Acellular Porcine Small Intestinal Submucosa Research Articles

The long-term outcomes of vaginoplasty using acellular porcine small intestinal submucosa grafts in patients with Mayer-Rokitansky-Küster-Hauser syndrome: A case series.

To investigate the long-term outcomes for Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) patients undergoing vaginoplasty using acellular porcine small intestinal submucosa grafts (SIS). A case series. Seventy-eight MRKH syndrome patients and a post-SIS patient who delivered a baby following the world's first robot-assisted uterus transplantation. Mayer-Rokitansky-Küster-Hauser syndrome patients were grouped based on the postoperative time and the diagnosis-surgery interval. Outcomes of sexual function and psychological status were assessed using the female sexual function index (FSFI), self-rating scale of body image (SSBI) and self-acceptance questionnaire (SAQ). Anatomical outcomes were measured by clinicians. The primary outcome was restoration of sexual function, defined by an FSFI score in the 'good' range. Anatomical and psychological outcomes were also analysed. Sexual function was restored in 42.3% (33/78) of patients and the total FSFI score was 23.44 ± 4.43. Three factors (body defect, recognition of physical appearance and willingness to change physical appearance scores) in the SSBI and two in the SAQ decreased as the postoperative time increased. Based on the interval between diagnosis and surgery, the total SSBI score was lower in the short-interval group than in the long-interval group (7.25 ± 5.55 versus 12.04 ± 10.21, p=0.038). Nearly half of MRKH patients in our study had good long-term sexual function after SIS vaginoplasty. Sexual function and psychological status improved as postoperative time increased. In addition, reducing the diagnosis to surgery interval was associated with improved psychological function.

Endoscopic transcanal tympanoplasty type I in children: Evolving experience in tragus perichondrium vs. acellular porcine small intestinal sub-mucosa grafts

ObjectivesEndoscopic trans-canal tympanoplasty type I (ETT) is gradually diffusing worldwide. It mainly allows less invasive surgery in children with respect to a microscope approach by avoiding post-auricular access. The aim of this study is to illustrate our experience in endoscopic reconstruction of tympanic membrane, using autologous tragus perichondrium (TP) and non-autologous acellular porcine small intestinal sub-mucosa (SIS) as grafts. MethodsBetween January 2011 and December 2020, the results of a prospective non-randomized series of consecutive ETT were analyzed. The primary outcome was closure rate at 6 months and secondary outcomes are closure rates associated with age, size of perforation, type of perforation and middle ear status, presence of myringosclerosis, type of graft, status of contralateral ear, adenoidectomy and pre-postoperative ABG change. Statistical analysis was performed using the SPSS statistical package. ResultsOne hundred and sixteen consecutive procedures, mean age 9.4 years (range 4–17 years), were evaluated. TP and SIS grafts were used in 65 (56%) and 51 (44%) procedures, respectively. Mean duration of surgical procedure was 53 ± 21 min for SIS and 77 ± 18 min for TP (P = 0.001) Total graft intake was 82.8%; TP and SIS intake were 86.2% and 78.4% (P = 0.3), respectively. Graft intake w.r.t. in age stratified age groups was not statistically significant. Average preoperative and postoperative air-bone gap was 12.1 ± 7.6 dB and 5.5 ± 3.8 dB, respectively (P = 0.001). The difference in closure rates was not significant. Neither intra- nor postoperative complications were observed. ConclusionsIn children, ETT is an applicable and less invasive technique compared to the microscope and offers less morbidity. The use of SIS contributes additional less invasiveness to endoscopic surgery by avoiding tragus harvesting with a comparable success rate and granting significantly less surgical duration.

Comparison of Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa graft and laparoscopic peritoneal vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser syndrome.

The aim of this study is to compare the perioperative, anatomical and functional outcomes of patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), undergoing Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa (SIS) graft or laparoscopic peritoneal (Davydov) vaginoplasty. In this retrospective study, a total of 117 patients with MRKHS undergoing creation of a neovagina from 2017 to 2020 were retrospectively investigated. Comparisons between continuous variables were performed using Student's t-test and between qualitative variables using chi-squared tests. The operative time, return of bowel activity and return to work were the longest in the laparoscopic Davydov group (P < 0.001). The total cost was the highest in the SIS graft group (P < 0.001). The length of the neovagina was 7.9 ± 1.2 cm in the Sheares group, 7.1 ± 0.8 cm in the SIS graft group and 8.1 ± 1.1 cm in the laparoscopic Davydov group. The difference in the length of the neovagina was significant (P < 0.001). There was significant difference in the duration of continuous mould wearing (P < 0.001). There were no significant differences in the total female sexual function index (FSFI) scores or in the satisfaction scores of the male partner among the three groups. Sheares vaginoplasty and the vaginoplasty using SIS graft caused less trauma and provided similar functional results to laparoscopic peritoneal vaginoplasty. However, the patients in the Sheares group and SIS graft group needed to wear the mould for a longer duration post-surgery. Sheares vaginoplasty can provide a valuable and economic alternative method for the creation of a neovagina in patients with MRKHS.

