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Deguchi K, Zambaiti E, De Coppi P. Regenerative medicine: current research and perspective in pediatric surgery. Pediatr Surg Int 2023; 39:167. [PMID: 37014468 PMCID: PMC10073065 DOI: 10.1007/s00383-023-05438-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 04/05/2023]
Abstract
The field of regenerative medicine, encompassing several disciplines including stem cell biology and tissue engineering, continues to advance with the accumulating research on cell manipulation technologies, gene therapy and new materials. Recent progress in preclinical and clinical studies may transcend the boundaries of regenerative medicine from laboratory research towards clinical reality. However, for the ultimate goal to construct bioengineered transplantable organs, a number of issues still need to be addressed. In particular, engineering of elaborate tissues and organs requires a fine combination of different relevant aspects; not only the repopulation of multiple cell phenotypes in an appropriate distribution but also the adjustment of the host environmental factors such as vascularisation, innervation and immunomodulation. The aim of this review article is to provide an overview of the recent discoveries and development in stem cells and tissue engineering, which are inseparably interconnected. The current status of research on tissue stem cells and bioengineering, and the possibilities for application in specific organs relevant to paediatric surgery have been specifically focused and outlined.
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Affiliation(s)
- Koichi Deguchi
- Stem Cells and Regenerative Medicine Section, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Elisa Zambaiti
- Stem Cells and Regenerative Medicine Section, University College London Great Ormond Street Institute of Child Health, London, UK
- UOC Chirurgia Pediatrica, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine Section, University College London Great Ormond Street Institute of Child Health, London, UK.
- NIHR BRC SNAPS Great Ormond Street Hospitals, London, UK.
- Stem Cells and Regenerative Medicine Section, Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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Tissue Engineering to Repair Diaphragmatic Defect in a Rat Model. Stem Cells Int 2017; 2017:1764523. [PMID: 28928772 PMCID: PMC5592000 DOI: 10.1155/2017/1764523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/16/2017] [Accepted: 05/25/2017] [Indexed: 12/02/2022] Open
Abstract
Tissue engineering is an emerging strategy for repairing damaged tissues or organs. The current study explored using decellularized rat diaphragm scaffolds combined with human amniotic fluid-derived multipotent stromal cells (hAFMSC) to provide a scaffold, stem cell construct that would allow structural barrier function during tissue ingrowth/regeneration. We created an innovative cell infusion system that allowed hAFMSC to embed into scaffolds and then implanted the composite tissues into rats with surgically created left-sided diaphragmatic defects. Control rats received decellularized diaphragm scaffolds alone. We found that the composite tissues that combined hAFMSCs demonstrated improved physiological function as well as the muscular-tendon structure, compared with the native contralateral hemidiaphragm of the same rat. Our results indicate that the decellularized diaphragm scaffolds are a potential support material for diaphragmatic hernia repair and the composite grafts with hAFMSC are able to accelerate the functional recovery of diaphragmatic hernia.
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Gubbels SP, Richardson M, Trune D, Bascom DA, Wax MK. Tracheal Reconstruction with Porcine Small Intestine Submucosa in a Rabbit Model. Otolaryngol Head Neck Surg 2016; 134:1028-35. [PMID: 16730551 DOI: 10.1016/j.otohns.2005.12.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 12/08/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE: To evaluate the ability of porcine small intestine submucosa (SIS) to 1) maintain airway patency, 2) integrate, 3) prevent granulation tissue formation, and 4) permit mucosalization when used for tracheal reconstruction. Further studies were performed to evaluate the ability of SIS to support neochondrogenesis and investigate the impact of neochondrogenesis on airway patency. STUDY DESIGN: Prospective, controlled animal trial with SIS used with and without a perichondrial flap to reconstruct a tracheal defect in a rabbit model. Functional, histologic and endoscopic analyses were performed. RESULTS: All animals except 1 control animal were without stridor. The SIS graft supported neochondrogenesis, was completely mucosalized and was well integrated into the neotrachea. There was minimal granulation tissue formation. Endoscopic analyses did not reveal a consistent, significant difference in airway patency when SIS, with or without a perichondrial flap, was used for reconstruction. CONCLUSION: SIS can be used to reconstruct a sublethal rabbit tracheal defect with no mortality and minimal morbidity.
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Affiliation(s)
- Samuel P Gubbels
- Department of Otolaryngology-Head and Neck Surgery, Portland, Oregon 97239, USA
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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.
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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:
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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.
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Affiliation(s)
- Katrien M Brouwer
- Department of Biochemistry, Nijmegen Centre for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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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.
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Affiliation(s)
- Masayasu Aikawa
- Department of Surgery, Gastrointestinal Center, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
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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
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Abstract
Repair of congenital diaphragmatic hernia (CDH) continues to pose a dilemma for the pediatric surgeon. While the management of CDH has evolved from surgical urgency to delayed repair after medical optimization with substantial improvements in mortality, morbidity continues to perplex clinicians. Significant morbidity occurs with recurrence, re-recurrence and complications such as obstructions, principally with mesh repair. When primary closure is not possible, mesh repair is indicated. While there are several non-absorbable prosthetic, absorbable biosynthetic and composite mesh types available, the ideal mesh remains elusive. In this article, we reviewed the current materials, reported advantages, and animal and clinical studies of non-absorbable prosthetic, absorbable biosynthetic and composite mesh. However, adequate comparative data are lacking, leaving a wide void for future animal models and clinical studies.
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Du XF, Kwon SK, Song JJ, Cho CG, Park SW. Tracheal reconstruction by mesenchymal stem cells with small intestine submucosa in rabbits. Int J Pediatr Otorhinolaryngol 2012; 76:345-51. [PMID: 22209333 DOI: 10.1016/j.ijporl.2011.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 12/14/2022]
Abstract
AIM The increasing number of newborns requiring intubation and artificial ventilation in the sophisticated premature and intensive care units of recent years has been followed by a concomitant increase in the number of children who develop tracheal stenosis as a sequela of prolonged intubation, with a consequent increasing need for tracheal surgical repair. The aim of this study was to evaluate tracheal reconstruction by monolayered autologous mesenchymal stem cells (MSCs) with small intestine submucosa (SIS) in a rabbit model. METHODS Twelve male rabbits were randomly divided into three groups: rabbits with tracheal defects without reconstruction (untreated group, n=4), rabbits with tracheal defects given porcine small intestine submucosa graft (SIS group, n=4), and rabbits with tracheal defects that underwent transplantation of monolayered mesenchymal stem cells on SIS (SIS+MSC group, n=4). Histological and endoscopic analyses were performed by hematoxylin-eosin staining (H&E), Prussian blue staining and endoscopy. RESULTS Tracheal stenosis in the SIS+MSC group was minimal, compared to the untreated group and SIS group. Specimens obtained from the untreated and SIS groups showed severe infiltration of inflammatory cells and granulation tissue formation into the trachea. In the SIS+MSC group, however, minimal infiltration of the inflammatory cells and granulation tissue formation were observed. Twelve weeks following the operation, regeneration of pseudostratified columnar epithelium was confirmed by H&E staining with minimal inflammatory cell infiltration in the SIS+MSC group. Moreover, Prussian blue staining clearly demonstrated the presence of labeled MSCs in the regenerated tissue of SIS+MSC group. CONCLUSIONS These results demonstrate that tracheal reconstruction by MSCs with SIS is effective in rabbits with tracheal defects with minimal mortality and morbidity, which appears to be a promising strategy in the treatment of tracheal defects.
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Affiliation(s)
- Xiao Fei Du
- Medical Science Research Institute and Department of Otorhinolaryngology - Head and Neck Surgery, Dongguk University Ilsan Hospital, Gyeonggi, Republic of Korea
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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.
