Augmentation of the insufficient tissue bed for surgical repair of hypospadias using acellular matrix grafts: A proof of concept study

Syed K Abbas,Ramnath Subramaniam,Debora Morgante,Eileen Ingham,Anna Radford,Jennifer Southgate

doi:10.1177/2041731421998840

Abstract

Acellular matrices produced by tissue decellularisation are reported to have tissue integrative properties. We examined the potential for incorporating acellular matrix grafts during procedures where there is an inadequate natural tissue bed to support an enduring surgical repair. Hypospadias is a common congenital defect requiring surgery, but associated with long-term complications due to deficiencies in the quality and quantity of the host tissue bed at the repair site. Biomaterials were implanted as single on-lay grafts in a peri-urethral position in male pigs. Two acellular tissue matrices were compared: full-thickness porcine acellular bladder matrix (PABM) and commercially-sourced cross-linked acellular matrix from porcine dermis (Permacol™). Anatomical and immunohistological outcomes were assessed 3 months post-surgery. There were no complications and surgical sites underwent full cosmetic repair. PABM grafts were fully incorporated, whilst Permacol™ grafts remained palpable. Immunohistochemical analysis indicated a non-inflammatory, remodelling-type response to both biomaterials. PABM implants showed extensive stromal cell infiltration and neovascularisation, with a significantly higher density of cells (p < 0.001) than Permacol™, which showed poor cellularisation and partial encapsulation. This study supports the anti-inflammatory and tissue-integrative nature of non-crosslinked acellular matrices and provides proof-of-principle for incorporating acellular matrices during surgical procedures, such as in primary complex hypospadias repair.

Highlights

Decellularised tissue matrices offer a promising natural biomaterial in surgical situations where there is either an inherent lack of a tissue bed for repair, or where the healthy tissue bed is compromised by trauma or fibrotic scarring
Surgery proceeded according to plan with biomaterials positioned as onlay urethral grafts (Figure 1(e)–(g))
Our study investigated the concept that an acellular matrix graft inserted into a peri-urethral position would become tissueintegrated, augmenting a deficient tissue bed on the ventral aspect and reducing the potential for surgical complications

Summary

Introduction

Decellularised tissue matrices offer a promising natural biomaterial in surgical situations where there is either an inherent lack of a tissue bed for repair, or where the healthy tissue bed is compromised by trauma or fibrotic scarring. One such need is encountered in surgical repair for hypospadias.

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