REPAIRING OF TRANSVERSELY CUTTING ACHILLES TENDONWITH AUTOGENOUSSMALL INTESTINAL SUBMUCOSAL LAYER IN DOGS

Abstract

The current trail designed toevaluate the effectivenessofusing small intestinalsubmucosa ( SIS ) to accelerate healing of Achilles tendon in thestray local breeddog .Ten healthy dogs of both sexeswere usedin thepresent studywhich randomly divided into two equal groups. Thefirstgroup;Achilles tendon acutetransversely transectedand sutured via cross mattress technique with silk suture materialwith supporting ofgypsona.The second groupacute transected tendon sutured andtreated with thesmall intestinal submucosal patch .All operative dogs inspected clinically,grossly as well ashistopathologically during different periods. Results obtained in the first group showed no contamination, no complicationsand there was no anatomical distortions were detectedat operative site except there is adhesion between tendon and neighboring tissues in the first group healing was uncompleted, suture material still presence up to 90 day.At treatment groupclinically animals lame and sign of mild stiffness appeared for three days, no serious complications, grossly was no adhesion detected, the submucosa subsided completely and complete healing occurs at 90 days postoperatively.Histologicallyatcontrol group 30 days post operativelyuncompleted healing, moderate fibroblast proliferation and inflammatory cells were presence, but at 90 dayspresence of dense connective at the site of operation. In treatmentgroup healing progress, autograft is mostly atrophied and organized with granulation at 90 days,hence healing completed perfectly at this period. In conclusion The repairing of acute transverse cutting of Achilles tendon was significantly accelerated with small intestinal submucosal layer which was absorbed andimproves the tissue quality render the native one . Bas.j.vet.Res. Vol.12,No.2,2013 922 INTRODUCTION The main objective of surgery for tendon injuries in the dog is to restore an adequate tensile strength to support body weight(1).As with other tissues its required to cell infiltrationfrom the blood system to provide the necessary reparative factors for tissue healing.(2(.Itis usually difficult and uncertain because the prognosis varies widely depending on the amount of trauma, vascularization, create adhesions and tension, active loads (3).Occurrence of massive adhesions post-operativelybetween tendon and surrounding soft tissuemay delay normal healing.(4), therefordifferent materials have been used for prevent adhesion such as small intestinal submucosa (SIS) has been used as a biological scaffold for the repair different tissue including those of the musculoskeletal systems and for repairing of defective urinary bladder in dog subcutaneous fascia in dogs (5-7).On other side ovine submucosa was used to repair superficial digital flexor tendon in goat(8). It has been also used experimentally in veterinary medicineas vascular grafts ,for reconstruction esophagus) and for accelerateligaments andtendons healing(8-11).the aim of present study to evaluate the efficiency of SIS to improve tendon healing. MATERIALS AND METHODS Tenadultsstray dogs of both sexeswere used in this study to perform current study . The experimentswere carried out withlicense ofveterinary medicine college in university of Mosul at animals house.Operative animals randomlydivided in two equal groups 5 for each.A protocol of anesthesia includedxylazine \ketamine mixture5mg \15 mg intramuscularly premedicated with atropine sulfate at dose of 0.04 mg \B.wt. In both groupssite of operation in left leg at Achilles tendon wasprepared aseptically, skin incised longitudinally about 5 cm over the tendon that exteriorizedfrom sheet Bas.j.vet.Res. Vol.12,No.2,2013 922 andresected transverselywith surgical blade.Group 1 ( control):tendon wassutured with cross mattress then sub cutaneous tissue closed with simple continuous suture technique then theskin incision was closed, gypsona applied to provide proper fixation. Group 2: The animals were prepared to perform laparotomy, loopfrom proximal jejunum exteriorized and 5 cm resected to preparethe submucosal layer.The tunica mucosa was mechanically removed by using a longitudinal wiping motion with ascalpel handle and moistened gauze. The segment was returned to original orientation and the tunica serosa and tunica muscularis were removed from the intestine by similar method. The remaining thin, whitish, translucent tube consisted of the tunica submucosa with attached stratum compactum and muscularis mucosa of the tunica mucosa (12). The SIS was then disinfected anddecellularized in a 0.1% peracetic acid for 2hand sterilized with ethylenealcohol 70 % for 18h and stored in distilled water at 4°C (hydrated form)and terminally re-hydrated in phosphate buffered saline for 20 min prior to use. In treatment group the Achills tendon was transected then sutured as group 1 the treated intestinalsubmucosa wasfixed firmly with non-absorbable suture material(Figure 1) then operation was completed as in group 1.The animals wereinspected clinically then gypsona removed after 30 days postoperatively, gross and histopathological examination were taken at 30 and 90 days post operatively. Bas.j.vet.Res. Vol.12,No.2,2013 929 Figure 1: Intestinalsubmucosa wasfixed firmly with non-absorbable suture material