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Böhm G, Binnebösel M, Krähling E, Schumpelick V, Steinau G, Stanzel S, Anurov M, Titkova S, Öttinger A, Speer M. Influence of the Elasticity Module of Synthetic and Natural Polymeric Tissue Substitutes on the Mobility of the Diaphragm and Healing Process in a Rabbit Model. J Biomater Appl 2011; 25:771-793. [DOI: 10.1177/0885328209360423] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Mesh implants are frequently used in congenital diaphragmatic hernia. This experimental study aimed to examine the influence of different materials on the diaphragmatic movement over time as well as their mechanical qualities after 4 months. Ultrapro®, Surgisis®, and Proceed ® were implanted onto a diaphragmatic defect in growing rabbits. Diaphragmatic mobility was determined at three time points. At 4 months, defect shrinkage and mechanical properties were measured. The break strength decreased for Ultrapro® and Surgisis®, but did not change relevantly for Proceed®. Ultrapro® (32.46 N/cm) and Proceed® (31.75 N/cm) showed a four-fold higher resistance to tearing than Surgisis® (8.31 N/cm). The elasticity of Ultrapro® showed no significant difference compared to Surgisis® ( p = 0.75). Proceed®, on the other hand, was more than twice as elastic as Ultrapro® or Surgisis ® ( p = 0.015). Ultrapro® had a higher spring rate (6.48 N/mm) compared to Surgisis® (3.82 N/mm) or Proceed ® (5.23 N/mm). Observing the standardized movement rates of the diaphragm for each mesh group over time the only statistical differences were seen for the Proceed® group. On account of its material qualities Ultrapro® was found to be the most suitable mesh material for demanding locations in our model.
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Affiliation(s)
- G. Böhm
- Department of Surgery, University Hospital Technical University of Aachen (RWTH), Germany,
| | - M. Binnebösel
- Department of Surgery, University Hospital Technical University of Aachen (RWTH), Germany
| | - E. Krähling
- Department of Surgery, University Hospital Technical University of Aachen (RWTH), Germany
| | - V. Schumpelick
- Department of Surgery, University Hospital Technical University of Aachen (RWTH), Germany
| | - G. Steinau
- Department of Surgery, University Hospital Technical University of Aachen (RWTH), Germany
| | - S. Stanzel
- Institute for Medical Statistics Technical University of Aachen (RWTH), Germany
| | - M. Anurov
- Joint Surgical Research Institute, University Moskow, Russia
| | - S. Titkova
- Joint Surgical Research Institute, University Moskow, Russia
| | - A. Öttinger
- Joint Surgical Research Institute, University Moskow, Russia
| | - M. Speer
- Department of Chemistry, Technical University of Aachen (RWTH), Germany
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Kim KS, Lee JY, Kang YM, Kim E, Kim GH, Rhee SD, Cheon HG, Kim JH, Min BH, Lee HB, Kim MS. Small intestine submucosa sponge for in vivo support of tissue-engineered bone formation in the presence of rat bone marrow stem cells. Biomaterials 2010; 31:1104-13. [DOI: 10.1016/j.biomaterials.2009.10.020] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
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Limpert JN, Desai AR, Kumpf AL, Fallucco MA, Aridge DL. Repair of abdominal wall defects with bovine pericardium. Am J Surg 2009; 198:e60-5. [PMID: 19811771 DOI: 10.1016/j.amjsurg.2009.01.027] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 01/14/2009] [Accepted: 01/16/2009] [Indexed: 01/12/2023]
Abstract
BACKGROUND Ventral hernia repair with prosthetic mesh has recurrence rates up to 54% and is contraindicated in the setting of infection. The aim of this study was to provide our experience with acellular bovine pericardium (Veritas collagen matrix; Synovis Life Technologies, Inc., St. Paul, MN) in complex abdominal wall reconstruction where prosthetic mesh had failed or was contraindicated. Between 2005 and 2008, a retrospective review of a single general surgeon's practice identified patients reconstructed with acellular bovine pericardium. Thirty primary or recurrent ventral hernias were treated in 26 patients. All patients presented with either contaminated wounds or failure of a prosthetic mesh material. RESULTS Hernia size ranged from 20 cm(2) to 600 cm(2) (mean 111 cm(2)). Seven patients had previous hernia repair with prosthetic mesh, and 16 patients had ongoing infection or gross contamination at the time of repair. The mean follow-up was 22 months. The hernia recurrence rate in our series was 19% with no fistula development. CONCLUSIONS Acellular bovine pericardium's high strength, minimal infection rate, and low cost allow its use in the reconstruction of complex abdominal wall defects.
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Araco F, Gravante G, Overton J, Araco P, Dati S. Transvaginal cystocele correction: Midterm results with a transobturator tension-free technique using a combined bovine pericardium/polypropylene mesh. J Obstet Gynaecol Res 2009; 35:953-60. [DOI: 10.1111/j.1447-0756.2009.01036.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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 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.
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Affiliation(s)
- Angelo A Andreoni
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8053 Zurich, Switzerland.
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Doede T, Bondartschuk M, Joerck C, Schulze E, Goernig M. Unsuccessful alloplastic esophageal replacement with porcine small intestinal submucosa. Artif Organs 2009; 33:328-33. [PMID: 19335409 DOI: 10.1111/j.1525-1594.2009.00727.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In general, there is no perfect method for esophageal replacement under consideration of the numerous associated risks and complications. The aim of this study was to examine a new material--small intestinal submucosa (SIS)--in alloplastic esophageal replacement. We implanted tubular SIS prosthesis about 4 cm in length in the cervical esophagus of 14 piglets (weight 9-13 kg). For the first 10 days, the animals were fed parenterally, supplemented by free given water, followed by an oral feeding phase. Four weeks after surgery, the animals were sacrificed. Only 1 of the 14 animals survived the study period of 4 weeks. The other piglets had to be sacrificed prematurely because of severe esophageal stenosis. On postmortem exploration, the prosthesis could not be found either macroscopically or histologically. Sutures between the prosthesis and the cervical muscles did not improve the results. Until now, the use of alloplastic materials in esophageal replacement has failed irrespective of the kind of material. As well as in our experiments, severe stenosis had been reported in several animal studies. The reasons for this unacceptable high rate of stenosis after alloplastic esophageal replacement seem to be multifactorial. Possible solutions could be transanastomotic splints, less inert materials, the decrease of anastomotic tension by stay sutures, the use of adult stem cells, and tissue engineering.
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Affiliation(s)
- Thorsten Doede
- Department of Pediatric Surgery, University Hospital of Jena, Jena, Germany.
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Aulin C, Foroughi F, Brown R, Hilborn J. Extracellular matrix-polymer hybrid materials produced in a pulsed-flow bioreactor system. J Tissue Eng Regen Med 2009; 3:188-95. [DOI: 10.1002/term.152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Al-Sahaf O, El-Masry S. The use of porcine small intestinal submucosa mesh (SURGISIS) as a pelvic sling in a man and a woman with previous pelvic surgery: two case reports. J Med Case Rep 2009; 3:70. [PMID: 19236700 PMCID: PMC2654899 DOI: 10.1186/1752-1947-3-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 02/23/2009] [Indexed: 12/03/2022] Open
Abstract
Introduction Closing the pelvic peritoneum to prevent the small bowel dropping into the pelvis after surgery for locally recurrent rectal cancer is important to prevent adhesions deep in the pelvis or complications of adjuvant radiotherapy. Achieving this could be difficult because sufficient native tissue is unavailable; we report on the use of small intestine submucosa extra-cellular matrix mesh in the obliteration of the pelvic brim. Case presentation We describe two cases in which submucosa extra-cellular matrix mesh was used to obliterate the pelvic brim following resection of a recurrent rectal tumour; the first patient, a 78-year-old Caucasian man, presented with small bowel obstruction caused by adhesions to a recurrent rectal tumour. The second patient, an 84-year-old Caucasian woman, presented with vaginal discharge caused by an entero-vaginal fistula due to a recurrent rectal tumour. Conclusion We report on the use of submucosa extra-cellular matrix mesh as a pelvic sling in cases where primary closure of the pelvic peritoneum is unfeasible. Its use had no infective complications and added minimal morbidity to the postoperative period. This is an original case report that would be of interest to general and colorectal surgeons.
