Matrix Graft Research Articles

Preliminary experimental study of urethral reconstruction with tissue engineering and RNA interference techniques.

This study investigated the feasibility of replacing urinary epithelial cells with oral keratinocytes and transforming growth factor-β1 (TGF-β1) small interfering RNA (siRNA)-transfected fibroblasts seeded on bladder acellular matrix graft (BAMG) in order to reconstruct tissue-engineered urethra. Constructed siRNAs, which expressed plasmids targeting TGF-β1, were transfected into rabbit fibroblasts. The effective siRNA was screened out by RT-PCR and was transfected into rabbit fibroblasts again. Synthesis of type I collagen in culture medium was measured by enzyme-linked immuno sorbent assay (ELISA). Autologous oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts were seeded onto BAMGs to obtain a tissue-engineered mucosa. The tissue-engineered mucosa was assessed morphologically and with the help of scanning electron microscopy. The TGF-β1 siRNA decreased the expression of fibroblasts synthesis type I collagen. Oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts were seeded onto sterilized BAMG to obtain a tissue-engineered mucosa for urethral reconstruction. The compound graft was assessed using scanning electron microscope. Oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts had a good compatibility with BAMG. The downregulation of fibroblasts synthesis type I collagen expression by constructed siRNA interfering TGF-β1 provided a potential basis for genetic therapy of urethral scar. Oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts had good compatibility with BAMG and the compound graft could be a new choice for urethral reconstruction.

253 EPITHELIAL-DIFFERENTIATED ADIPOSE-DERIVED STEM CELLS SEEDED BLADDER ACELLULAR MATRIX GRAFTS FOR URETHRAL RECONSTRUCTION: AN ANIMAL MODEL

You have accessJournal of UrologyStem Cell Research1 Apr 2013253 EPITHELIAL-DIFFERENTIATED ADIPOSE-DERIVED STEM CELLS SEEDED BLADDER ACELLULAR MATRIX GRAFTS FOR URETHRAL RECONSTRUCTION: AN ANIMAL MODEL Hong-Bin Li, Yue-Min Xu, Qiang Fu, Chao Li, Qin Zhang, Min-Kai Xie, and Ying Wang Hong-Bin LiHong-Bin Li Shanghai, China, People's Republic of More articles by this author , Yue-Min XuYue-Min Xu Shanghai, China, People's Republic of More articles by this author , Qiang FuQiang Fu Shanghai, China, People's Republic of More articles by this author , Chao LiChao Li Shanghai, China, People's Republic of More articles by this author , Qin ZhangQin Zhang Shanghai, China, People's Republic of More articles by this author , Min-Kai XieMin-Kai Xie Shanghai, China, People's Republic of More articles by this author , and Ying WangYing Wang Shanghai, China, People's Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1635AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The limited amount of available epithelial tissue is considered a main cause of the high rate of urethral reconstruction failures. The aim of this study was to investigate whether epithelial-differentiated rabbit adipose-derived stem cells (Epith-rASCs) could play a role of epithelium in vivo functionally and be a potential substitute of urothelium. METHODS Substitution urethroplasty was performed to repair an anterior urethral defect in male New Zealand rabbits using Epith-rASCs seeded bladder acellular matrix grafts (BAMGs) after 5-bromo-2`-deoxyuridine (BrdU) labeling of the implanted cells, based on the in vitro epithelial induction system we previously described. Urethroplasty with unseeded BAMGs, and with undifferentiated rASCs (Und-rASCs) seeded BAMGs were performed as controls. After operation, retrograde urethrograms and macroscopic inspection were performed for the assessment of urethral caliber and continuity. Immunofluorescent staining and western blot analysis were performed to evaluate the development of BrdU labeled Epith-rASCs and epithelial markers expression. RESULTS A notable amelioration of graft contracture and recovery of urethral continuity were observed in the Epith-rASCs/BAMG group, in contrast to the two controls. Immunofluorescence revealed that the labeled Epith-rASCs/Und-rASCs colocalized with cytokeratin 13 and myosin. Consistent with the results of the western blot analysis, at 1 and 2 months postimplantation, multi-layered epithelial cells were observed in the Epith-rASCs/BAMG group, whereas no significant growth and local monolayer growth profile of epithelial cells were observed in BAMG group and Und-rASCs/BAMG group, respectively. CONCLUSIONS The results showed that Epith-rASCs could produce functional effects of urothelium as seeding cells for urethral tissue engineering, and be available to prevent lumen contracture and subsequent complications including recurrent stricture. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e104 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hong-Bin Li Shanghai, China, People's Republic of More articles by this author Yue-Min Xu Shanghai, China, People's Republic of More articles by this author Qiang Fu Shanghai, China, People's Republic of More articles by this author Chao Li Shanghai, China, People's Republic of More articles by this author Qin Zhang Shanghai, China, People's Republic of More articles by this author Min-Kai Xie Shanghai, China, People's Republic of More articles by this author Ying Wang Shanghai, China, People's Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Lichtenstein repair of indirect inguinal hernias with acellular tissue matrix grafts in adolescent patients: a prospective, randomized, controlled trial