The Effect of Biological Scaffold (Biodesign) in Postmastectomy Direct-to-Implant Breast Reconstruction: A 5-Year Single-Institution Experience.

Direct-to-implant (DTI) breast reconstruction is one of the immediate implant-based breast reconstruction methods. If the amount of soft tissue (eg, muscle or fascia) is insufficient to completely cover the implant, biological scaffold or acellular dermal matrix can be safely used for implant coverage. In this study, we used an acellular porcine small intestinal submucosa (SIS) mesh (Biodesign; Cook Medical Inc, Bloomington, IN) for DTI reconstruction to explore the impact of its use on breast reconstruction results. We retrospectively assessed cases involving DTI reconstruction at Taipei Veterans General Hospital from 2015 to 2019. Women, 18 years or older, who underwent immediate DTI reconstruction after mastectomy were included in the study. Mastectomy may have been performed because of therapeutic or prophylactic reasons. Patients who did and did not use SIS mesh for reconstruction were studied separately, and the 2 groups were compared in terms of clinical outcomes and complications. The validated, self-administered BREAST-Q Reconstruction Module version 2.0 survey was used to evaluate health-related quality of life and satisfaction among patients who underwent breast reconstruction. A total of 30 DTI breast reconstructions were enrolled. The mean age was 49.2 years, and the mean body mass index was 22.3 kg/m2. The mean postoperative follow-up duration was 17.1 months. Nipple-sparing mastectomy was performed for 26 cases (86.7%), and DTI breast reconstructions using SIS mesh for implant coverage were done in 14 cases (46.7%). The overall complication rate was 53.3% in 30 reconstructions, with nipple complications being the most common complication. The non-SIS and SIS-using groups had a similar overall complication rate postoperatively. As for the quality-of-life assessment, the SIS group obtained a higher score on BREAST-Q than those for whom SIS was not used. Porcine SIS mesh might be a safe and effective alternative to biological scaffolds in immediate 1-stage implant-based breast reconstruction to improve the quality of life after surgery.

Cervicovaginal reconstruction with small intestinal submucosa graft in congenital cervicovaginal atresia: A report of 38 cases

ObjectiveTo evaluate the quality of life and surgical outcomes in patients with congenital cervicovaginal malformation after cervicovaginal reconstruction. Study designThirty-eight patients diagnosed with congenital cervicovaginal aplasia and underwent cervicovaginal reconstruction using acellular porcine small intestinal submucosa (SIS) grafts were included in the study from January 2012 to December 2019. Of these, twenty-one patients underwent conventional laparoscopy, nine underwent robotic surgery, and eight underwent laparoendoscopic single-site (LESS) surgery. Clinical characteristics, perioperative data, condition of the neovagina and neocevix, post-operation complications, body image, resumption of menstruation, sexual function, and quality of life were assessed. ResultsThe average age of the patients was 16.4 ± 5.78 years. The operative procedure lasted 182.29 ± 70.85 min, with a hemoglobin decrease of 12.53 ± 7.55 g/dl. All surgery was completed successfully without complications. The total cost was highest in the robotic surgery group (P < 0.001). The cosmetic scores were significantly higher in the LESS group (P < 0.001). At a median follow-up of 49.79 ± 31.02 months, all patients resumed menstruation, except one patient who underwent hysterectomy due to vaginal obstruction. The average length of neovagina was 8.11 ± 0.75 cm, and the length of the cervix was 1.73 ± 1.00 cm. There were one patient with vaginal stenosis, two patients with cervical occlusion, two patients with cervical stenosis, and six patients with intrauterine device loss. Fourteen patients experienced sexual activity, with the total female sexual function index scores of 26.83 ± 3.49. Six patients had a desire of pregnancy, and one patient had pregnant via assisted-reproduction techniques. No differences in the mean physical component score (PCS) and mental component score (MCS) were identified among three different groups at baseline and all post-surgery time points (P > 0.05), but with the extension of follow-up, both PCS and MCS increased significantly in all groups (P < 0.001). ConclusionCervicovaginal reconstruction using an SIS graft is safe and efficient to the management of congenital cervicovaginal atresia whatever by the conventional laparoscopy, robotic surgery or LESS, with good surgical outcomes and high of quality of life.

