Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box #8109, St. Louis, MO 63110, USA.
Hernia. 2010 Dec;14(6):599-610. doi: 10.1007/s10029-010-0684-x. Epub 2010 Jun 12.
The purpose of this study is to compare the tissue incorporation of a novel fenestrated and non-fenestrated crosslinked porcine dermal matrix (CPDM) (CollaMend™, Davol Inc., Warwick, RI) in a porcine model of ventral hernia repair.
Bilateral abdominal wall defects were created in 12 Yucatan minipigs and repaired with a preperitoneal or intraperitoneal technique 21 days after hernia creation. Animals were randomized to fenestrated or non-fenestrated CPDM for n = 6 pieces of each graft in the preperitoneal or intraperitoneal location. All animals were sacrificed at 1 month. Adhesion characteristics and graft contraction/growth were measured by the Garrard adhesion grading scale and transparent grid overlay. Histological analysis of hematoxylin and eosin (H&E)-stained slides was performed to assess graft incorporation. Tissue incorporation strength was measured by a T-peel tensile test. The strength of explanted CPDM alone and de novo CPDM was measured by a uniaxial tensile test using a tensiometer (Instron, Norwood, MA) at a displacement rate of 0.42 mm/s. Statistical significance (P < 0.05) was determined for histological analysis using a Kruskal-Wallis non-parametric test with a Bonferroni correction, and for all other analyses using a two-way analysis of variance (ANOVA) with a Bonferroni post-test or a Kruskal-Wallis non-parametric test with a Dunn's post-test.
Intraperitoneal placement of fenestrated CPDM resulted in a significantly higher area of adhesions and adhesion score compared to the preperitoneal placement of fenestrated CPDM (P < 0.05). For both preperitoneal and intraperitoneal placement, histological findings demonstrated greater incorporation of the graft due to the fenestrations. No significant differences were detected in the uniaxial tensile strengths of the graft materials alone, either due to the graft type (non-fenestrated vs. fenestrated) or due to the placement location (preperitoneal vs. intraperitoneal). The incorporation strength (T-peel force) was significantly greater for fenestrated compared to non-fenestrated CPDM when placed in the preperitoneal location (P < 0.01). The incorporation strength was also significantly greater for fenestrated CPDM placed in the preperitoneal location compared to fenestrated CPDM placed in the intraperitoneal location (P < 0.05).
Fenestrations in CPDM result in greater tissue incorporation strength and lower adhesion area and score when placed in the preperitoneal location. Fenestrations in CPDM allow for greater tissue incorporation without accelerating graft degradation. Fenestrations may be placed in CPDM while still allowing adequate graft strength for intraperitoneal and preperitoneal hernia repairs at 1 month in a porcine model.
本研究旨在比较新型有孔和无孔交联猪真皮基质（CPDM）（CollaMend™，Davol Inc.，Warwick，RI）在猪腹疝修补模型中的组织整合。
在 12 只 Yucatan 小型猪中创建双侧腹壁缺损，并在疝形成后 21 天通过腹膜前或腹腔内技术进行修复。动物随机分为有孔或无孔 CPDM，每组 n = 6 块，分别放置在腹膜前或腹腔内。所有动物均在 1 个月时处死。通过 Garra rd 粘连分级量表和透明网格叠加测量粘连特征和移植物收缩/生长。通过苏木精和伊红（H&E）染色载玻片的组织学分析评估移植物整合。通过 T 剥离拉伸试验测量组织整合强度。通过张力计（Instron，Norwood，MA）以 0.42mm/s 的位移率对单独植入的 CPDM 和新形成的 CPDM 进行单轴拉伸试验，测量 CPDM 的强度。使用 Kruskal-Wallis 非参数检验和 Bonferroni 校正进行组织学分析的统计学意义（P < 0.05），使用双向方差分析（ANOVA）和 Bonferroni 后检验或 Kruskal-Wallis 非参数检验和 Dunn 后检验进行所有其他分析。
与腹膜前放置有孔 CPDM 相比，腹膜内放置有孔 CPDM 导致粘连面积和粘连评分显著升高（P < 0.05）。对于腹膜前和腹腔内放置，组织学发现由于有孔导致移植物的整合度更高。单独的移植物材料的单轴拉伸强度没有因移植物类型（无孔与有孔）或放置位置（腹膜前与腹腔内）而有显著差异。与无孔 CPDM 相比，当放置在腹膜前位置时，有孔 CPDM 的整合强度（T 剥离力）显著更高（P < 0.01）。与腹腔内放置的有孔 CPDM 相比，当放置在腹膜前位置时，有孔 CPDM 的整合强度也显著更高（P < 0.05）。
CPDM 中的孔可在腹膜前位置提供更高的组织整合强度、更低的粘连面积和评分。CPDM 中的孔可在不加速移植物降解的情况下促进组织整合。在猪模型中，CPDM 中的孔可以放置在 1 个月时的腹膜内和腹膜前疝修补术中，同时保持足够的移植物强度。
