Acellular Dermal Matrix Patch Research Articles

Arthroscopic Incomplete Rotator Cuff Repair With Patch Augmentation Using Acellular Dermal Matrix Allograft

Arthroscopic rotator cuff repair has been shown promising clinical outcomes. However, large to massive rotator cuff tears are difficult to completely repair with appropriate tension because of their size or poor tissue quality. An incomplete repair using the “hybrid technique” is one of way to solve this problem by maximizing the contact area between the tendon and the footprint of greater tuberosity. Additionally, the acellular dermal matrix patch augmentation has emerged as an adjuvant technique to enhance the biomechanical properties to promote healing of the repaired construct. This Technical Note describes arthroscopic incomplete rotator cuff repair using the “hybrid technique” with acellular dermal matrix patch augmentation.

Urethral Tissue Reconstruction Using the Acellular Dermal Matrix Patch Modified with Collagen-Binding VEGF in Beagle Urethral Injury Models.

Objectives Urethral tissue reconstruction for hypospadias is challenging for urologists. In this study, bovine acellular dermal matrix (ADM) patch loading with collagen-binding vascular endothelial growth factor (CBD-VEGF) was used to repair the urethral injury in beagles. Methods The safety and effectiveness of the scaffold implantation were carefully evaluated by comparing among the urethral injury control group, ADM implantation group, and ADM modified with CBD-VEGF implantation group during 6 months. Urodynamic examination, urethral angiography, and pathological examination were performed to evaluate the recovery of urethral tissue. Results Stricture, urethral diverticulum, and increased urethral closure pressure were observed in the control group. Fistula was observed in one animal in the ADM group. By contrast, no related complications or other adverse situations were observed in animals treated with ADM patch modified with CBD-VEGF. The average urethra diameter was significantly smaller in the control animals than in scaffold implantation groups. Pathological examination revealed more distribution of proliferative blood vessels in the animals treated with ADM modified with CBD-VEGF. Conclusions Overall, ADM patches modified with CBD-VEGF demonstrated an optimized tissue repair performance in a way to increase tissue angiogenesis and maintain urethral function without inducing severe inflammation and scar formation.

Application of acellular dermal matrix loaded collagen binding domain-vascular endothelial growth factor patch in urethral wound repair in beagles

Objective: To investigate the application value of acellular dermal matrix (ADM) loaded collagen binding domain-vascular endothelial growth factor (CBD-VEGF) patch in the repair of urethral wound in beagles. Methods: Twenty-one healthy adult beagles were selected to establish urethral wound model and randomly divided into 3 groups, which were treated with different repair methods. CBD-VEGF patch was prepared and instantaneous implantation was performed as the models were successfully built. The blank control group was treated without any repair materials;the ADM group was treated with collagen patch for repair and the ADM loaded with CBD-VEGF group was treated with collagen patch loaded with VEGF for repair. The safety and effectiveness of the three groups of materials implanted into the urethral wound model at 6 months after surgery were compared. Urodynamic examination, urethral angiography and pathological examination were used to evaluate the recovery of urethral tissue in the three groups. Result: Compared with blank control group and ADM patch group, there was no complications or other adverse conditions in the ADM-loaded CBD-VEGF patch group. Urethrography was performed to measure the diameter of the urethra in the experimental segment, the mean urethral diameter of blank control group [(3.07±0.43) mm] was significantly smaller than that of ADM patch group [(3.73±0.11) mm] and ADM loaded CBD-VEGF patch group [(3.64±0.32) mm], with statistical difference (P<0.05). Pathological examination with HE and Masson staining showed more proliferative blood vessels in the ADM loaded CBD-VEGF patch group. HE staining indicated that there were more proliferative vessels in the group of CBD-VEGF patch loaded with ADM. Masson staining showed that the positive area percentage of collagen tissue in the three groups was 34.27%±7.40%, 29.08%±3.79% and 28.02%±2.39%, respectively, with no statistical difference between the three groups(all P>0.05). There was no excessive deposition of collagen tissue in the two groups using collagen patch. The percentage of positive staining per unit area in the three groups were 1.4%±0.1%,1.8%±0.1%3.1%±0.2%, respectively, and the difference was statistically significant among three groups and between every two groups (all P<0.01), indicating the vascular density of CBD-VEGF group loaded with ADM was the highest. Conclusion: ADM loaded CBD-VEGF patch is a good biological support material for covering the wound after urethral surgery, and it provides an alternative direction for promoting the healing of the urethral wound.