To evaluate the outcomes of Lichtenstein hernioplasty using acellular tissue matrix (ACTM) grafts in adolescent patients. One hundred patients, 13-18years old, with primary unilateral indirect inguinal hernias, were randomly assigned to receive Lichtenstein hernioplasty using ACTM or traditional high ligation of the hernia sac (control group).The outcome measures were the length of the operation, postoperative visual analogue scale (VAS) pain score, length of hospitalization, postoperative complications and recurrence rate. The length of hospitalization and VAS score were not different between the groups, and the minimum follow-up was 30months. No postoperative wound infections, chronic postoperative pain or local foreign body sensation occurred in either group. Six patients (14.3%) in the experimental group and five (11.6%) in the control group developed scrotal hydroceles (P>0.05); all resolved with conservative management. There were no recurrences in the experimental group, while there were three (6%) in the control group (P>0.05) and all occurred in patients with Gilbert type 3 hernias. Lichtenstein hernioplasty using ACTM grafts has comparable safety and efficacy to traditional high ligation of the indirect hernia sac in adolescent patients. ACTM can reduce the incidence of recurrence in adolescents with Gilbert type 3 hernias.

Report of Multidisciplinary Treatment of an Extensive Mandibular Ameloblastoma With Free Iliac Crest Bone Flap, Dental Implants, and Acellular Dermal Matrix Graft

Report of Multidisciplinary Treatment of an Extensive Mandibular Ameloblastoma With Free Iliac Crest Bone Flap, Dental Implants, and Acellular Dermal Matrix Graft

Urethral Reconstruction With Tissue Engineering and RNA Interference Techniques in Rabbits

To investigate the feasibility of replacing urinary epithelial cells with oral keratinocytes and transforming growth factor β (TGF-β)1 siRNA transfected fibroblasts seeded on bladder acellular matrix graft (BAMG) to reconstruct urethra. Autologous oral keratinocytes and TGF-β1 siRNA transfected fibroblasts were seeded onto BAMGs to obtain a tissue-engineered mucosa. The tissue-engineered mucosa was assessed using morphology and scanning electron microscopy. In 27 male rabbits, a ventral urethral mucosal defect was created. Urethroplasty was performed with autogenic oral keratinocyte and TGF-β1 siRNA transfected fibroblast-seeded BAMGs (9 rabbits, group 1), with autogenic oral keratinocyte-seeded BAMGs (9 rabbits, group 2) or with BAMGs with no cell seeding (9 rabbits, group 3). Retrograde urethrography and histological analyses were performed to evaluate the results of urethroplasty. In vitro, oral keratinocytes and TGF-β1 siRNA transfected fibroblasts had good biocompatibility with BAMGs. In vivo, the urethra kept a wide caliber in groups 1 and 2. Strictures were observed in group 3. Histologically, the retrieved urethra in group 3 showed fibrosis and inflammation during 6 months. Stratified epithelial layer regenerated in group 2, whereas there was no evidence of formation of capillary in the epithelial lower layer during the study period. Stratified epithelial layer and formation of capillary in the epithelial lower layer were evident after 6 months in group 1. Our study suggested that oral keratinocytes and TGF-β1 siRNA transfected fibroblasts could be used as a source of seed cells for urethral tissue engineering.

