Bryan Nicholas, Ahswin Helen, Smart Neil, Bayon Yves, Wohlert Stephen, Hunt John A
Clinical Engineering, UKCTE, UKBioTEC, The Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, L69 3GA, UK.
J Biomed Mater Res B Appl Biomater. 2014 May;102(4):709-20. doi: 10.1002/jbm.b.33050. Epub 2013 Oct 24.
Hernias are defects in which an anatomical fascia is breached resulting in ectopic positioning of an organ into an orifice which routinely does not contain it. Intervention often involves repositioning translocated organs and repair of damaged fascia using exogenous grafts. Despite hernia prevalence, repairs can still fail due to postoperative complications, such as chronic pain and decreased mobility. This study compared repair capacities and characterized the foreign body response elicited by a number of hernia repair grafts to deduce their bulk inflammatory properties while also concluding the point in their fabrication when these are inferred. Materials derived from human dermis (Alloderm(®) ), porcine dermis (Permacol™, patch A, patch D and Strattice(®) ), porcine small-intestinal submucosa (Surgisis™) and a synthetic (multifilament Surgipro™) were implanted into a rat full-thickness abdominal wall excision model, incubated for up to 2 years and characterized histopathologically. Surgisis™ resorbed the fastest of the materials tested (1-3 months) resulting in a mechanically stable parietal peritoneum. Decellularization using sodium dodecyl sulfate (patch A) stimulated a large early inflammatory response which ultimately may have contributed to increased resorption of porcine dermal matrix however the remaining materials typically persisted throughout the 2-year incubation. Cross-linking porcine dermis using 1,6-hexamethylene disocyanate (vs. an identical noncross-linked counterpart) showed no difference in cell recruitment or material integration over 2 years. Typically Strattice(®) and Alloderm(®) recruited larger early populations of cells than Permacol™; however, over extended periods of time in vivo this response normalized.
疝是指解剖学上的筋膜出现缺损，导致器官异位进入通常并不容纳该器官的孔道。干预措施通常包括将移位的器官复位，并使用外源性移植物修复受损的筋膜。尽管疝很常见，但由于术后并发症，如慢性疼痛和活动能力下降，修复仍可能失败。本研究比较了多种疝修补移植物的修复能力，并对其引发的异物反应进行了表征，以推断它们的整体炎症特性，同时确定在制造过程中出现这些特性的时间点。将来源于人真皮的材料（Alloderm®）、猪真皮的材料（Permacol™、贴片A、贴片D和Strattice®）、猪小肠黏膜下层的材料（Surgisis™）和一种合成材料（多丝Surgipro™）植入大鼠全层腹壁切除模型中，孵育长达2年，并进行组织病理学表征。在测试的材料中，Surgisis™吸收最快（1 - 3个月），从而形成机械稳定的壁腹膜。使用十二烷基硫酸钠进行脱细胞处理（贴片A）引发了强烈的早期炎症反应，这最终可能导致猪真皮基质吸收增加，然而其余材料在整个2年的孵育过程中通常持续存在。使用1,6 - 己二异氰酸酯交联猪真皮（与相同的非交联对应物相比）在2年时间内细胞募集或材料整合方面没有差异。通常，Strattice®和Alloderm®在早期募集的细胞群体比Permacol™更大；然而，在体内长时间观察，这种反应会趋于正常。
