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Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model.

Mayer S, Decaluwe H, Ruol M, Manodoro S, Kramer M, Till H, Deprest J - PLoS ONE (2015)

Bottom Line: 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).Tensiometry revealed a reduced bursting strength but normal compliance for SIS.Compliance was reduced in Matricel and Gore-Tex (p<0.01).

View Article: PubMed Central - PubMed

Affiliation: 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.

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.

No MeSH data available.


Related in: MedlinePlus

Surgical procedure.A left-dorsolateral thoracotomy was performed to expose the diaphragm. After placement of a traction suture (A, arrow) a 2.0 x 1.0 cm defect was cut in the tendomuscular part of the diaphragm and repaired by either placing a running suture (B) or inserting a cone-shaped patch (C, D) made from different materials.
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pone.0132021.g001: Surgical procedure.A left-dorsolateral thoracotomy was performed to expose the diaphragm. After placement of a traction suture (A, arrow) a 2.0 x 1.0 cm defect was cut in the tendomuscular part of the diaphragm and repaired by either placing a running suture (B) or inserting a cone-shaped patch (C, D) made from different materials.

Mentions: All surgical interventions were performed under sterile conditions as well as continuous monitoring of the heart rate and oxygen saturation. The animal was placed on its right side; the left laterodorsal thorax and upper abdomen were shaved, disinfected with povidone iodine (Isobetadine; Astra Medica, Brussels, Belgium) and covered with sterile draping. A left anterolateral thoracotomy [5] was performed in the third lowest intercostal space and a rib spreader was inserted to allow access to the diaphragm (Fig 1). A 5/0 polypropylene traction suture (Prolene; Ethicon, Dilbeek, Belgium) was placed at the anterolateral edge of the diaphragm prior to standardized resection of 2.0 x 1.0 cm of the lateral tendomuscular part of the diaphragm, approximating ⅓ to ½ of the diaphragm. This defect was either primarily repaired by a running 4/0 polyglecaprone suture (Monocryl; Ethicon) or overlaid by a 2.0 x 2.0 cm cone-shaped patch—as clinically done [25]—allowing an increased abdominal capacity. We temporarily left a thoracic drain (CH 8–10, Kendall Argyle suction catheter; Covidien, Belgium) connected to a ‘water-seal’ system until the thoracic wall was closed in layers using 4/0 polyglactine (Vicryl; Ethicon). Once the perioperative pneumothorax was evacuated, the drain was removed. The skin was closed with a running intracutaneous polyglecaprone suture (3/0 Monocryl; Ethicon). The wound was disinfected again with povidone iodine and covered with aluminum spray to prevent scratching and biting during the reconvalescence period.


Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model.

Mayer S, Decaluwe H, Ruol M, Manodoro S, Kramer M, Till H, Deprest J - PLoS ONE (2015)

Surgical procedure.A left-dorsolateral thoracotomy was performed to expose the diaphragm. After placement of a traction suture (A, arrow) a 2.0 x 1.0 cm defect was cut in the tendomuscular part of the diaphragm and repaired by either placing a running suture (B) or inserting a cone-shaped patch (C, D) made from different materials.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493058&req=5

pone.0132021.g001: Surgical procedure.A left-dorsolateral thoracotomy was performed to expose the diaphragm. After placement of a traction suture (A, arrow) a 2.0 x 1.0 cm defect was cut in the tendomuscular part of the diaphragm and repaired by either placing a running suture (B) or inserting a cone-shaped patch (C, D) made from different materials.
Mentions: All surgical interventions were performed under sterile conditions as well as continuous monitoring of the heart rate and oxygen saturation. The animal was placed on its right side; the left laterodorsal thorax and upper abdomen were shaved, disinfected with povidone iodine (Isobetadine; Astra Medica, Brussels, Belgium) and covered with sterile draping. A left anterolateral thoracotomy [5] was performed in the third lowest intercostal space and a rib spreader was inserted to allow access to the diaphragm (Fig 1). A 5/0 polypropylene traction suture (Prolene; Ethicon, Dilbeek, Belgium) was placed at the anterolateral edge of the diaphragm prior to standardized resection of 2.0 x 1.0 cm of the lateral tendomuscular part of the diaphragm, approximating ⅓ to ½ of the diaphragm. This defect was either primarily repaired by a running 4/0 polyglecaprone suture (Monocryl; Ethicon) or overlaid by a 2.0 x 2.0 cm cone-shaped patch—as clinically done [25]—allowing an increased abdominal capacity. We temporarily left a thoracic drain (CH 8–10, Kendall Argyle suction catheter; Covidien, Belgium) connected to a ‘water-seal’ system until the thoracic wall was closed in layers using 4/0 polyglactine (Vicryl; Ethicon). Once the perioperative pneumothorax was evacuated, the drain was removed. The skin was closed with a running intracutaneous polyglecaprone suture (3/0 Monocryl; Ethicon). The wound was disinfected again with povidone iodine and covered with aluminum spray to prevent scratching and biting during the reconvalescence period.

Bottom Line: 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).Tensiometry revealed a reduced bursting strength but normal compliance for SIS.Compliance was reduced in Matricel and Gore-Tex (p<0.01).

View Article: PubMed Central - PubMed

Affiliation: 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.

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.

No MeSH data available.


Related in: MedlinePlus