Effect of immobilization on rotator cuff reconstruction with acellular dermal matrix grafts in an animal model

Using a rat model we determined whether immobilization improves tendon-to-bone healing and tendon maturation after rotator cuff reconstruction with acellular dermal matrix (ADM) grafts. Sprague-Dawley rats were randomly assigned to 3 equal groups. All rats were subjected to rotator cuff reconstruction and their shoulder was not immobilized (N-IM controls) or immobilized for 2- or 6 weeks immediately thereafter (2- and 6-IM groups, respectively). After detaching the rotator cuff including the full-thickness supraspinatus tendon at its insertion on the greater tuberosity, a defect was created. ADM patches were used for rotator cuff reconstruction. Specimens obtained 2, 6, and 12weeks after surgery were subjected to semiquantitative histomorphological measurements to assess cellularity, vascularity, and collagen organization. In addition, specimens at 12 weeks were submitted for biomechanical analysis. Cell density decreased over time in all 3 groups; there was no significant difference among the groups at 2 weeks. However, the 6-IM group harbored more cells in the tendon-to-bone interface than the 2-IM group at 6 weeks and the N-IM group at 12 weeks. Vascularity in the interface decreased over time in the N-IM and 2-IM groups but not the 6-IM rats. At 6 and 12 weeks, the 2-IM group manifested better collagen organization than the other groups. The 2-IM group exhibited higher ultimate load-to-failure than the other groups. Stiffness was similar in the 3 groups. Remodeling of ADM grafts placed in rat rotator cuff defects was promoted by 2- but not 6-week immobilization.

V56 Corpora cavernosa reconstruction with porcine dermal matrix graft and inflatable penile prosthesis implant in a case of massive, post-infective penile fibrosis

V56 Corpora cavernosa reconstruction with porcine dermal matrix graft and inflatable penile prosthesis implant in a case of massive, post-infective penile fibrosis

Hybrid matrix grafts to favor tissue regeneration in rabbit femur bone lesions

Hybrid matrix grafts to favor tissue regeneration in rabbit femur bone lesions

A comparative clinical study of the efficacy of subepithelial connective tissue graft and acellular dermal matrix graft in root coverage: 6-month follow-up observation

Aims:The purpose of this study was to compare the clinical efficacy of subepithelial connective tissue graft and acellular dermal matrix graft associated with coronally repositioned flap in the treatment of Miller's class I and II gingival recession, 6 months postoperatively.Settings and Design:Ten patients with bilateral Miller's class I or class II gingival recession were randomly divided into two groups using a split-mouth study design.Materials and Methods:Group I (10 sites) was treated with subepithelial connective tissue graft along with coronally repositioned flap and Group II (10 sites) treated with acellular dermal matrix graft along with coronally repositioned flap. Clinical parameters like recession height and width, probing pocket depth, clinical attachment level, and width of keratinized gingiva were evaluated at baseline, 90th day, and 180th day for both groups. The percentage of root coverage was calculated based on the comparison of the recession height from 0 to 180th day in both Groups I and II.Statistical Analysis Used:Intragroup parameters at different time points were measured using the Wilcoxon signed rank test and Mann–Whitney U test was employed to analyze the differences between test and control groups.Results:There was no statistically significant difference in recession height and width, gain in CAL, and increase in the width of keratinized gingiva between the two groups on the 180th day. Both procedures showed clinically and statistically significant root coverage (Group I 96%, Group II 89.1%) on the 180th day.Conclusions:The results indicate that coverage of denuded root with both subepithelial connective tissue autograft and acellular dermal matrix allograft are very predictable procedures, which were stable for 6 months postoperatively.