Sacrocolpopexy: Patient Outcomes Support the Use of Non-Crosslinked Acellular Dermal Matrix as an Alternative to the Synthetic Polypropylene Mesh.

Objective: This study was conducted to evaluate the use of non-crosslinked acellular dermal matrix (ADM) in laparoscopic sacrocolpopexy by analyzing clinical outcomes and patient-satisfaction surveys.Materials and Methods: Two hundred and eleven patients underwent laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) between January 6, 2012, and December 31, 2017. Each patient had her pelvic-floor measurements diagrammed with the POP-Q [Quantification] system using the interactive tool provided by the American Urogynecologic Society. The Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7), used to make comprehensive assessments of women with urogynecologic problems, were mailed to all patients. If responses were not received, the patients were contacted by telephone. Patients who were not reached by either mail or telephone had their charts individually reviewed to extract the information. Trained surveyors scored the PFDI-20 and the PFIQ-7 questionnaires. The de-identified data were analyzed for patient satisfaction and outcomes. This information was obtained by a review of patient charts at 4-week postoperative and annual examinations; any phone calls with complaints and/or problem office visits were noted. Biopsies from the sacrocolpopexy area were taken if a patient had another incidental gynecologic procedure unrelated to the prolapse or at the time of repeat sacrocolpopexy for POP and the paraffin cell block was sent to McGowan Institute for Tissue Regeneration.Results: One hundred and five patients responded to the survey. Charts were completed for 106. The majority of interviewed patients stated that they were doing a “little better” or “much better” (77/88; 87.5%). The third-quartile PFDI-20 score was 93 with a median of 60 and the PFIQ-7 score was 43 with a median of 29. Five patients underwent reoperations (4.76%). The most-common postoperative complaint was overactive bladder symptoms, followed by vaginal discharge. Histology showed either a lack of regenerative healing tissue at the failure site or good results showing neovascularization and a presence of connective and ligamentous tissue around the matrix. No intense fibrosis or neoplastic formation was reported.Conclusions: A non-crosslinked ADM patch can be a good alternative to synthetic polypropylene mesh in patients undergoing sacrocolpopexy for POP.

Cryopreserved human umbilical cord versus acellular dermal matrix patches for in utero fetal spina bifida repair in a pregnant rat model.