OPTIMIZATION OF ACELLULAR MATRIX BIOMATERIAL FOR CARDIAC REGENERATION

Epicardial infarct repair (EIR) is an emerging therapy to promote adaptative post-infarct cardiac regeneration. EIR is achieved by applying bioactive “patches” to epicardium over an ischemic region. We previously showed that acellular porcine small intestinal submucosa ECM (SIS-ECM) biomaterials release factors including fibroblast growth factor-2 (FGF-2) that promote regenerative fibroblast activity and improve post-infarct cardiac function. Human trials are ongoing (NCT02887768). We aim to optimize EIR by developing enhanced biomaterials. Herein, we evaluate a modified SIS-ECM with more extensive decellularization and higher FGF-2 levels (Aug-ECM).

1469 Comparison of Neovaginoplasty Using Acellular Porcine Small Intestinal Submucosa Graft or Interceed in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome

Study Objective To compare using the acellular porcine small intestinal submucosa (SIS) graft or the Interceed in patients with MRKH syndrome undergoing creation of a neovagina. Design Retrospective study. Setting Academic affiliated community hospital. Patients or Participants Patients with MRKH syndrome undergoing creation of a neovagina from 2016 to 2018 were retrospectively investigated. Interventions Wharton-Sheares-George neovaginoplasty was performed using the acellular porcine small intestinal submucosa (SIS) graft or the Interceed. Measurements and Main Results Overall 67 patients were included (24 for the SIS graft, 43 for the Interceed) for analysis. The operating time, the estimated blood loss and return of bowel activity in the SIS graft group were similar with that in the Interceed group. However, the total cost in the SIS group was significantly higher than that in the Interceed group due to the cost of the SIS graft ($2570 per graft). All patients had a continuous mold wearing time for 6 months postoperatively and then returned for their follow-up. The mean length and width of the neovagina in the SIS graft group were similar with the Interceed group (7.0±0.6 cm vs 7.1±0.8 cm, P=.54, 2.8±0.3 cm vs 2.7±0.5 cm, P=.74, respectively). However, the incidence of granulation at the vaginal apex was higher in the SIS graft group than that in the Interceed group (6/24 vs 4/43, p Conclusion Our results demonstrated that Wharton-Sheares-George provided the patients to have satisfactory sexual intercourse. The Interceed played a role in the reconstruction of neovagina no less than the SIS graft.

31 - A Comparative Study of Sexual and Functional Outcomes of Vaginoplasty Through Three Methods

Study Objective: To compare the sexual and functional outcomes in patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) through Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa (SIS) graft and laparoscopic peritoneal vaginoplasty.

The Study of Acellular Porcine Small Intestinal Submucosa Powders as a Hemostatic Agent to Stop the Bleeding in a Rat Spleen Partial Resection Model

The Study of Acellular Porcine Small Intestinal Submucosa Powders as a Hemostatic Agent to Stop the Bleeding in a Rat Spleen Partial Resection Model

Use of porcine small intestinal submucosa for pediatric endoscopic tympanic membrane repair.

Tympanic membrane perforationsoccur frequently in children, and can result in hearing loss, otorrhea, pain, and cholesteatoma. Due to the narrower ear canal in children, a postauricular incision is often needed to access the tympanic membrane for surgical repair. Endoscopic approaches are increasingly being used for tympanic membrane repair, reducing the need for postauricular incisions. As the need for a postauricular incision decreases, the demand for non-autologous grafting material has increased. Acellular porcine small intestinal submucosa (SIS) has been described in the literature as an alternative to commonly used autologous grafts, and is well suited for use with transcanal endoscopic ear surgery as a minimally invasive approach. This paper describes techniques for use of SIS in endoscopic tympanic membrane repair in children.

