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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

Radiographic evaluation.Unoperated control (d90; A), left-convex scoliosis, postoperative changes of the 9th and 10th left rib (SIS d90; B), discrete elevation of the left diaphragm (SIS d60; C), and discrete reduced left-thoracic volume with postoperative calcifications adjacent to the 8th left rib (Matricel d90; D).
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pone.0132021.g002: Radiographic evaluation.Unoperated control (d90; A), left-convex scoliosis, postoperative changes of the 9th and 10th left rib (SIS d90; B), discrete elevation of the left diaphragm (SIS d60; C), and discrete reduced left-thoracic volume with postoperative calcifications adjacent to the 8th left rib (Matricel d90; D).

Mentions: Only limited changes were observed on chest x-ray. Discrete elevation of the left diaphragm was seen in three animals at 60 days, one in the Gore-Tex and SIS group (Fig 2C) and remarkably also in an unoperated control. We did not find true herniation of abdominal organs through the diaphragm nor noticed any signs of infection or pulmonary atelectasis. One animal presented with a left-convex scoliosis (Fig 2B; SIS d90) and one (Matricel d90) had a slightly reduced left-thoracic volume with postoperative calcifications adjacent to the 8th left rib (Fig 2D).


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)

Radiographic evaluation.Unoperated control (d90; A), left-convex scoliosis, postoperative changes of the 9th and 10th left rib (SIS d90; B), discrete elevation of the left diaphragm (SIS d60; C), and discrete reduced left-thoracic volume with postoperative calcifications adjacent to the 8th left rib (Matricel d90; D).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132021.g002: Radiographic evaluation.Unoperated control (d90; A), left-convex scoliosis, postoperative changes of the 9th and 10th left rib (SIS d90; B), discrete elevation of the left diaphragm (SIS d60; C), and discrete reduced left-thoracic volume with postoperative calcifications adjacent to the 8th left rib (Matricel d90; D).
Mentions: Only limited changes were observed on chest x-ray. Discrete elevation of the left diaphragm was seen in three animals at 60 days, one in the Gore-Tex and SIS group (Fig 2C) and remarkably also in an unoperated control. We did not find true herniation of abdominal organs through the diaphragm nor noticed any signs of infection or pulmonary atelectasis. One animal presented with a left-convex scoliosis (Fig 2B; SIS d90) and one (Matricel d90) had a slightly reduced left-thoracic volume with postoperative calcifications adjacent to the 8th left rib (Fig 2D).

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