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Affiliation(s)
- Osama Al-Sahaf
- Department of General Surgery, Our Lady of Lourdes Hospital, Drogheda, Co, Louth, Ireland.
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Pribitkin EA, Ambro BT, Bloeden E, O'Hara BJ. Rabbit Ear Cartilage Regeneration With a Small Intestinal Submucosa Graft. Laryngoscope 2009; 114:1-19. [PMID: 15475771 DOI: 10.1097/00005537-200409001-00001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective was to demonstrate that interpositional grafting with porcine small intestinal submucosa promotes cartilage regeneration following excision of rabbit auricular cartilage. STUDY DESIGN Blinded, controlled study. METHODS Eight New Zealand white rabbits underwent excision of auricular cartilage on two sites with and two sites without preservation of perichondrium. Porcine small intestinal submucosa was implanted into one site with and one site without intact perichondrium. Remaining sites served as control sites. Histological assessment was performed at 3 (n = 4) and 6 (n = 3) months and at 1 year (n = 1) after grafting. RESULTS Histological evaluation showed cartilage regeneration accompanied by chronic inflammation in areas in which porcine small intestinal submucosa was implanted between layers of intact perichondrium. Other sites failed to show significant cartilage regeneration. CONCLUSION The results of the study using porcine small intestinal submucosa as a bioscaffold for cartilage regeneration are promising and justify further animal and human studies.
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Affiliation(s)
- Edmund A Pribitkin
- Department of Otolaryngology-Head and Neck Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Are Surgisis biomeshes effective in reducing recurrences after laparoscopic repair of large hiatal hernias? Surg Laparosc Endosc Percutan Tech 2008; 18:433-6. [PMID: 18936659 DOI: 10.1097/sle.0b013e3181802ca7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prosthetic repair is frequently advocated after repair of large hiatal hernias, and biomeshes have been proposed to help reduce the high recurrence rate. All patients undergoing laparoscopic repair of primary or recurrent large hiatal hernia, and with intraoperative finding of weak diaphragmatic pillars, as judged by the surgeon, were included, from June 2004 to July 2005, in a prospective observational study. In these patients, Surgisis biomeshes were employed to assist the repair. Six patients (4 for primary and 2 for recurrent hernia) received biomesh hiatoplasty. Four had mild dysphagia at 1 month that disappeared at the next follow-up. Three had slow radiologic transit through the esophagogastric junction, still present in 1 patient at 1 year. One patient had hernia recurrence 6 months after surgery and 2 other patients had radiologic recurrence of a small hernia at 1-year follow-up; in all 3, the recurrence was small and asymptomatic and none were reoperated. The short-term recurrence rate using biomesh for the laparoscopic repair of large hiatal hernias in patients with weak diaphragmatic pillars was high at 50%. Postoperative morbidity and mesh-related complications were almost absent. Biomeshes can be safely used as on lay reinforcement in hiatoplasty, but do not reduce the hiatal recurrence rate.
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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.
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Keckler SJ, St. Peter SD, Calkins CM, Holcomb GW. Occlusion of a Recurrent Tracheoesophageal Fistula with Surgisis. J Laparoendosc Adv Surg Tech A 2008; 18:465-8. [DOI: 10.1089/lap.2007.0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Scott J. Keckler
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Shawn D. St. Peter
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Casey M. Calkins
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - George W. Holcomb
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
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Cook JL, Fox DB, Kuroki K, Jayo M, De Deyne PG. In vitro and in vivo comparison of five biomaterials used for orthopedic soft tissue augmentation. Am J Vet Res 2008; 69:148-56. [PMID: 18167101 DOI: 10.2460/ajvr.69.1.148] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare biomaterials used in orthopedics with respect to in vitro cell viability and cell retention and to in vivo tissue healing and regeneration. ANIMALS 65 adult female Sprague-Dawley rats and synovium, tendon, meniscus, and bone marrow specimens obtained from 4 adult canine cadavers. PROCEDURES Synovium, tendon, meniscus, and bone marrow specimens were used to obtain synovial fibroblasts, tendon fibroblasts, meniscal fibrochondrocytes, and bone marrow-derived connective tissue progenitor cells for culture on 5 biomaterials as follows: cross-linked porcine small intestine (CLPSI), non-cross-linked human dermis, cross-linked porcine dermis, non-cross-linked porcine small intestine (NCLPSI), and non-cross-linked fetal bovine dermis. After 1 week of culture, samples were evaluated for cell viability, cell density, and extracellular matrix production. Biomaterials were evaluated in a 1-cm(2) abdominal wall defect in rats. Each biomaterial was subjectively evaluated for handling, suturing, defect fit, and ease of creating the implant at the time of surgery, then grossly and histologically 6 and 12 weeks after surgery. RESULTS All biomaterials allowed for retention of viable cells in culture; however, CLPSI and NCLPSI were consistently superior in terms of cell viability and cell retention. Cell infiltration for NCLPSI was superior to other biomaterials. The NCLPSI appeared to be replaced with regenerative tissue most rapidly in vivo and scored highest in all subjective evaluations of ease of use. CONCLUSIONS AND CLINICAL RELEVANCE These data suggested that NCLPSI and CLPSI have favorable properties for further investigation of clinical application in orthopedic tissue engineering.
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Affiliation(s)
- James L Cook
- Comparative Orthopaedic Laboratory, University of Missouri, Columbia, MO 65211, USA
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Keckler SJ, Spilde TL, St Peter SD, Tsao K, Ostlie DJ. Treatment of Bronchopleural Fistula With Small Intestinal Mucosa and Fibrin Glue Sealant. Ann Thorac Surg 2007; 84:1383-6. [PMID: 17889008 DOI: 10.1016/j.athoracsur.2007.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 04/30/2007] [Accepted: 05/03/2007] [Indexed: 11/18/2022]
Abstract
Bronchopleural fistula can be a devastating complication of pulmonary resections. Treatment options are often limited and carry significant morbidity or mortality, or both. We present a case of bronchopleural fistula occurring after pulmonary lobectomy for aspergilloma in a patient with recurrent acute lymphoblastic leukemia. The bronchopleural fistula was treated using bronchoscopic obliteration with Tisseel VH Fibrin Sealant (Baxter Healthcare Corp, Westlake Village, CA) and small intestinal submucosa with complete resolution and no morbidity. The relevant literature is reviewed.
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Affiliation(s)
- Scott J Keckler
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri 64108, USA
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Rauth TP, Poulose B, Davidson J, Nanney L, Holzman M. Mechanical Abrasion Improves Early Incorporation of Small Intestinal Submucosa. Am Surg 2007. [DOI: 10.1177/000313480707300702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It has been shown that gross incorporation of porcine-derived small intestinal submucosa (SiS) is limited at 2 weeks. This study evaluates a technique for improving the early incorporation of implanted eight-ply SiS. Six pigs underwent implantation of SiS on the peritoneal surface using three techniques: suture fixation of stock-perforated SiS, suture fixation of manually perforated SiS, and suture fixation of stock-perforated SiS to mechanically abraded peritoneum. Gross incorporation was evaluated and random samples harvested for tensiometric analysis 2 weeks after implantation. SiS placed onto mechanically abraded peritoneum demonstrated significantly greater gross incorporation than both stock-perforated SiS (100% versus 42%, P = 0.015) and manually perforated SiS (100% versus 50%, P = 0.042). There was no difference in gross incorporation between stock and manually perforated SiS. Using tensiometric analysis, the force required to separate the peritoneum from the SiS implant was significantly greater for the SiS placed onto mechanically abraded peritoneum (4.4 ± 1.7 kg · f/cm2) than for both the stock-perforated SiS samples (1.0 ± 0.5 kg · f/cm2) and the needle-perforated SiS samples (1.4 ± 0.9 kg · f/cm2; P < 0.001). There was no difference between stock and manually perforated SiS at 2 weeks. Mechanical abrasion of the peritoneum before SiS onlay leads to improved gross incorporation 2 weeks after implantation in a porcine model of herniorrhaphy. Long-term studies and histologic analysis are needed to validate this method as a means for improving early incorporation of SiS.
