Use of small intestinal submucosal and acellular dermal matrix grafts in giant omphaloceles in neonates and a rabbit abdominal wall defect model

详细信息    查看全文

• 作者：Weiwei Jiang¹ ; Jie Zhang¹ ; Xiaofeng Lv ; Changgui Lu ; Huan Chen ; Xiaoqun Xu ; Weibing Tang ; ^{tangweibingcn@163.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Small intestinal submucosa ; acellular dermal matrix ; omphaloceles
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：51
• 期：3
• 页码：368-373
• 全文大小：1486 K

文摘

The described surgical strategies for the management of omphalocele include primary closure, staged closure, and delayed closure. A primary repair is not suitable for all giant omphaloceles. We implanted two grafts, small intestinal submucosal (SIS) and acellular dermal matrix (ADM) onto abdominal wall defects in neonates to study the safety and efficacy of SIS and ADM graft techniques for initial closure of giant omphaloceles in infants, and we also implanted these grafts onto abdominal wall defects in an animal model.

Methods

Twenty-four patients with giant omphaloceles were divided into two groups (ADM group, 12 patients; SIS group, 12 patients). The operative time, skin healing time postoperatively, and the incidence of skin infections, and abdominal wall hernias were observed. In the rabbit animal model, bilateral full-thickness incisions were made through the rabbit rectus abdominus muscles and a 2 × 4 cm longitudinal whole layer defect was created on either the left or right lateral anterior abdominal wall. A four-layered variant of the SIS graft was used to repair the right abdominal defect; ADM was used to repair the left. Tensile strength was measured using an Instron tensiometer. Electron scanning and light microscopy were used to evaluate neovascularization, collagen deposition, and muscle fibers at 2, 4, 8, and 16 weeks postimplantation.

Results

In the neonatal patients, there was no statistically significant difference between the two groups with respect to operative time, skin healing time postoperatively, the incidence of skin infections, or abdominal wall hernias. In the SIS group, only one patient developed a skin infection, which led to skin necrosis and sloughing. In the ADM group, four patients developed skin infection postoperatively, and the patch was gradually removed. In the animal study, there was no significant difference between the mean breaking strength of ADM versus SIS repairs. Scanning electron and light microscopy showed collagen deposition, increased vascularization, fibroblasts, and muscular regeneration in both SIS and ADM repairs. SEM showed that the SIS graft was absorbed, while ADM was not. Light microscopy showed foreign body macrophages in ADM, but not in the SIS repairs.

Conclusion

SIS and ADM grafts adequately enhance healing with a low complication rate. Compared with ADM grafts, SIS is absorbable, induces less inflammation, and is more biocompatible, and therefore might be more useful and suitable for closure of abdominal wall defects.