Despite significant improvement in spinal cord function after in utero spina bifida (SB) repair compared with traditional postnatal repair, over half of the children who undergo this procedure do not benefit completely. This lack of benefit has been attributed to closure methods of the defect, with subsequent spinal cord tethering at the repair site. Hence, a regenerative patch or material with antiinflammatory and anti-scarring properties may alleviate comorbidities with improved outcomes. The authors' primary objective was therefore to compare cryopreserved human umbilical cord (HUC) versus acellular dermal matrix (ADM) patches for regenerative repair of in utero SB lesions in an animal model. In vivo studies were conducted in retinoic acid-induced SB defects in fetuses of Sprague-Dawley rats. HUC or ADM patches were sutured over the SB defects at a gestational age of 20 days. Repaired SB defect tissues were harvested after 48-52 hours. Tissue sections were immunofluorescently stained for the presence of neutrophils, macrophages, keratinocytes, meningeal cells, and astrocytes and for any associated apoptosis. In vitro meningeal or keratinocyte cell coculture experiments with the ADM and HUC patches were performed. All experiments were scored quantitatively in a blinded manner. Neutrophil counts and apoptotic cells were lower in the HUC-based repair group (n = 8) than in the ADM patch repair group (n = 7). In the HUC patch repair group, keratinocytes were present on the outer surface of the patch, meningeal cells were present on the inner surface of the patch adjacent to the neural placode, and astrocytes were noted to be absent. In the ADM patch repair group, all 3 cell types were present on both surfaces of the patch. In vitro studies showed that human meningeal cells grew preferentially on the mesenchymal side of the HUC patch, whereas keratinocytes showed tropism for the epithelial side, suggesting an inherent HUC-based cell polarity. In contrast, the ADM patch studies showed no polarity and decreased cellular infiltration. The HUC patch demonstrated reduced acute inflammation and apoptosis together with superior organization in regenerative cellular growth when compared with the ADM patch, and is therefore likely the better patch material for in utero SB defect repair. These properties may make the HUC biomaterial useful as a "meningeal patch" during spinal cord surgeries, thereby potentially reducing tethering and improving on spinal cord function.

Acellular dermal matrix for esophageal stricture prevention after endoscopic submucosal dissection in a porcine model

Endoscopic submucosal dissection (ESD) is considered an effective treatment for early esophageal cancer and precancerous lesions. Esophageal stenosis is closely associated with quasi-circumferential ESD. We examined whether post-ESD esophageal stricture can be prevented by grafting an acellular dermal matrix (ADM) membrane. Fourteen Bama miniature pigs were randomly divided into an ADM group (n= 7) and a control group (n= 7). Semicircumferential ESD was performed at the distal esophagus in all animals, and in the ADM group an ADM patch graft was placed at the resection site and secured innovatively with metal clips. Animals in the control group underwent ESD only. Endoscopy was performed at 3 days, 1 week, 2 weeks, and 4 weeks post-ESD, and fluoroscopy was performed at 4 weeks for assessment of the degree of stenosis, after which the remodeled esophageal tissues were excised for histologic analysis. No animals in the ADM group developed clinically significant esophageal stenosis, whereas 42.8% (3/7) in the control group did. The degree of stenosis was severe in the control group (39.8% vs 17.2%, respectively; P= .01). Animals in the ADM group had less feeding difficulty and lost less weight (-.9 kg vs-4.1 kg, respectively; P= .007). Histologically, complete mucosal epithelium, slight local inflammation, and organized collagenous fibers were observed in the ADM group. ADM patch graft appears, after short-term observation, to be a potentially useful new treatment strategy for prevention of esophageal stricture after ESD. A metal clip fixation technique is effective for endoscopic graft attachment.

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English

The experiment study of mesenchymal stem cells modified wtih galectin- 1 gene co-cultured with dermal matrix patch

Objective To explore the feasibility of mesenchymal stem cells(MSCs) modified wtih galectin- 1 gene co- cultured with dermal matrix patch. Methods After the bone marrow MSCs(BMSCs) were transfected with Ad- green fluorescent protein(GFP)- galectin- 1, the fluorescence in BMSCs was observed under fluorescence microscope.Real- time quantitative reverse transcriptase- polymerase chain reaction(RT- qPCR) was used to detect the expression of galectin- 1 gene, and the protein expression of galectin- 1 and desmin was detected by enzyme linked immune sorbent assay(ELISA)and Western blotting, respectively.The growth of BMSCs transfected with Ad- GFP- galectin- 1 and co- cultured with acellular dermal matrix patch(ADM) was observed. Results The green fluoresence was observed and reached to peak at 72 h after the transfection of BMSCs with Ad- GFP- galectin- 1 under fluorescence microscope.The result of RT- qPCR and ELISA confirmed that BMSCs over- expressed galectin- 1.The RT- qPCR result of galectin- 1,which the relative expression folds was 1.00 in phosphate buffer(PBS) group,4.11 in Ad- GFP- galectin- 1 group,1.09 in Ad- GFP group;The result of galectin- 1 measured by ELISA was that 48 h:(197.28±8.78),(25.52±1.56),(24.53±2.96)μg/L; 72 h:(264.33± 5.43),(25.40±2.06),(25.46±1.13)μg/L;96 h:(172.41±3.61),(25.22±1.61),(28.01±1.26) μg/L; 120 h:(155.53±7.25),(24.84±2.35),(26.65±1.54)μg/L ordered by Ad- GFP-galectin- 1 group, Ad- GFP group and PBS group.The expression of desmin which co- cultured with dermal matrix patch(ADM) were well grown. Conclusion Galectin- 1 could induce BMSCs to express desmin.BMSCs transfected with Ad- GFP- galectin- 1 showed good compatibility with ADM. Key words: Galectin-1; Bone mesenchymal marrow cell; Acellular dermal matrix patch; Co-culture