EARLY HYDRODYNAMIC ASSESSMENT OF INTESTINAL SUB-MUCOSA BIOSCAFFOLD FOR MITRAL VALVE REPLACEMENT

Background: Infants and children with severe valve lesions have limited surgical options. It has been shown that acellular porcine small intestinal submucosa (PSIS) scaffolds support cell infiltration and tissue remodeling after implantation. Our group has implanted custom-made PSIS valves in 4

脱细胞猪小肠粘膜下层材料体内外降解过程对比研究

通过对脱细胞猪小肠粘膜下层基质材料进行体内外降解实验，考察了SIS材料在不同降解环境下的降解行为，为其在临床应用中的有效性提供依据。体外降解实验采用I型胶原酶，蛋白酶K酶解来模拟体内降解环境；体内降解实验采用大鼠和新西兰兔分别进行皮下以及腹壁植入。结果显示SIS材料在体内修复组织需要8~12周，相当于体外I型胶原酶降解12 h (降解40.24%)，蛋白酶K降解60 min (56.33%)；材料在体内完全降解的时间为24周，而体外胶原酶和蛋白酶K完全降解分别需要96 h和120 min，同时SIS材料组织相容性好，无黏连，血肿等症状发生。结果表明SIS降解与组织修复过程相匹配，排异反应弱，可以为组织修复提供力学强度与生物学模板，表明SIS材料是一种可用于临床修复的生物材料。 Degradation behaviors of acellular porcine small intestinal submucosa (SIS) matrix under different circumstances were investigated by taking the degradation experiments in vivo and in vitro respectively. In vitro, solutions of collagenase type I and Proteinase K were used to mimic the de-gradation environment. Wistar mice and New Zealand Rabbits were used as subcutaneous and abdominal degradation model in vivo. Results showed that it took 8-12 weeks for the tissue to re-pair in vivo, while the time intervals needed to get the same degradation percentage for collagenase I and Proteinase K in vitro were 12 h and 60 min respectively. SIS was totally degraded in 24 weeks in vivo and the corresponding time for collagenase I and Proteinase K in vitro were 96 h and 120 min. Besides, SIS showed good histocompatibility and did not have symptoms of adhesion and hematomas. Results demonstrated the processes of degradation and tissue repair were matched well with each other without immunological rejection and SIS could supply the mechanical strength and biological template during tissue repair, suggesting SIS is a potential surgical biomaterial for clinical applications.

Functional Outcomes of Robotic Assisted Laparoscopic Mesh Sacrocolpopexy (RASC) and Mesh Rectopexy for Combined Vaginal and Rectal Prolapse

Study Objective: To compare the effectiveness and long-term anatomic and functional results of vaginoplasty using acellular porcine small intestinal submucosa (SIS) graft with laparoscopic peritoneal vaginoplasty in patients with MRKHS. Design: Prospective follow-up study. Setting: Academic hospital. Patients: From December 2011 to January 2013, 30 patients underwent vaginoplasty using SIS graft in our hospital. The follow-up information were compared with those of 41 patients who underwent laparoscopic peritoneal vaginoplasty during January 2005 to January 2013. Intervention: Patients and surgical data, follow-up information and Female Sexual Function Index (FSFI) scores were recorded and analyzed. Measurements and Main Results: Comparedwith Laparoscopic Davydov procedure, the operating time of vaginoplasty using SIS graft was significantly shorter, the estimated blood loss was significantly less. The patients in the SIS group had earlier return of bowel activity, and earlier

Acellular porcine small intestinal submucosa graft for cervicovaginal reconstruction in eight patients with malformation of the uterine cervix