Adipose-Derived Stem Cells Seeded on Acellular Dermal Matrix Grafts Enhance Wound Healing in a Murine Model of a Full-Thickness Defect

The promotion of wound healing using dermal substitutes has become increasingly widespread, but the outcomes of substitute-assisted healing remain functionally deficient. Adipose-derived stem cells (ASCs) have been investigated widely in regenerative medicine and tissue engineering, and they have the potential to enhance wound healing. In this study, we focused on investigating the effects and mechanism of ASCs combined with an acellular dermal matrix (ADM) to treat full-thickness cutaneous wounds in a murine model. The ADM was prepared from the dorsal skin of nude mice by decellularization by treatment with trypsin followed by Triton X-100. The human ASCs were isolated and cultured from abdominal lipoaspirate. We created a rounded, 8-mm, full-thickness cutaneous wound in nude mice and divided the mice into the following 4 groups: silicon sheet cover only, silicon sheet with spreading ASCs, ADM only, and ASCs seeded on ADM. The granulation thickness was evaluated by histology after 7 days. Further comparisons between the ADM only and ASC-seeded ADM groups were undertaken by assessing the reepithelialization ratio and blood vessel density at postoperative days 9 and 14. Statistical analyses were conducted using Student 2-tailed t test. Immunofluorescent histology and ASC labeling were also performed to identify possible mechanisms. The ADM was successfully prepared, and the cytometry analysis and differentiation assay provided the characterization of the human ASCs. A marked improvement in granulation thickness was detected in the ADM-ASC group in comparison with other 3 groups. A significantly increased rate of reepithelialization in the ADM-ASC group (80 ± 6%) compared to the ADM only group (60 ± 7%) was noted on postoperative day 9. The blood vessel density was evidently increased in the ADM-ASC group (7.79 ± 0.40 vessels per field) compared to the ADM only group (5.66 ± 0.23 vessels) on day 14. Cell tracking experiments demonstrated that labeled ASCs were colocalized with staining for VEGF or endothelial cell maker vWF after the transplantation of ADM-ASCs on postoperative day 14. Adipose-derived stem cells seeded on an ADM can enhance wound healing, promote angiogenesis, and contribute to newly formed vasculature, and VEGF-expressing ASCs can be detected after transplantation. This model could be used to improve the other clinical applications of ASCs and to decipher the detailed mechanism by which ASCs interact with wound tissue.

The Use of Acellular Dermal Matrices in Revisional Breast Reconstruction

The use of acellular dermal matrices in breast surgery has become popular in the last two decades, with a corresponding increase in experience and literature. The authors reviewed the literature and summarize key technical points regarding use of acellular dermal matrices in reconstructive breast surgery. Current applications have emphasized both primary and secondary breast reconstruction. Newer approaches focus on breast revisional surgery, especially when matrix material is used to correct deformities commonly arising after breast implant placement. In these situations, matrices have widened the indications and improved results by providing additional support to the lower pole, extending the pectoralis major muscle, and smoothing surface irregularities. Increased use of these products has also spurred our understanding of their biological properties of cell infiltration, tolerance, and inflammation. Acquired deformities, such as symmastia, rippling, malposition, and lower pole bottoming out, that were previously difficult to treat are significantly improved by placement of acellular dermal matrix in the affected area. Although most of the available studies demonstrate short-term results (1 to 2 years of follow-up), our technical ability to treat complications after breast augmentation and mastopexy has expanded. Use of onlay grafts of matrix in areas of capsulectomy and capsulorrhaphy, placement of grafts of varying thickness for thinned tissues, and the wide variety of shapes and sizes of product available are reducing unfavorable aesthetic results. Increased complications, including seroma formation, infection, wound dehiscence, and implant exposure, remain challenging problems. Long-term studies will be needed to prove the durability of acellular dermal matrices in breast revisional surgery.