Repair effect of human acellular dermal matrix on filtering blebs leakage in rabbit eye

Background Package and tissue patch implantation are common methods for repair of filtering bleb leaking after anti-glaucoma surgery.But the scarring or re-leakage of filtering bleb probably occur again. Objective This study was to investigate the repair effect of acellular dermal matrix (ADM) on filtering bleb leaking in rabbit model and compare the effectiveness among ADM, amniotic membrane and conjunctival overlap. Methods Trabeculectomy was performed on 48 eyes of 24 New Zealand rabbits, and models of filtering bleb leaking were established.The models were randomized into ADM group, amniotic membrane group and conjunctival covering group based on randomized number table.ADM patches with 4 mm×4 mm were implanted across lamellar cornea and sclera at a bridge in the ADM group, and the same size of amniotic membranes were used in the amniotic membrane group, and conjunctiva was sutured to limbus in the conjunctiva overlap group.The intraocular pressure (IOP) was measured before surgery and 1 day, 1 week, 1 month, 3 months and 6 months after surgery.The biocompatibility of materials above was assessed under the slit lamp microscope, and the status of filtering bleb was evaluated and compared with anterior segment optical coherent tomography (AS-OCT) 1 day, 1 week, 1 month, 3 months and 6 months after surgery. Results Before surgery and 1 day, 1 week, 1 month, 3 months and 6 months after surgery, the IOP was (26.9±4.3), (16.6±5.1), (22.1±6.2), (18.3±6.5), (22.7±2.5), (23.4±1.4) mmHg in the AMD group, (29.9±5.4), (14.9±6.4), (21.6±7.8), (26.3±4.1), (26.0±4.2) and (23.0±5.3) mmHg in the amniotic membrane group, and (28.7±4.3), (15.7±7.0), (22.0±6.3), (28.2±4.1), (24.7±4.1), (23.0±2.7) mmHg in the conjunctival overlap group, showing significant differences among different groups and various time points (Fgroup=8.419, P=0.011; Ftime=15.543, P=0.000). The IOPs were significantly lower from 1 day through 3 months after operation than those before operation in the AMD group (P=0.000, 0.000, 0.006, 0.045); while the IOPs were reduced only from 1 day through 1 week after operation in comparison with before operation in the amniotic membrane group and the conjunctival overlap group (P=0.000, 0.001). One month after surgery, the IOPs were significantly declined in the ADM group compared with the amniotic membrane group and the conjunctival overlap group (P=0.001, 0.000). The grafts were clear under the slit lamp microscope and exhibited the valid filtering bleb until 3 months after operation under the AS-OCT in the ADM group.However, the valid filtering bleb remained only 1 month after surgery in the amniotic membrane group and the conjunctival overlap group.Neovascularization on the filtering bleb was found 3 months in the AMD group but 1 month in the amniotic membrane group and the conjunctival overlap group. Conclusions Compared with amniotic membrane and conjunctival tissue, ADM patch for the repair of filtering bleb leakage can increase the survival duration of filtering bleb and remain lower IOP. Key words: Human acellular dermal matrix; Trabeculectomy/complication; Filtering blebs; Leakage; Repair; Amniotic membrane; Intraocular pressure; Rabbit

Clinical Outcomes for Breast Cancer Patients Undergoing Mastectomy and Reconstruction with Use of DermACELL, a Sterile, Room Temperature Acellular Dermal Matrix.