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Affiliation(s)
- Thomas P. Rauth
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - B.K. Poulose
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - J.M. Davidson
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - L.B. Nanney
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - M.D. Holzman
- Vanderbilt University School of Medicine, Nashville, Tennessee
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Ueno T, Oga A, Takahashi T, Pappas TN. Small intestinal submucosa (SIS) in the repair of a cecal wound in unprepared bowel in rats. J Gastrointest Surg 2007; 11:918-22. [PMID: 17476557 DOI: 10.1007/s11605-007-0171-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE Porcine-derived small intestinal submucosa (SIS) has been accepted as an acellular matrix for tissue regeneration. However, its use for remodeling gastrointestinal defects has been poorly investigated. Our previous study of the rodent stomach has demonstrated that the SIS stimulates regeneration of native tissue under acidic conditions. The purpose of this paper was to investigate the feasibility of using SIS as a bioscaffold for a colonic defect in unprepared bowel. METHODS A 1 x 1-cm whole layer was excised on the anterior wall of the cecum in 24 rats, followed by onlay repair with SIS. Measurement outcomes included animal survival, mesh stability in situ, and histologic evaluation at 3 weeks and 6 months. RESULTS Rats showed a significant weight gain and had no evidence of postoperative leakage. All wounds were secured and associated with either omental or other fatty adhesions. Histological findings revealed that intact mucosa covered the area of the graft in all cases 6 months after surgery and that the defect was completely replaced by the normal constituents (mucosa, muscle, and nerve cells) of the bowel wall. CONCLUSIONS SIS was largely successful in promoting healing in a cecal wound in unprepared bowel and serving as a bioscaffold for regeneration of the native colonic tissue. Small intestinal submucosa may be useful in surgical anastomoses to promote healing and presumably prevent leakage.
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Affiliation(s)
- Tomio Ueno
- Department of Surgery II, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi 755-8505, Japan.
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Upadhyaya M, Orford JE, Smith N, Barker A, Gollow I. Incorporation of Integra in tissue defects: a pilot study in the rat model. Pediatr Surg Int 2007; 23:669-73. [PMID: 17486356 DOI: 10.1007/s00383-007-1928-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2007] [Indexed: 10/23/2022]
Abstract
Integra has been shown to be very useful in accelerating the growth of neodermis. It has found extensive use in case of burns as a primary dressing immediately after a burn, after release of contractures and following scar revision. It has been used to achieve cover after the debridement of extensive infective processes involving the skin. Encouraged by these results we have assessed the application of Integra to augment and/or patch defects of the urinary bladder, diaphragm and the abdominal wall in the rat model. This was a pilot study and involved the incorporation of Integra in the diaphragm, the urinary bladder (extramucosal) and the muscle layer of the abdominal wall. Eight adult Wistar rats were given general anaesthesia and Integra was implanted with absorbable sutures at the sites mentioned. The omentum was hitched to the collagen matrix surface to revascularise the graft. The silicone was left in situ. The operative period was covered with antibiotics. The anaesthesia was then reversed. Postoperatively the rats were given analgesia and feeds started immediately. The rats were sacrificed after 3 weeks. The abdominal cavity was examined for adhesions. The Integra implant along with adjacent tissue was harvested and examined histologically. There were no visible intra-abdominal adhesions. The histology revealed good degree of neovascularisation and fibrosis in and adjacent to the implant. This was comparable to the changes seen in the skin. This pilot study has shown that implanting Integra invokes a similar response in deeper tissues and it can develop neovascularisation from the omentum. Hence, this could find some application in treating congenital conditions such as diaphragmatic hernias, abdominal wall defects and for bladders requiring augmentation. Our initial results are quite encouraging and we feel that this field should be further explored.
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Affiliation(s)
- Manasvi Upadhyaya
- Department of General Surgery, Princess Margaret Hospital for Children, Perth, Australia.
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Handel LN, Frenkl TL, Kim YH. Results of Cystocele Repair: A Comparison of Traditional Anterior Colporrhaphy, Polypropylene Mesh and Porcine Dermis. J Urol 2007; 178:153-6; discussion 156. [PMID: 17499285 DOI: 10.1016/j.juro.2007.03.041] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE Because traditional anterior colporrhaphy can have a high recurrence rate, we assessed the recurrence rate of 3 methods of cystocele repair, including 1) traditional anterior colporrhaphy, 2) repair using porcine dermis interposition graft and 3) repair using polypropylene mesh. Additionally, we compared the rate of erosion of porcine dermal graft with that of polypropylene mesh. MATERIALS AND METHODS The records of patients who underwent cystocele repair by the same urologist using porcine dermal graft, polypropylene mesh or traditional repair from January 1999 to August 2005 were reviewed. Data were collected on history, physical examination, outcomes and complications. Using the Baden-Walker system a cystocele of grade 2 or higher on followup examination was considered recurrence. RESULTS A total of 119 patients underwent cystocele repair from January 1999 to August 2005. Followup was available on 99 patients and it averaged 13.5 months (range 2 to 46). Of the patients 56 (57%) underwent cystocele repair using porcine dermal graft, 25 (25%) received polypropylene mesh and 18 (18%) underwent traditional repair. Of the 99 patients 22 (22%) had cystocele recurrence. Based on the type of repair 36% of patients (20 of 56) with porcine dermal grafts had recurrence compared to 4% (1 of 25) and 6% (1 of 18) using polypropylene and traditional repair, respectively. Mean time to cystocele recurrence was 4.9 months (range 0.5 to 20). A total of 12 patients (21%) had extrusion of porcine grafts through the anterior vaginal wall incision compared to 1 (4%) with polypropylene mesh. CONCLUSIONS In our patient population the short-term failure rate for anterior vaginal wall prolapse using porcine dermis interposition graft was higher than that for traditional anterior colporrhaphy or polypropylene mesh. In addition, the incidence of vaginal extrusion of porcine graft was unacceptably high. Porcine dermis is a less suitable material for cystocele repair than polypropylene mesh or traditional anterior colporrhaphy. Prospective, randomized trials are necessary to determine the true efficacy and complication rates of these graft materials for anterior vaginal wall prolapse repair.