Can surgical reconstruction of the cervix and vagina in patients be achieved using an acellular porcine small intestinal submucosa (SIS) graft? Our experiences of combined laparoscopic and vaginal cervicovaginal reconstruction using an SIS graft in eight patients were positive, with successful reconstruction and no complications, cervical stenosis or vaginal stenosis. In patients with agenesis and dysgenesis of the uterine cervix and vagina, surgical reconstruction of the internal genitalia is a challenging problem for gynecologists. Hysterectomy with the creation of an artificial vagina was the treatment of choice in the 1990s. Recently, conservative management has been gradually adopted to avoid extirpation of the uterus, including the canalization techniques, the uterovaginal anastomosis and the reconstruction of cervical and vaginal agenesis with some autologous tissues. This prospective observational study from January 2012 to March 2013 included 8 patients aged 10-18 years with malformation of the cervix (1 with cervical agenesis, 1 with a cervical body consisting of a fibrous band and 6 with obstruction of the cervical os) and vagina (4 with complete vaginal aplasia and 4 with a 1-3 cm long vaginal pouch) diagnosed by physical examination and magnetic resonance imaging. Eight patients underwent combined laparoscopic and vaginal cervicovaginal reconstruction using an SIS graft during the end of menstruation. A T-shaped intrauterine device connected with a 14-French Foley catheter was inserted into the uterine cavity to keep the newly created cervix patent, and then a permanent lower uterine cerclage was placed. Patients were assessed post-operatively at 1, 2, 4, 6, 12 and 15 months, and data on menstruation and the morphology of the neovagina and cervix were recorded. The mean ± SD age of the patients was 14.5 ± 2.8 (10-18) years. All patients had a history of cyclic abdominal pain, and the average delay in diagnosis was 4.5 ± 4.0 (0-12) months. One patient had a previous history of unsuccessful attempt at canalization and two post-operative hematometra drainages before referral. The mean operating time was 201 ± 67 (120-330) min, with a mean estimated blood loss of 157 ± 154 (30-500) ml. The first case was converted to laparotomy, and the others were successfully completed. None of the patients had a complication or required blood transfusion. All the patients showed resumption of menstruation. The patients were followed for 8 ± 4 (4-15) months, and no cervical or vaginal stenosis occurred in any of the cases. The sample size of this study was small. A larger study that compared this method with previous techniques regarding the complication and success rates would increase the value of the study. A combined laparoscopic and vaginal cervicovaginal reconstruction with an SIS graft is a potential alternative to the management of congenital agenesis and dysgenesis of uterine cervix and vagina. The work was supported by National Key Clinical Faculty Construction Program of China. No competing interests are declared.

Tissue engineered esophagus scaffold constructed with porcine small intestinal submucosa and synthetic polymers

Acellular porcine small intestinal submucosa (SIS) has been successfully used for reconstructing esophagus with half circumferential defects. However, repairing full circumferential esophageal defects with SIS has been restricted due to the latter's poor mechanical properties. In the present study, synthetic polyesters biomaterial poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) and poly(lactide-co-glycolide) (PLGA) have been used to improve the mechanical properties of SIS. Feasibility of SIS/PHBHHx-PLGA composite material scaffold for esophageal tissue engineering has been assessed through a series of testing. The appropriate mixing ratio of PHBHHx and PLGA polymers has been determined as 5:5 by mechanical testing and in vitro degradation experiment. The morphology of constructed membranous and tubular scaffolds was also characterized. As confirmed by enzyme-linked immunosorbent assay, the contents of VEGF and TGF-β have respectively reached 657 ± 18 ng mL−1 and 130 ± 4 pg mL−1 within the SIS/PHBHHx-PLGA specimens. Biocompatibility of the SIS/PHBHHx-PLGA specimens with rat bone marrow mesenchymal stem cells (MSCs) was also evaluated by scanning electron microscopy and a live–dead cell viability assay. Actin filaments of MSCs on the composite materials were labeled. Biological safety of the extract from SIS/PHBHHx-PLGA specimens, measured as hemolysis rate, was all lower than 5%. Compared with SIS and SIS/PHBHHx-PLGA specimens, inflammatory reaction provoked by the PHBHHx-PLGA specimens in rats was however more severe. Our results have suggested that SIS/PHBHHx-PLGA composite material can offer a new approach for esophageal tissue engineering.

Tissue engineered esophagus by copper—small intestinal submucosa graft for esophageal repair in a canine model

Acellular porcine small intestinal submucosa (SIS) has been used for esophagoplasty with success in a canine model. However, it did not lead to complete epithelialization. For better reconstruction, a cellular component is required. Moreover, promotion of angiogenesis with copper has been widely recognized by basic research as well as clinical studies. In this study, we have evaluated the feasibility and effectiveness of combined Cu and SIS (SIS-Cu patch) for the esophageal repair using a canine model. Eighteen male beagle dogs were subjected to surgical resection to produce cervical esophageal defects (5 cm in length, 180° in range). SIS with Cu (5 or 25 μmol L(-1) copper) or without Cu was patched on the esophageal defects. Barium esophagram and histology exam were carried out to evaluate the effectiveness of the therapy. As shown, the SIS-Cu graft promoted re-epithelialization, re-vascularization and muscular regeneration. SIS-Cu patch is more effective than SIS alone for esophageal repair, and the SIS+25 μmol L(-1) Cu group demonstrated additional advantages over the SIS+5 μmol L(-1) Cu.

