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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

Tensiometric and histological results.Maximal stress at the point of disruption (A, p = 0.01$) and stiffness of the comfort zone (B, p = 0.3) for the mesh-tissue interface (white) compared to the right-sided unoperated diaphragm (black). Inflammatory response (C): foreign body giant cells (FBGC; p = 0.0008; white), polymorphonuclear cells (PMN; p<0.0001; black) resp. macrophages (RAM 11; p<0.0001; light grey). Fibrotic process (D): collagen organization (p = 0.2; dark grey), composition (p = 0.0005; black) and amount (p = 0.1$; light grey), neovascularization (p = 0.2; white). Mean+SD with overall p-value (Kruskal-Wallis test or ANOVA [$]). Multiple groups comparison (Wilcoxon each pair test or posthoc Tukey test): solid line = significant, dashed line = non-significant, * = significant difference between unoperated controls / primary repair and the three patch materials. Matched-pairs comparison (paired t-test or Wilcoxon signed rank test): [squared bracket = significance level].
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pone.0132021.g004: Tensiometric and histological results.Maximal stress at the point of disruption (A, p = 0.01$) and stiffness of the comfort zone (B, p = 0.3) for the mesh-tissue interface (white) compared to the right-sided unoperated diaphragm (black). Inflammatory response (C): foreign body giant cells (FBGC; p = 0.0008; white), polymorphonuclear cells (PMN; p<0.0001; black) resp. macrophages (RAM 11; p<0.0001; light grey). Fibrotic process (D): collagen organization (p = 0.2; dark grey), composition (p = 0.0005; black) and amount (p = 0.1$; light grey), neovascularization (p = 0.2; white). Mean+SD with overall p-value (Kruskal-Wallis test or ANOVA [$]). Multiple groups comparison (Wilcoxon each pair test or posthoc Tukey test): solid line = significant, dashed line = non-significant, * = significant difference between unoperated controls / primary repair and the three patch materials. Matched-pairs comparison (paired t-test or Wilcoxon signed rank test): [squared bracket = significance level].

Mentions: The point of disruption was at the interface between the implant and the host tissue in 24 of 27 samples. In only one (Gore-Tex) the explant and in two (Matricel) the native tissue disrupted first. The maximal strength at disruption (Fig 4A) of SIS explants was lower than that of the right-sighted native tissue (p<0.0001), irrespective of the visible persistence (p = 0.01) or absorption (p = 0.005) of the initial material. It was also lower than that of Gore-Tex (p = 0.01) but not of Matricel patches (p = 0.08). Conversely, the maximal strength at disruption of Matricel and Gore-Tex explants fell in the range of what was measured in the intact native tissue (both p = 0.08). There was neither any difference between the two materials (p = 0.6).


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)

Tensiometric and histological results.Maximal stress at the point of disruption (A, p = 0.01$) and stiffness of the comfort zone (B, p = 0.3) for the mesh-tissue interface (white) compared to the right-sided unoperated diaphragm (black). Inflammatory response (C): foreign body giant cells (FBGC; p = 0.0008; white), polymorphonuclear cells (PMN; p<0.0001; black) resp. macrophages (RAM 11; p<0.0001; light grey). Fibrotic process (D): collagen organization (p = 0.2; dark grey), composition (p = 0.0005; black) and amount (p = 0.1$; light grey), neovascularization (p = 0.2; white). Mean+SD with overall p-value (Kruskal-Wallis test or ANOVA [$]). Multiple groups comparison (Wilcoxon each pair test or posthoc Tukey test): solid line = significant, dashed line = non-significant, * = significant difference between unoperated controls / primary repair and the three patch materials. Matched-pairs comparison (paired t-test or Wilcoxon signed rank test): [squared bracket = significance level].
© Copyright Policy
Related In: Results  -  Collection

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

pone.0132021.g004: Tensiometric and histological results.Maximal stress at the point of disruption (A, p = 0.01$) and stiffness of the comfort zone (B, p = 0.3) for the mesh-tissue interface (white) compared to the right-sided unoperated diaphragm (black). Inflammatory response (C): foreign body giant cells (FBGC; p = 0.0008; white), polymorphonuclear cells (PMN; p<0.0001; black) resp. macrophages (RAM 11; p<0.0001; light grey). Fibrotic process (D): collagen organization (p = 0.2; dark grey), composition (p = 0.0005; black) and amount (p = 0.1$; light grey), neovascularization (p = 0.2; white). Mean+SD with overall p-value (Kruskal-Wallis test or ANOVA [$]). Multiple groups comparison (Wilcoxon each pair test or posthoc Tukey test): solid line = significant, dashed line = non-significant, * = significant difference between unoperated controls / primary repair and the three patch materials. Matched-pairs comparison (paired t-test or Wilcoxon signed rank test): [squared bracket = significance level].
Mentions: The point of disruption was at the interface between the implant and the host tissue in 24 of 27 samples. In only one (Gore-Tex) the explant and in two (Matricel) the native tissue disrupted first. The maximal strength at disruption (Fig 4A) of SIS explants was lower than that of the right-sighted native tissue (p<0.0001), irrespective of the visible persistence (p = 0.01) or absorption (p = 0.005) of the initial material. It was also lower than that of Gore-Tex (p = 0.01) but not of Matricel patches (p = 0.08). Conversely, the maximal strength at disruption of Matricel and Gore-Tex explants fell in the range of what was measured in the intact native tissue (both p = 0.08). There was neither any difference between the two materials (p = 0.6).

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