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Affiliation(s)
- LiAnn N Handel
- Rhode Island Hospital, Brown University, Providence, Rhode Island, and Merck and Co., Inc., Rahway, New Jersey, USA
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Bruen K, Downey E. Successful Repair of a Diaphragmatic Hernia Through a Pericardial Window with Acellular Dermal Matrix. J Laparoendosc Adv Surg Tech A 2007; 17:383-6. [PMID: 17570794 DOI: 10.1089/lap.2006.0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A successful placement of a transabdominal pericardial window is associated with diaphragmatic hernia. In this paper, we present the case of a 5-month-old ex-31-weeks-premature baby who developed a symptomatic diaphragmatic hernia following a chronic pericardial effusion who was treated successfully with a laparoscopic transabdominal pericardial window. Laparoscopy and a pericardial window were used to manage the symptomatic effusion that developed following a bilateral thoracotomy and median sternotomy for the patient's massive hygroma. The patient was followed before and after pericardial drainage with a serial examination, chest radiography, and echocardiography. In addition, computerized tomography was also used for long-term follow-up following the repair of the hernia. An acellular dermal matrix was utilized for patching the hernia with a laparotomy. The abdominal approach in both operations offered direct access to the pericardial space and hernia, thereby avoiding previously operated thoraces. A subsequent follow-up at 9 months following the creation of the window suggested a recurrent tamponade physiology. Plain radiographs and an echocardiogram showed herniation into the pericardial sac. The hernia was operatively reduced and repaired with an acellular dermal matrix. Recovery and subsequent followup at 1 year revealed no hernia, full symptom resolution, and no recurrence of the pericardial effusion. A pericardial window is an effective approach for the management of chronic pericardial effusion. Diaphragmatic herniation through a pericardial window can be successfully repaired with an acellular dermal matrix.
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Affiliation(s)
- Kevin Bruen
- Department of Surgery, Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113, USA
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Zhang L, Liu Z, Cui P, Zhao D, Chen W. SIS with tissue-cultured allogenic cartilages patch tracheoplasty in a rabbit model for tracheal defect. Acta Otolaryngol 2007; 127:631-6. [PMID: 17503233 DOI: 10.1080/00016480600987750] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONCLUSIONS In the rabbit model, small intestinal submucosa (SIS) compounded with tissue-cultured allogenic cartilages appeared to be an efficacious method for the patch repair of partial circumferential tracheal defects instead of autologous grafts. SIS appears to be a safe and promising means of facilitating neovascularization and tissue regeneration. The long-term use of SIS and tissue-cultured allogenic cartilages warrants further investigation. BACKGROUND Tracheal defect reparation remains a challenging surgical problem that can require reconstruction using autologous grafts or artificial stents. This study was performed to evaluate the efficacy of SIS, a biocompatible, acellular matrix, compounded with different tissue-cultured allogenic cartilages, in the repair of a critical-size tracheal defect. MATERIALS AND METHODS A full-thickness defect (4 x 8 mm) was created in tracheal rings four to six in adult rabbits. A piece of 8-ply SIS sandwiched in thyroid cartilage, auricular cartilage, or without cartilage, respectively (designated experiment 1, 2, or 3, respectively), was sutured to the edges of the defect with interrupted 4-0 polypropylene sutures. In control animals, the defect was closed with lamina praetrachealis. All animals were followed until signs of dyspnea became apparent or for 4 or 12 weeks. After follow-up and euthanasia, the trachea was harvested and prepared for histologic evaluation using conventional techniques. RESULTS All animals tolerated the procedure well but two animals in group 1 (n=5), three in group 2 (n=5), and one in group 3 (n=5) had stridor after operation and expired within <1 month with different degrees of obstruction. The other animals in these groups and the control animals (n =3) all survived >1 month. Histologically, neovascularization of the patch was noted with moderate inflammation. The surface of the SIS patch was covered with a lining of ciliated epithelial cells. The tissue-cultured allogenic cartilages degraded to some extent.
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Affiliation(s)
- Longfang Zhang
- Department of Otolaryngology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
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Zheng F, Xu L, Verbiest L, Verbeken E, De Ridder D, Deprest J. Cytokine production following experimental implantation of xenogenic dermal collagen and polypropylene grafts in mice. Neurourol Urodyn 2007; 26:280-9. [PMID: 17009249 DOI: 10.1002/nau.20317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIM We earlier showed that xenogenic Pelvicol (Bard, Olen, Belgium) implants induce a lesser inflammatory response than Prolene (Johnson and Johnson, Dilbeek, Belgium). The purpose of this study was to determine cytokine profiles in the host immune responses to Pelvicol in a mouse model. The hypothesis was that Pelvicol would induce a "T-helper2" (Th2) rather than T-helper1 (Th1) type of inflammatory response. METHODS Mice were implanted subcutaneously with Pelvicol or Prolene and the graft sites were harvested at 3 to 28 days. Histopathology was done and cytokine levels were determined by immunohistochemistry and RT-PCR. Flow cytometry was used to identify which cell population contributed to the observed cytokine production profiles. RESULTS Pelvicol induced a decreased inflammation and displayed an increase in IL-10 and TGF-beta, but reduce of TNF-alpha and IFN-gamma, indicating a Th2 type dominated response as examined by immunohistochemistry and RT-PCR. Flow cytometry showed that the monocytes/maceophages were the main cell population responsible for production of these cytokines. Monocytes/maceophages from Pelvicol explants showed upregulated expression of IL-10 while Prolene explants expressed TNF-alpha. CONCLUSION Pelvicol induced a Th2 type cytokine-dominated immune response after subcutaneous implantation in mice.
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Affiliation(s)
- Fang Zheng
- Center for Surgical Technologies, University Hospitals Leuven, Katholieke Universiteit Leuven, Minderbroedersstraat 17, 3000-Leuven, Belgium
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Fox DB, Cook JL, Kuroki K, Cockrell M. Effects of dynamic compressive load on collagen-based scaffolds seeded with fibroblast-like synoviocytes. ACTA ACUST UNITED AC 2006; 12:1527-37. [PMID: 16846349 DOI: 10.1089/ten.2006.12.1527] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Synoviocytes have been speculated to play potential reparative and remodeling roles in vascular meniscal injuries. In addition, synoviocytes may mediate the transformation of intraarticularly placed collagen-based scaffolds into fibrocartilage through exposure to dynamic compressive loads. The objectives of this study were to assess the feasibility of using fibroblast-like synoviocytes (FLS) to engineer meniscal-like fibrocartilage and to better understand the mechanosensitivity of FLS by seeding them onto collagen scaffolds exposed to dynamic compressive loads. Canine FLS were seeded onto disks of four commercially available collagen-based scaffolds (Restore, Permacol, Cuff Patch, and Graff Jacket) and subjected either to one of two levels of intermittent dynamic compressive load or no load. The disks were harvested at 1 and 2 weeks and assessed for cell viability, retention, and infiltration, as well as extracellular matrix production. In general, loading regimens decreased cellularity, and nonloaded Restore grafts retained the most cells across time intervals. Spatial distribution of FLS was optimized in Restore grafts and was overall better in non-crosslinked collagen scaffolds (Restore and Graft Jacket) than cross-linked matrices. Collagen production was noted in association with penetrating FLS clusters in the Restore scaffolds only. The applied biomechanical stimulus did not appear to induce fibrochondrogenesis in any treatment group. These data suggest that Restore scaffolds may foster greater cell retention and infiltration when compared to other commercially available, collagen-based biomatrices.
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Affiliation(s)
- Derek B Fox
- The Comparative Orthopaedic Laboratory, University of Missouri-Columbia, Columbia, Missouri 65211, USA.