Acellular Porcine Small Intestinal Submucosa (SIS) Graft for Cervicovaginal Reconstruction in Malformation of the Uterine Cervix and Vagina

This video shows Acellular porcine small intestinal submucosa (SIS) graft for cervicovaginal reconstruction in malformation of the uterine cervix and vagina. This 14y old girl was referred to our hospital for progressive cyclic abdominal pain. She had a history of primary amenorrhea, and was diagnosed as atresia of the uterine cervix and the upper vagina, and had a previous history of unsuccessful attempt at canalization and 2 postoperative hematometra drainage before referral. The patient underwent combined laparoscopic and vaginal cervicovaginal reconstruction with SIS graft. A T shaped intrauterine device connected with a 14 French Foley catheter was inserted into the uterine cavity to keep the newly created cervix patent, and then a permanent lower uterine cerclage was placed. The patients were instructed to wear the mould for successive 6 months. Menstruation restored in this patients, and the neovagina had a good morphological result.

Laparoscopic–Assisted Uterovaginal Anastomosis for Uterine Cervix Atresia With Vaginal Aplasia Using a Silicone Stent Lined With Acellular Porcine Small Intestinal Submucosa Graft Inserted Using a 16F Foley Catheter

Herein is reported a novel technique for cervical reconstruction of congenital cervicovaginal atresia. The patient was a 16-year-old girl with congenital atresia of the cervix and vagina, didelphic uterus, and right hematosalpinx. At laparoscopic-assisted creation of a neocervix, a silicone stent was inserted using a 16F Foley catheter and lined with an acellular porcine small intestinal submucosa graft under ultrasound guidance. At 3-month clinical follow-up after placement of the stent, the patient had regular menstrual flow. The neocervix was completely mucosalized on the inner surface at 4 months after surgery. There were no complications related to the silicone stent or the cervical stent. Cervical reconstruction using a vaginal mucosa–lined silicone stent is accessible and effective, and provides an alternative option to preserve reproductive potential in patients with cervicovaginal atresia.

Vaginoplasty Using Acellular Porcine Small Intestinal Submucosa Graft in Two Patients with Meyer-von-Rokitansky-Küster-Hauser Syndrome: A Prospective New Technique for Vaginal Reconstruction

The objective of this case study is to present our experience of a surgical approach for vaginal agenesis using an acellular porcine small intestinal submucosa (SIS) graft. The present report involved 2 patients diagnosed as having vaginal agenesis due to Meyer-von-Rokitansky-Küster-Hauser syndrome. The operation procedure involved the creation of a neovaginal tunnel and then a mold wrapped with the SIS graft was placed in the neovagina. The duration of surgery was less than 45 min with minimal blood loss and no operative and postoperative complications. Epithelialization of the neovagina was achieved within 2 months after surgery. The neovagina created with this procedure was the same as that of a normal adult vagina histologically and physiologically. In conclusion, the creation of a neovagina using a SIS graft resulted in a favorable outcome and this approach may be a potential alternative to the management of vaginal agenesis.

Grafts of Porcine Small Intestinal Submucosa with Cultured Autologous Oral Mucosal Epithelial Cells for Esophageal Repair in a Canine Model

The acellular porcine small intestinal submucosa (SIS) has been successfully used for esophagoplasty. However, it does not lead to a complete epithelialization in a canine model. A cellular component may be required for better reconstruction. The present study was undertaken to investigate the feasibility and effectiveness of the combination of SIS and autologous oral mucosal epithelial cells (OMECs) for esophageal reconstruction. The OMECs harvested from beagle dogs were cultured and propagated, and the 3rd passage cells were seeded on a single-layer SIS. Male beagle dogs were subjected to surgical resection to produce cervical esophageal defects (5 cm in length, 180 degrees in range). SIS with or without OMECs was patched on the esophageal defects. Barium esophagram, immunohistochemistry, and histology were performed to evaluate the therapeutic effectiveness. Four weeks after surgery, the histological examination showed a complete re-epithelialization and almost no inflammation in the SIS with OMECs group. But in the SIS group, only a partial epithelialization was observed along with inflammation. Eight weeks after surgery, the squamous epithelium was found to cover the entire graft surface in both groups; however, the muscular regeneration was observed in the SIS with OMECs, but not in the SIS group. The graft of SIS combined with autologous OMECs promotes re-epithelialization and muscular regeneration. It is an effective alternative method for esophageal repair.