There was no difference between groups in either pre or postoperative symptom severity. Patients with a recurrent hernia had more chest pain (2.7 vs. 1.0, P = 0.03) and early satiety (2.8 vs. 1.3, P = 0.02) and worse physical functioning (63 vs. 72, P = 0.03 per SF-36). CONCLUSIONS Adding a biologic prosthesis during LPEHR reduces the likelihood of recurrence at 6 months, without mesh-related complications or side effects.
Collapse
|