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Kunisaki SM, Jennings RW, Fauza DO. Fetal cartilage engineering from amniotic mesenchymal progenitor cells. Stem Cells Dev 2006; 15:245-53. [PMID: 16646670 DOI: 10.1089/scd.2006.15.245] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We determined whether cartilage could be engineered from mesenchymal progenitor cells (MPCs) normally found in amniotic fluid. Mesenchymal amniocytes were isolated from ovine amniotic fluid samples (n = 5) and had their identity confirmed by immunocytochemistry. Cells were expanded and then cultured as micromass pellets (n = 5) in a chondrogenic medium containing transforming growth factor-beta2 (TGF-beta2) and insulin growth factor-1 (IGF-1) for 6-12 weeks. Pellets derived from fetal dermal fibroblasts (n = 4) were cultured under identical conditions. Additionally, expanded mesenchymal amniocytes were seeded onto biodegradable polyglycolic acid scaffolds (n = 5) and maintained in the same chondrogenic medium within a rotating bioreactor for 10-15 weeks. Engineered specimens were analyzed quantitatively and compared with native fetal hyaline cartilage samples (n = 5). Statistical analysis was by the unpaired Student's t-test (p < 0.05). The isolated cells stained positively for vimentin and cytokeratins-8 and -18, but negatively for CD31. Micromass pellets derived from mesenchymal amniocytes exhibited chondrogenic differentiation by both standard and matrix-specific staining. In contrast, these findings could not be replicated in dermal fibroblast-based pellets. The engineered constructs derived from mesenchymal amniocytes similarly displayed histological evidence of chondrogenic differentiation and maintained their original size and three-dimensional architecture. Quantitative assays of the engineered constructs revealed lower concentrations of collagen type II, but similar amounts of glycosaminoglycans, elastin, and DNA, when compared to native fetal hyaline cartilage. We conclude that mesenchymal amniocytes can be used for the engineering of cartilaginous tissue in vitro. Cartilage engineering from the amniotic fluid may become a practical approach for the surgical treatment of select congenital anomalies.
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Affiliation(s)
- Shaun M Kunisaki
- Advanced Fetal Care Center and the Department of Surgery, Children's Hospital Boston, MA 02115, USA
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Liptak JM, Brebner NS. Hemidiaphragmatic reconstruction with a transversus abdominis muscle flap after resection of a solitary diaphragmatic mesothelioma in a dog. J Am Vet Med Assoc 2006; 228:1204-8. [PMID: 16618223 DOI: 10.2460/javma.228.8.1204] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 2-year-old Siberian Husky was evaluated because of a 2-week history of coughing and gagging and decreased appetite and activity level. CLINICAL FINDINGS Radiography, surgery, and immunohistochemical examination revealed a solitary sclerosing mesothelioma extending from the left thoracic diaphragmatic surface that was adherent to the pericardium and the caudal mediastinum. TREATMENT AND OUTCOME The tumor was resected along with most of the left hemidiaphragm, and the left transversus abdominis muscle was used to reconstruct the diaphragm. The 13th rib formed the base of the muscle flap. The muscle flap was transposed into the defect so that the mesothelium-lined surface faced the thoracic cavity and the deep aspect of the muscle formed the abdominal surface of the diaphragm. To minimize risk of adhesions, the exposed raw aspect of the abdominal surface was covered with porcine small intestinal submucosa. Recovery was uncomplicated, and the dog's appetite and activity level soon returned to normal. Evaluation 54 days after surgery revealed 2 subcutaneous masses on the thorax and masses in the liver and both kidneys; histologic and immunohistochemical analyses revealed metastasis of the original tumor. The dog was euthanatized. CLINICAL RELEVANCE Hemidiaphragmatic reconstruction with a transversus abdominis muscle flap after resection of a diaphragmatic tumor was successful. The muscle flap was easily harvested and transposed into the diaphragmatic defect.
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Affiliation(s)
- Julius M Liptak
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada
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Brizendine JB, LeFaivre JF, Yost MJ, Fann SA. Reconstruction of parasacral hernia with acellular human dermis graft. Hernia 2006; 10:360-3. [PMID: 16705361 DOI: 10.1007/s10029-006-0092-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2005] [Accepted: 03/22/2006] [Indexed: 10/24/2022]
Abstract
Parasacral hernias are defects through the pelvic floor which occur as the result of sacral resection. These defects are often large, and are frequently the result of treatment for sacral malignancies. This report documents the case of a 71-year-old woman who underwent radical coccygectomy and partial sacrectomy for a chordoma and subsequently presented 1 year later with a large parasacral hernia. The defect was repaired using an acellular human dermis graft with a gluteus maximus muscle-advancement flap overlay. This article summarizes the current literature of this challenging clinical problem, and examines the use of acellular human dermis in the repair of complex hernias.
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Affiliation(s)
- J B Brizendine
- Department of Surgery, University of South Carolina School of Medicine, 2 Med Park, Suite 402, Columbia, SC 29203, USA.
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Sandoval JA, Lou D, Engum SA, Fisher LM, Bouchard CM, Davis MM, Grosfeld JL. The whole truth: comparative analysis of diaphragmatic hernia repair using 4-ply vs 8-ply small intestinal submucosa in a growing animal model. J Pediatr Surg 2006; 41:518-23. [PMID: 16516627 DOI: 10.1016/j.jpedsurg.2005.11.068] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diaphragmatic reconstruction remains a challenging problem. There is limited information concerning the use of small intestinal submucosa (SIS) in congenital diaphragmatic hernia repair. A canine model was used to evaluate the use of a SIS patch in diaphragmatic reconstruction. METHODS Eleven beagle puppies (1.6-4.2 kg, 8 weeks old) underwent left subcostal laparotomy, central left hemidiaphragm excision (2 x 7 cm, 50% loss), and reconstruction with a 4-ply group I (n = 5) or 8-ply group II (n = 6) SIS patch. Chest radiographs were taken at time of operation and 3 and 6 months postoperatively. Animals were killed at 6 months. Adhesion formation (both pleural and abdominal), gross visual evaluation of the patch, and histology were compared. RESULTS In group I (4-ply), 1 animal died at 3 months from patch deterioration accompanied by stomach herniation that resulted in respiratory failure. In the 4 remaining animals, chest radiographs showed no evidence of herniation or eventration. On physical examination, there was no evidence of chest wall deformity. During gross surgical examination, the 4-ply patches showed thinning, multiple defects, and liver herniation in 3 animals. In 1 pup, the patch was thickened, intact, well incorporated at the repair site, and adherent to the liver and spleen. In group II (8-ply), 1 animal died of cardiopulmonary failure in the early postoperative period. In the other 5 animals, chest radiographs showed evidence of eventration in 1. On gross examination the patch adhered to the liver in all 5 surviving animals. In 4, the patches were thickened, viable, but had some shrinkage. One patch pulled away from the native diaphragm laterally; however, no visceral herniation was present. In the 1 animal with eventration, there was no evidence of a patch. Adhesion scores (AS) were graded and determined by the sum of extent (0-4), type (0-4), and tenacity (0-3). Average abdominal AS in group I was 5.6 +/- 0.8 vs 10.2 +/- 0.2 (P = .079) for group II. Average lung AS was 0.6 +/- 0.6 in group I vs 3.8 +/- 1.1 (P = .0476) for group II. Histological examination showed group II patches had greater collagen deposition with central calcification and mild inflammation within the residual graft, whereas group I patches were much thinner and were composed of granulation tissue without evidence of residual graft. CONCLUSIONS These data indicate that 8-ply SIS repair of diaphragmatic defects was superior (80%; 4/5 to 4-ply, 20%; 1/5, success). Organ adherence appears to be necessary for neovascularization of the SIS composite. Eight-ply grafts appear to be more durable and persist for a longer period, which may improve neovascularization. Long-term follow-up to evaluate remodeling characteristics of the patch material is required.