Simultaneous implantation of bilateral ureters into bladder acellular matrix graft after partial cystectomy in a porcine model

What's known on the subject? and What does the study add? The process of bladder regeneration with a bladder acellular matrix graft (BAMG) is thought to be accelerated by administration of vascular endothelial growth factor into the host bladder. In the present study, we showed that simultaneous implantation of bilateral ureters into a BAMG after a partial cystectomy is reasonable and provides an increased opportunity to the bio-scaffold for communication with host tissues from which a blood supply and stem cells will be generated. • To evaluate if the implantation of bilateral ureters into a bladder acellular matrix graft (BAMG) at the time of its implantation would enhance bladder regeneration in a partial substitution BAMG. • Partial cystectomies were performed under general anaesthesia in 12 pigs, followed by augmentation with a BAMG. • Six (ureteric implantation group) also received simultaneous implantation of bilateral ureters into the BAMG, while the remaining six (control group) did not have ureteric implantation. • In both groups, bladder regeneration was evaluated using endoscopic and histopathological methods at 1, 2, 4, and 8 weeks after implantation. • At 1 week after BAMG implantation, there were significant inflammatory changes on the host bladder in both groups, while no significant endoscopic changes were seen on the BAMG luminal surfaces. • At 2 weeks, inflammatory changes were diminished and epithelialisation on the BMAG was identified, especially near the host bladder in both groups. • Similarly, epithelialisation on the BAMG near the implanted ureters was seen in the ureteric implantation group. • At 4 and 8 weeks, epithelialisation remained in progress in both groups, although it was more active and expansive in the ureteric implantation group. • In our porcine model, endoscopic and histopathological examinations showed that simultaneous implantation of bilateral ureters into a BAMG enhanced epithelialisation of the AMG. • This new approach using host ureters and bladder as a potential source of bladder regeneration may provide for rapid and complete regeneration of a bladder substitute.

Application of Acellular Dermal Matrix in Reconstruction of Oral Mucosal Defects in 36 Cases

Artificial grafts have been investigated for use in the repair of oral mucosal defects. The aim of this retrospective study was to present the outcomes of the use of acellular dermal matrix (ADM) grafts to repair oral mucosal defects. Data from 36 patients with oral mucosal defects reconstructed with ADM grafts from 2003 through 2009 were reviewed. All patients were followed-up for at least 6 months to observe the graft repair, wound-healing time, contracture, color, infection, pain, immunologic reaction, texture of the graft, and clinical course. Graft success was defined as the ADM graft being replaced by new mucosa-like tissue and the oral mucosal defect being covered with the new mucosa-like tissue. Any evidence of incomplete graft re-epithelialization or graft sloughing was considered a graft failure (complete or incomplete). Of the 36 cases, 34 grafts (94.4%) were successfully replaced with new mucosa-like tissues and only 2 grafts (5.6%) failed. No complaints such as pain, immunologic reaction, or infection were observed during the follow-up. Mild graft contraction occurred in 7 patients with lip or buccal defects, especially at approximately 3 to 5 weeks after the reconstructive surgery. The ADM grafts for oral mucosal defects were safe and effective. The present data support the clinical application of ADM grafts in reconstructing oral mucosal defects caused by various oral diseases.

Extracellular matrix graft for vascular reconstructive surgery: evidence of autologous regeneration of the neoaorta in a murine model

The study aimed to evaluate the efficacy of the porcine small intestine submucosa extracellular matrix (SIS-ECM) in a murine model, as a possible vascular patch for clinical use in reconstructive vascular and potentially cardiac surgery. Fifteen adult male Sprague Dawley rats and five green fluorescent protein (GFP) rats were enrolled in this study. The SIS-ECM graft (6 mm long, 4 mm wide) was implanted for patch plasty on the abdominal aorta of the animal, after excising part of its anterior wall. Histology and immunohistochemistry were used to evaluate the results at 15, 30, 90 and 180 days post-surgery. Graft re-population was demonstrated 15 days after implantation. The luminal surface of the regenerating tissue was partially covered by endothelial cells, and intimal hyperplasia occurred in the central part of the graft. Complete re-endothelialization of the patch with smooth muscle cells colonizing the graft and acting as the neoaortic wall was observed after 30 days. Near complete absorption of the biomaterial was observed after 180 days. No inflammatory cell reaction occurred. All animals survived and no graft aneurysm was observed. A SIS-ECM patch allowed the colonization of host endothelial and smooth muscle cells in the graft. This material may be an ideal substitute for reconstructive vascular surgery, and its use could be extended to surgical repair of cardiac defects.

