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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

Macroscopic findings.A. Primary repair (d60), polyglecaprone suture absorbed (arrow). B. Gore-Tex (d 60), encapsulated with perihepatic adhesions. Matricel patches were preserved in all (d60; C) but one animal (d90; D, arrow = patch remnant) with high-grade perihepatic adhesions (D). SIS patches were degraded in five animals with bulging of viscera in three (d60, E). Seroma was observed twice (d 60, F, asterisk).
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pone.0132021.g003: Macroscopic findings.A. Primary repair (d60), polyglecaprone suture absorbed (arrow). B. Gore-Tex (d 60), encapsulated with perihepatic adhesions. Matricel patches were preserved in all (d60; C) but one animal (d90; D, arrow = patch remnant) with high-grade perihepatic adhesions (D). SIS patches were degraded in five animals with bulging of viscera in three (d60, E). Seroma was observed twice (d 60, F, asterisk).

Mentions: The thoracic wall scars were unremarkable, neither were there intrathoracic signs of infection and none of the diaphragmatic repairs failed. Adhesions to the side of the thoracic incision were comparable in all operated groups (median grade 2; p = 0.8). Adhesions away from the surgical field were sparse (median grade 0) and only present after patch repair (p = 0.2). However, adhesions to the left lung (p = 0.008) and the liver (p<0.0001) differed between groups. The primarily repaired animals had no adhesions to the liver or lung (Fig 3A). Adhesions to the left lung were of a median grade 0.5 in Matricel animals and of a median grade 1.0 in SIS resp. Gore-Tex, whilst hepatic adhesions ranged from median grade 2.5 in the Gore-Tex group and grade 3.0 in the SIS group to a grade 4.0 in the Matricel group (Fig 3B and 3D).


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)

Macroscopic findings.A. Primary repair (d60), polyglecaprone suture absorbed (arrow). B. Gore-Tex (d 60), encapsulated with perihepatic adhesions. Matricel patches were preserved in all (d60; C) but one animal (d90; D, arrow = patch remnant) with high-grade perihepatic adhesions (D). SIS patches were degraded in five animals with bulging of viscera in three (d60, E). Seroma was observed twice (d 60, F, asterisk).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132021.g003: Macroscopic findings.A. Primary repair (d60), polyglecaprone suture absorbed (arrow). B. Gore-Tex (d 60), encapsulated with perihepatic adhesions. Matricel patches were preserved in all (d60; C) but one animal (d90; D, arrow = patch remnant) with high-grade perihepatic adhesions (D). SIS patches were degraded in five animals with bulging of viscera in three (d60, E). Seroma was observed twice (d 60, F, asterisk).
Mentions: The thoracic wall scars were unremarkable, neither were there intrathoracic signs of infection and none of the diaphragmatic repairs failed. Adhesions to the side of the thoracic incision were comparable in all operated groups (median grade 2; p = 0.8). Adhesions away from the surgical field were sparse (median grade 0) and only present after patch repair (p = 0.2). However, adhesions to the left lung (p = 0.008) and the liver (p<0.0001) differed between groups. The primarily repaired animals had no adhesions to the liver or lung (Fig 3A). Adhesions to the left lung were of a median grade 0.5 in Matricel animals and of a median grade 1.0 in SIS resp. Gore-Tex, whilst hepatic adhesions ranged from median grade 2.5 in the Gore-Tex group and grade 3.0 in the SIS group to a grade 4.0 in the Matricel group (Fig 3B and 3D).

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