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Affiliation(s)
- John A Sandoval
- Department of Surgery, Indiana University School of Medicine and the James Whitcomb Riley Children's Hospital, Indianapolis, IN 46202, USA
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Kolker AR, Brown DJ, Redstone JS, Scarpinato VM, Wallack MK. Multilayer reconstruction of abdominal wall defects with acellular dermal allograft (AlloDerm) and component separation. Ann Plast Surg 2006; 55:36-41; discussion 41-2. [PMID: 15985789 DOI: 10.1097/01.sap.0000168248.83197.d4] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Multiple techniques have been employed for the repair of abdominal incisional hernias with varying rates of success. Primary fascial apposition and prosthetic implantation have been associated with high rates of secondary recurrence, infection, and other complications, often due to insufficient alleviation of tension and implant intolerance. This study evaluates the repair of incisional and recurrent abdominal hernias with multilayered acellular dermal allograft (AlloDerm; LifeCell Corporation, Branchburg, NJ) and musculofascial separation. Patients with incisional or recurrent abdominal hernias were treated between January 2003 and March 2004. The surgical technique involved musculofascial release of the external oblique, followed by a double-layer implantation of dermal allograft. The primary allograft layer was placed as an "underlay" interposition, sutured under moderate tension beneath the fascial edges of the defect. When minimal tension remained, the native fascial margins of the defect were directly repaired. A second allograft layer was then placed and sutured to the superficial aspect of the ventral fascia to complete the repair. Data were reviewed retrospectively. Sixteen patients were treated. There were 10 males and 6 females, mean age 56 years (range 44--72 years). Fifteen patients (94%) had previous hernia repair procedures, and 6 patients (38%) had undergone 2 or more previous procedures. Nine patients (56%) were treated with hernia site infections or prosthetic exposure. Mean follow-up is 16 months (range 9 to 23 months). There were 2 seromas (13%). One patient (6%) developed a wound dehiscence with allograft exposure that healed by secondary intention. There were no recurrences. By minimizing tension and providing a durable biocompatible matrix for support, component separation with bilaminar acellular dermal allograft should be considered for the repair of complex and recurrent ventral hernias.
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Affiliation(s)
- Adam R Kolker
- Department of Surgery, Division of Plastic Surgery, Mount Sinai School of Medicine, New York, NY 10021, USA.
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Kunisaki SM, Fuchs JR, Kaviani A, Oh JT, LaVan DA, Vacanti JP, Wilson JM, Fauza DO. Diaphragmatic repair through fetal tissue engineering: a comparison between mesenchymal amniocyte- and myoblast-based constructs. J Pediatr Surg 2006; 41:34-9; discussion 34-9. [PMID: 16410104 DOI: 10.1016/j.jpedsurg.2005.10.011] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We have previously shown that fetal tissue engineering is a preferred alternative to diaphragmatic repair in a large animal model. This study was aimed at comparing diaphragmatic constructs seeded with mesenchymal amniocytes and fetal myoblasts in this model. METHODS Neonatal lambs (n = 14) underwent repair of an experimental diaphragmatic defect with identical scaffolds, either seeded with labeled autologous cells (mesenchymal amniocytes in group 1 and fetal myoblasts in group 2) or as an acellular graft (group 3). At 1 to 12 months postoperatively, implants were harvested for multiple analyses. RESULTS Repair failure (reherniation or eventration) was significantly higher in group 3 than in groups 1 and 2, with no difference between groups 1 and 2. Seeded fetal myoblasts quickly lost their myogenic phenotype in vivo. All grafts contained cells with a fibroblastic-myofibroblastic profile. Elastin concentrations and both modular and ultimate tensile strengths were significantly higher in group 1 than in groups 2 and 3. There were no differences in glycosaminoglycans and type I collagen levels among the groups. CONCLUSIONS Diaphragmatic repair with a mesenchymal amniocyte-based engineered tendon leads to improved structural outcomes when compared with equivalent fetal myoblast-based and acellular grafts. The amniotic fluid is a preferred cell source for tissue-engineered diaphragmatic reconstruction.
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Affiliation(s)
- Shaun M Kunisaki
- Department of Surgery, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA
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Fimiani M, Pianigiani E, Di Simplicio FC, Sbano P, Cuccia A, Pompella G, De Aloe G, Petraglia F. Other uses of homologous skin grafts and skin bank bioproducts. Clin Dermatol 2005; 23:396-402. [PMID: 16023935 DOI: 10.1016/j.clindermatol.2004.07.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The main use of homologous skin grafts or grafts of related bioproducts is in the treatment of severe burns. However, various new clinical and experimental sectors, in which this type of skin substitute can be useful, have recently emerged. The main new clinical indications for skin allografts include: skin loss, surgical wounds and bullous diseases. In these fields donor skin can be used for different purposes: as a physiological biological dressing to control pain and protect deep structures such as tendons, bones, cartilage and nerves, and to promote reepithelization with a significant reduction in healing time, and as skin substitute with dermal tissue to guide repair and make it as physiological as possible. In particular, skin bank bioproducts are currently used in the treatment of several conditions such venous and arterial leg ulcers, pressure ulcers, diabetic foot ulcers, pyoderma gangrenosum, post traumatic lesions, Mohs surgery, reconstructive surgery, wound cover in critical areas, aesthetic surgery, congenital epidermolysis bullosa and Lyell's syndrome. Skin bank bioproducts have also been used for experimental indications, to study in vitro toxicology and in vitro skin biology. Recently the demonstration that de-epidermized dermis (DED) has all the characteristics of an excellent dermal substitute into which various types of cells can be introduced and made to develop, opens exciting new possibilities of research in the field of wound healing and tissue engineering. Our preliminary observations seems to indicate that CD 34+ stem cells from umbilical cord blood can survive in DED and in a few weeks populate collagen bundles. The observation of tubular structures without lumina close to collagen bundles as well as clusters of epithelioid or fibroblast-shaped cells may represent aspects of differentiation of CD 34+ stem cells. More detailed and sophisticated studies are clearly needed to answer all the questions that these initial observations pose. Anyway the 3-dimensional model proposed seems to be suitable for the study of the behaviour of peripheral CD 34+ and perhaps also other types of stem cells in 3-dimensional dermal matrix.
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Affiliation(s)
- Michele Fimiani
- Department of Dermatologic Sciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy.
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Kaleya RN. Evaluation of implant/host tissue interactions following intraperitoneal implantation of porcine dermal collagen prosthesis in the rat. Hernia 2005; 9:269-76. [PMID: 16136391 DOI: 10.1007/s10029-005-0003-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Accepted: 04/06/2005] [Indexed: 12/13/2022]
Abstract
An ideal prosthesis for ventral hernia repair should minimize development of postoperative adhesions. This study evaluates adhesion formation following intraperitoneal implantation of acellular porcine dermal collagen (PDC) and polypropylene (PP) mesh in 16 rats. Implant placement alternated left/right. Sacrifice (4 or 12 weeks) was randomized. Methods included adhesion grading (extent, severity, required dissection method) and histological evaluation. At 4 weeks, 7 of 8 PDC specimens and 0 of 8 PP implants were adhesion-free; results were identical at 12 weeks. Four-week adhesions were less developed than 12-week adhesions. Histology showed mononuclear cell foreign body reaction and disorganized collagen deposition for PPs compared to infiltration with neovascular channels and qualitatively less intense foreign body reaction for PDCs. PDC exhibits fewer adhesions and more favorable cellular response than PP in the rat.
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Affiliation(s)
- Ronald N Kaleya
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
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Abstract
BACKGROUND Laparoscopic repair of congenital diaphragmatic hernias has been sparsely reported. Moreover, each report has primarily been a single operative case. In most of the reports, prosthetic mesh has not been used, and when used, it has been nonabsorbable in nature. Most of these case reports have documented only a few months of clinical follow-up. METHODS After institutional review board approval (No. 01-12-115X), the clinical course and outcome of 3 patients undergoing laparoscopic repair of foramen of Morgagni and Bochdalek hernias using 4-ply Surgisis soft tissue graft (Cook Inc, Bloomington, Ind) were reviewed to determine if this approach is appropriate. RESULTS In 2001, 2 patients, ages 9 months and 14 years, underwent laparoscopic foramen of Morgagni repair and one 5-day-old underwent laparoscopic foramen of Bochdalek repair using Surgisis soft tissue graft as a patch to close the diaphragmatic defects because there was too much tension with primary repair. In each case, the prosthesis was secured to the rim of the defect using interrupted silk sutures tied intracorporally. The mean operative time for repair of the Morgagni defects was 230 minutes with a postoperative discharge of 1 and 2 days. For the foramen of Bochdalek repair, the operative time was 204 minutes, and the patient was discharged at 3 weeks. No complications have occurred during or after any of the procedures, but the oldest patient underwent diagnostic laparoscopy 3 months postoperatively for a radiographic finding of suspected recurrence. At laparoscopy, the patch was intact, and no diaphragmatic hernia was noted. CONCLUSIONS Laparoscopic repair of congenital diaphragmatic defects using prosthetic material is possible although the operative time required is around 3.5 hours. Because of the brief postoperative course, the laparoscopic approach appears justified in the nonneonatal patients. Whether this approach is appropriate for repair of neonatal Bochdalek hernias remains unclear.
