Department of Surgery, Washington University, St Louis, MO, USA.
J Am Coll Surg. 2011 Mar;212(3):327-39. doi: 10.1016/j.jamcollsurg.2010.12.006.
The purpose of this study was to compare tissue incorporation and adhesion characteristics of a novel fenestrated versus nonfenestrated crosslinked porcine dermal matrix (CPDM) (Bard CollaMend) in a porcine model of ventral hernia repair.
Bilateral abdominal wall defects were created in 24 Yucatan minipigs, resulting in 48 defects, which were allowed to mature for 21 days. Twelve defects were repaired with fenestrated CPDM using a preperitoneal technique, 12 with fenestrated CPDM using an intraperitoneal technique, 12 with nonfenestrated CPDM using a preperitoneal technique, and 12 with nonfenestrated CPDM using an intraperitoneal technique. Half of the animals in the intraperitoneal group were euthanized after 1 month, and the other half after 3 months. Similarly, half of the animals in the preperitoneal group were euthanized after 1 month, and the other half after 6 months. Biomechanical testing and histologic evaluation were performed.
Intraperitoneal placement of the CPDM products resulted in significantly greater adhesed area compared with preperitoneal placement (p < 0.05). Tissue ingrowth into preperitoneal fenestrated and nonfenestrated CPDM resulted in significantly greater incorporation strengths after 6 months compared with 1 month (p = 0.03 and p < 0.0001). Histologic analysis showed significantly greater cellular infiltration, extracellular matrix deposition, and neovascularization, with less fibrous encapsulation through the center of the fenestrations compared with all other sites evaluated, including nonfenestrated grafts.
Histologic findings revealed increased tissue incorporation at fenestration sites compared with nonfenestrated grafts regardless of implant location or time in vivo. However, preperitoneal placement resulted in greater incorporation strength, less adhesed area, and lower adhesion scores compared with intraperitoneal placement for both fenestrated and nonfenestrated CPDM.
本研究旨在比较新型有孔与无孔交联猪真皮基质（CPDM）（Bard CollaMend）在猪腹疝修补模型中的组织结合和粘连特性。
在 24 头尤卡坦小型猪中创建双侧腹壁缺损，共产生 48 个缺损，让其成熟 21 天。12 个缺损采用经腹前壁技术使用有孔 CPDM 修复，12 个缺损采用经腹腔技术使用有孔 CPDM 修复，12 个缺损采用经腹前壁技术使用无孔 CPDM 修复，12 个缺损采用经腹腔技术使用无孔 CPDM 修复。腹腔组中的一半动物在 1 个月后处死，另一半在 3 个月后处死。同样，经腹前壁组中的一半动物在 1 个月后处死，另一半在 6 个月后处死。进行生物力学测试和组织学评估。
CPDM 产品经腹腔内放置与经腹前壁放置相比，粘连面积显著增大（p < 0.05）。经腹前壁放置的有孔和无孔 CPDM 的组织内生长在 6 个月时与 1 个月时相比，结合强度显著增大（p = 0.03 和 p < 0.0001）。组织学分析显示，与所有其他评估部位（包括无孔移植物）相比，穿过孔中心的细胞浸润、细胞外基质沉积和新生血管形成显著增加，纤维包裹明显减少。
组织学研究发现，与无孔移植物相比，有孔部位的组织结合增强，无论植入物位置或体内时间如何。然而，与经腹腔内放置相比，经腹前壁放置无论是有孔还是无孔 CPDM，都具有更大的结合强度、更小的粘连面积和更低的粘连评分。