Threatened ventriculostomy shunt exposure: augmenting native soft tissue coverage with acellular dermal matrix graft

Avoiding threatened ventriculostomy shunt exposure in the pediatric population remains a difficult problem for the neurosurgeon and reconstructive surgeon. In this case series, the authors present a novel method of augmenting scalp soft tissue with acellular dermal matrix (ADM) in patients with a history of ventricular shunt revisions. Soft tissue augmentation with ADM successfully prevented shunt exposure in 3 patients with a history of shunt revision due to impending exposure following conventional techniques.

Management of Full-Thickness Abdominal Wall Defects Following Tumor Resection

Abdominal wall reconstruction continues to evolve with improvement in technique and technology. This study reviews our experience with challenging full thickness (skin, muscle, and fascia) defects following tumor resections often in high-risk patients. All patients who underwent abdominal wall reconstruction following full thickness tumor resection were included in the series. Data queried included patient demographics, indications, tumor defect, risk factors, type of repair, complications, and recurrence of the hernia. A total of 30 patients underwent reconstruction after full thickness resection of abdominal wall tumors or tumors of intra-abdominal organs involving abdominal wall. The indications included desmoid tumors (n=6); abdominal wall sarcoma (n=7); colon cancer invading abdominal wall (n=10); pancreatic, ovarian, and retroperitoneal sarcoma with abdominal wall invasion (n=3); and other (n=4). In all, 17 patients underwent simultaneous resection of one or more intra-abdominal organs. The type of repair included primary closure (±components separation), or mesh-assisted closure (±primary fascial closure). Acellular dermal matrix was used more commonly in the patients with tumors of gastrointestinal origin. The average follow-up period was 23 months. Postoperative complications developed in 6 patients (20.6%). Incidence of postoperative complications was higher in patients with colon cancer invading the abdominal wall or those with bowel anastomosis or radiation therapy. An abdominal bulge or hernia developed in 4 patients (13.7%); it was higher in patients who did not have mesh reconstruction. Abdominal wall reconstruction after full thickness tumor resection is challenging. It can be performed safely and effectively with attention to surgical technique, patients' risk of infection, and type of mesh. Acellular dermal matrix graft has been a useful addition to minimize morbidity and recurrence in these high-risk patients.

Application of Small Intestinal Submucosa Graft for Repair of Complicated Vesicovaginal Fistula: A Pilot Study

Vesicovaginal fistula is a socially debilitating problem with important psychological and medicolegal implications. Complicated fistulas include large fistulas or those with failed prior repair attempts. The key to successful closure of such fistulas is the use of adjuncts such as a Martius, peritoneal or omental flap. Small intestinal submucosa is an acellular collagen matrix graft that is nonimmunogenic, biodegradable and ready to use off the shelf. We evaluated small intestinal submucosa as an interposition patch during complicated vesicovaginal fistula repair. A total of 23 women with a mean age of 33.5 years who had a complicated vesicovaginal fistula were enrolled in this clinical trial. Complicating factors were failed primary repair in 9 cases, excessive perifistulous scarring in 4 patients and a fistula 1.5 cm or greater in the remainder. Transvaginal repair was done in 7 low fistula cases and transabdominal repair was done in the remainder with a high fistula. A small intestinal submucosa patch was interposed in all cases at classic abdominal or vaginal repair. All patients were evaluated 1, 3 and 6 months postoperatively. All patients who underwent vaginal repair were dry during followup. Of the 16 women who underwent transabdominal repair 14 were dry. The overall success rate was 91.3%. No reported allergic or inflammatory reactions were documented. Using small intestinal submucosa as an interposition layer at anatomical vaginal and/or transabdominal repair of complicated vesicovaginal fistulas seems to be a simple, feasible solution.