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Affiliation(s)
- George W Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108-4698, USA.
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Smith NP, Jesudason EC, Featherstone NC, Corbett HJ, Losty PD. Recent advances in congenital diaphragmatic hernia. Arch Dis Child 2005; 90:426-8. [PMID: 15781941 PMCID: PMC1720369 DOI: 10.1136/adc.2003.045765] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is a common birth defect which continues to challenge paediatric surgeons and intensivists. Affecting approximately 1:2500 births, a baby with CDH is born every 24-36 hours in the UK.
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Affiliation(s)
- N P Smith
- Department of Paediatric Surgery, Royal Liverpool Children's Hospital (Alder Hey) and University of Liverpool, UK
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Rutherford EJ, Skeete DA, Brasel KJ. Management of the patient with an open abdomen: techniques in temporary and definitive closure. Curr Probl Surg 2005; 41:815-76. [PMID: 15685140 DOI: 10.1067/j.cpsurg.2004.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Edmund J Rutherford
- Surgical Intensive Care Unit, University of North Carolina, Chapel Hill, North Carolina, USA
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Drewa T, Galazka P, Prokurat A, Wolski Z, Sir J, Wysocka K, Czajkowski R. Abdominal wall repair using a biodegradable scaffold seeded with cells. J Pediatr Surg 2005; 40:317-21. [PMID: 15750922 DOI: 10.1016/j.jpedsurg.2004.10.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE The repair of large abdominal wall defects is still a challenge for pediatric surgeons. Synthetic materials, however, may lead to high complication rates. This study was aimed at applying tissue-engineering methods to abdominal wall repair. METHODS 3T3 mouse fibroblasts were expanded in vitro. In the next step, a biodegradable material--polyglycolic acid (PGA)--was actively seeded with 10(7) cells/scm of PGA scaffold. Culture medium (Dulbecco's Modified Eagle's Medium with 10% fetal bovine serum) was changed every 6 hours after seeding cells on PGA fibers. Under general anaesthesia, C57BL/6J black mice underwent creation of a 2 x 3-cm abdominal wall defect (60%-70% of abdominal surface). The defect was repaired in the experimental group with the fibroblast-seeded PGA scaffold. In the first control group, the defect was covered with acellular PGA, and in the second control group, by skin closure. Animals were killed after 30 days to assess the histologic and gross findings. RESULTS No abdominal hernia was found in animals repaired with cell-seeded and acellular scaffolds. All animals with skin closure died within 7 days. In every case, tissue-engineered construct was thicker then in controls. Histologic and gross examination revealed a good neovascularisation in tissue-engineered abdominal walls comparing to the acellular matrix. There was no intensive scar formation between abdominal wall and skin. CONCLUSIONS Engineered soft tissue constructs can provide structural replacement of severe and large abdominal wall defects. Tissue engineering in the near future will possibly enter clinical practice.
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Affiliation(s)
- Tomasz Drewa
- Department of Urology, The L. Rydygier Medical University, 85-094 Bydgoszcz, Poland.
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Abstract
Bioscaffolds derived from xenogeneic extracellular matrix (ECM) have been used in numerous tissue engineering applications. The safety and efficacy of such scaffolds when used for the repair and reconstruction of numerous body tissues including musculoskeletal, cardiovascular, urogenital and integumentary structures has been shown in both preclinical animal studies and in human clinical studies. More than 200,000 human patients have been implanted with xenogeneic ECM scaffolds. These ECM scaffolds are typically prepared from porcine organs such as small intestine or urinary bladder, which are subjected to decellularization and terminal sterilization without significant loss of the biologic effects of the ECM. The composition of these bioscaffolds includes the structural and functional proteins that are part of native mammalian extracellular matrix. The three-dimensional organization of these molecules distinguishes ECM scaffolds from synthetic scaffold materials and is associated with constructive tissue remodeling instead of scar tissue. The biologic response to these xenogeneic bioscaffolds, including the immune response, is discussed herein.
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Affiliation(s)
- Stephen F Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 100 Technology Drive, Suite 200, Pittsburgh, PA 15219, USA.
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Smith MJ, Paran TS, Quinn F, Corbally MT. The SIS extracellular matrix scaffold-preliminary results of use in congenital diaphragmatic hernia (CDH) repair. Pediatr Surg Int 2004; 20:859-62. [PMID: 15565305 DOI: 10.1007/s00383-004-1298-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2004] [Indexed: 10/26/2022]
Abstract
There is no ideal bio-tensile material for tissue replacement in paediatric surgical conditions. A variety of materials have been described to replace or reinforce tissue deficits in congenital diaphragmatic hernia (CDH). The problems with these materials range from extensive surgery to body wall deformity and hernia recurrence. The ideal graft would be safe, strong, have the potential to grow and not require replacement, not affect chest wall development or produce deformity, and have minimal risk of recurrence. Surgisis is a biomaterial composed of porcine intestinal submucosa that provides inherent tensile strength as a collagen lattice and is ultimately replaced by native collagen tissue. Our objective was to prospectively assess the utility of Surgisis as a replacement graft in a cohort of 10 children undergoing primary or recurrent CDH repair. The graft was well tolerated, and there was no recurrence of herniation. We conclude that Surgisis collagen mesh may be a useful alternative for tissue replacement or reinforcement in difficult cases of CDH and diaphragmatic agenesis. The biological framework of Surgisis may also prove useful in other situations of complex tissue loss in children.
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Affiliation(s)
- M J Smith
- Department of Paediatric Surgery, Our Lady's Hospital for Sick Children, 12 Crumlin, Dublin, Ireland.
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Abstract
Despite the use of various types of grafts, no surgical treatment currently exists to restore a tendon to its normal condition. Tissue engineering techniques are being used to develop therapies for tendon reconstruction. Biologic and synthetic scaffolds can both repair tendon defects and improve healing by allowing for the regeneration of the tendon's natural biologic composition to restore its mechanical capacity. This process can be further enhanced through augmentation methods such as cell seeding, growth factor implantation, and gene therapy.
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Affiliation(s)
- Michael J DeFranco
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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50
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Abstract
Although total parenteral nutrition prevents patients with short bowel syndrome from dying of starvation, having short bowel remains a severely debilitating condition. The best current treatment for inadequate absorptive surface area is through intestinal transplantation. However, this therapy is associated with significant morbidity and patients suffer from consequences of long-term immunosuppression. Additionally, the numbers of organs are limited. A new frontier in medicine is the field of tissue engineering. We will review the progress of intestinal bioengineering with a focus on the use of animal models. Investigators initially used autologous tissue as a patch to study intestinal regeneration. Subsequent studies focused on the use of absorbable biomaterials as a patch for tissue ingrowth. The most novel methodology consists of seeding a resorbable scaffold and implanting this construct to observe the regeneration of neointestine. Successful creation of esophagus, stomach, small bowel and colon has been demonstrated. Although these studies are preliminary, the results suggest that tissue-engineered intestine will become a real therapeutic option in the not too distant future for patients with inadequate intestinal tissue.
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Affiliation(s)
- M K Chen
- Department of Surgery, University of Florida, Gainesville, FL 32610, USA.
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