Background. Decellularized human skin has been used in a variety of medical applications, primarily involving soft tissue reconstruction, wound healing, and tendon augmentation. Theoretically, decellularization removes potentially immunogenic material and provides a clean scaffold for cellular and vascular in growth. The use of acellular dermal matrix in two-stage postmastectomy breast reconstruction is described. Methods. Ten consecutive breast cancer patients were treated with mastectomies and immediate reconstruction from August to November 2011. There were 8 bilateral and 1 unilateral mastectomies for a total of 17 breasts, with one exclusion for chronic tobacco use. Reconstruction included the use of a new 6 × 16 cm sterile, room temperature acellular dermal matrix patch (DermACELL) soaked in a cefazolin bath. Results. Of the 17 breasts, 15 reconstructions were completed; 14 of them with expander to implant sequence and acellular dermal matrix. Histological analysis of biopsies obtained during trimming of the matrix at the second stage appeared nonremarkable with evidence of normal healing, cellularity, and vascular infiltration. Conclusion. Postoperative observations showed that this cellular dermal matrix appears to be an appropriate adjunct to reconstruction with expanders. This acellular dermal matrix appeared to work well with all patients, even those receiving postoperative chemotherapy, postoperative radiation, prednisone, or warfarin sodium.

Experimental study of acellular dermal matrix biological patch enriched with bone marrow mesenchymal cells for the treatment of external anal sphincter injury

To investigate the feasibility of bone marrow mesenchymal stem cells(MSC)with the acellular dermal matrix(ADM) biological patch for the treatment of external anal sphincter injury on the animal models. Thirty Wistar rats with sphincter injury were randomly divided into three groups. Group A underwent end to end sphincteric repair directly, group B underwent end to end repair and then covered by ADM patch, and group C underwent end to end repair and then covered by ADM which was previously seeded with MSC. After six weeks, the whole ring specimens including anal canal and lower rectum were removed. The hematoxylin and eosin stain and Masson trichrome stain were performed to observe the change of histomorphology. Two weeks later, the majority of rat models presented with moist anus and crissum with loose stools, which indicated that the model was established successfully. Six weeks after repair, in group A and B, the suffusion of fibrous connective tissue and the infiltration of inflammatory cells were observed at the repair site of sphincter. And lots of collagen fiber which was stained into blue deposited dispersedly at the site of repair with no obvious proliferation of capillaries. However, in group C, the blue collagenous fiber which deposited at the sphincter injury site was less than that in groups A and B. Muscle fibers were observed to be stained into red distributed dispersedly at the repair site of sphincter in group C. Transplantation of ADM biological patch rich in bone MSC can partly improve the regeneration of rat injured anal sphincter and lessen the formation of cicatrix.

An experimental study on tympanic membrane reconstruction with acellular dermal matrix

Conclusion: Acellular dermal matrix (ADM) can be used as a substitute for tympanic membrane (TM) reconstruction. Objective: To investigate the effectiveness of ADM in the treatment of TM perforations. Methods: Fifty guinea pigs were used to create TM perforations. The perforations of the left TM were repaired with ADM by patch technique in 28 guinea pigs and by underlay technique in 22 guinea pigs. The right ears were used as the control group by establishing TM perforation but without TM reconstruction. The morphological and structural status of the grafts was observed by immunohistochemistry and scanning electron microscopy. Results: There was no statistically significant difference in TM perforation closure between the ADM patch technique group and the ADM underlay technique group, but these groups had a higher success rate in closing TM perforation than the control group. The healed TMs with ADM had the same characteristics as normal TM on histological examination.

Reconstruction of large rotator-cuff tears with acellular dermal matrix grafts in rats

With the acellular dermal matrix (ADM), it may be possible to bridge large rotator cuff tears and induce tendon regeneration. A 3 x 5 mm defect of the rotator cuff was created on both shoulders of adult male Sprague-Dawley rats. The graft group (n = 15) underwent reconstruction of the rotator cuff defect with an ADM patch graft; in the defect group (n = 15) no repair was performed. We sacrificed 5 rats from each group at 2, 6, and 12 weeks after surgery and harvested both shoulders; 3 specimens were subjected to histological analysis and the other 7 specimens were used for biomechanical testing. The controls were 5 unoperated rats; they were sacrificed to obtain 3 histologic and 7 biomechanical control shoulder specimens. At each time points, the graft group had significantly higher modified tendon maturing scores than the defect group (p < 0.002); specimens from the graft group demonstrated a greater mean ultimate force to failure than those from the defect group (p < 0.05). Within 12 weeks, the ADM graft was histologically incorporated into a structure resembling control specimen; the mean ultimate force to failure in control was significantly greater than in specimens from both groups (p < 0.01). Although the defect was restored in the defect group, histologically and biomechanically specimens from the defect group were inferior to the graft group. ADM grafts were useful as a scaffold in the reconstruction of large rotator cuff defects in rats. Basic science study.

Laparoscopic hiatal hernia repair with human acellular dermal matrix patch: our initial experience

Background The laparoscopic repair of large hiatal hernia followed by an antireflux procedure is currently the gold standard therapy for gastroesophgeal reflux disease. However, it is recognized that recurrent hiatal herniation and wrap migration are major sources of operative failures in these patients. Some have described a reduction of such events with the placement of nonbiodegradable prosthetic patches over the primary cruroplasty. This prosthetic material may be associated with transesophageal and gastric erosions and a higher rate of postoperative dysphagia and chest pain when compared with simple suture cruroplasty alone. The aim of this study is to compare hiatal closure with a biodegradable patch (acellular dermal matrix) and simple suture curaplasty in patients undergoing laparoscopic antireflux surgery. Methods A total of 44 patients were prospectively enrolled in this study. Twenty-two consecutive patients undergoing large hiatal hernia repair (>5 cm) and fundoplication with primary suture cruroplasty only (group 1) were compared with 22 consecutive patients undergoing the same procedure with suture cruroplasty reinforced with an onlay acellular dermal matrix patch (group 2). The 2 groups were compared with regards to demographics, size of the hiatal hernia, pre- and postoperative symptom scores, pH studies, operative times, and hiatal hernia recurrence. Results Patients in both groups were well matched by age, weight, height, and size of hiatal hernia. There were similar preoperative values in esophageal manometry, 24-hour pH monitoring, and symptom scoring in both groups. Average operative time was 108 minutes in group 1 and 121 minutes in group 2. There were no major complications in either group. The median period of hospitalization was 1 day in both groups. Postoperative pH studies and symptoms score data were significantly improved in both groups. There was no significant difference in postoperative symptoms scores for dysphagia between the 2 groups. Two patients (one in each group) underwent esophageal dilatation for mild dysphagia postoperatively. In group 1, 2 patients (9%) had Nissen failure with hiatal hernia recurrences 6 months after surgery. There were no recurrences for the follow-up period in group 2. Conclusions Our early results suggest that hiatal hernia repair reinforced with an acellular dermal matrix patch may reduce the incidence of recurrent herniation and wrap migration. In addition, the increase in postoperative dysphagia, chest pain, and esophageal erosions associated with nondegradable mesh has not been observed in those with an acellular dermal matirx patch to this point in our follow up. However, future investigation of the material for this particular application as well as longer follow-up is necessary.