Hybrid Matrix Grafts to Favor Tissue Regeneration in Rabbit Femur Bone Lesions

At present, typical approaches employed to repair fractures and other bone lesions tend to use matrix grafts to promote tissue regeneration. These grafts act as templates, which promote cellular adhesion, growth and proliferation, osteoconduction, and even osteoinduction, which commonly results in de novo osteogenesis. The present work aimed to study the bone-repairing ability of hybrid matrixes (HM) prepared with polyvinyl alcohol (PVA) and bioactive glass in an experimental rabbit model. The HM were prepared by combining 30% bioactive glass (nominal composition of 58% SiO2 -33 % CaO - 9% P2O5) and 70% PVA. New Zealand rabbits were randomly divided into the control group (C group) and two groups with bone lesions, in which one received a matrix implant HM (Implant group), while the other did not (no Implant group). Clinical monitoring showed no altered parameters from either the Implant or the no Implant groups as compared to the control group, for the variables of diet grades, day and night temperatures and hemograms. In the Implant group, radiologic and tomographic studies showed implanted areas with clean edges in femoral non-articular direction, and radio-dense images that suggest incipient integration. Minimum signs of phlogosis could be observed, whereas no signs of rejection at this imaging level could be identified. Histological analysis showed evidence of osteo-integration, with the formation of a trabecular bone within the implant. Together, these results show that implants of hybrid matrixes of bioactive glass are capable of promoting bone regeneration.

Original Technique for Penile Girth Augmentation Through Porcine Dermal Acellular Grafts: Results in a 69‐Patient Series

Although different techniques for augmentation phalloplasty have been reported in the medical literature, this issue is still highly controversial, and none of the proposed procedures has been unanimously approved. The aim of this study is to describe an innovative surgical technique for penile girth augmentation with porcine dermal acellular grafts, through a small transverse incision at the penile base, along the penopubic junction. Between 2000 and 2009, 104 patients were referred to our institution for penile enhancement. After a preoperative psychosexual consultation and a general medical assessment, 69 patients were deemed suitable good candidates for surgery. The average penis circumference was measured at the mid-length of the penis and was 8.1 cm (5.4-10.7 cm) and 10.8 cm (6.5-15.8 cm) during flaccidity and erection, respectively. All patients received penile augmentation with porcine dermal acellular grafts. Results evaluation of an innovative technique for penile girth augmentation through exogenous porcine grafts and small penobubic incision. Postoperative measurements were performed at 6 and 12 months. At the 1-year follow-up, the average penis circumference was 11.3 cm (8.2-13.2 cm, 3.1 cm mean increase) during flaccidity and 13.2 cm (8.8-14.5 cm, 2.4 cm mean increase) during erection. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. Sexual activity was resumed from 1 to 2 months after surgery. The psychosexual impact of the operation was beneficial in the majority of cases. Penile girth enlargement with acellular dermal matrix grafts has several advantages over augmentation with autogenous dermis-fat grafts: the elimination of donor site morbidity and a significantly shorter operation time. With this approach, through a short dorsal incision at the base of the penis, the scar is concealed in a crease covered by pubic hair and thus hardly visible.

A Randomized comparative clinical study of two surgical procedures to improve root coverage with the acellular dermal matrix graft

This randomized, controlled, clinical study compared two surgical techniques for root coverage with the acellular dermal matrix graft (ADMG) to evaluate which procedure could provide better root coverage and greater amounts of keratinized tissue. Fifteen pairs of bilateral Miller Class I or II gingival recessions were treated and assigned randomly to the test group, and the contra-lateral recessions were assigned to the control group. The ADMG was used in both groups. In the control group, the graft and flap were positioned at the level of the cemento-enamel junction (CEJ), and in the test group, the graft was positioned 1 mm apical to the CEJ and the flap 1 mm coronal to the CEJ. The clinical parameters were taken before the surgeries and after 6 months. The gingival recession area, a new parameter, was measured in standardized photographs through a special device and software. There were statistically significant differences favouring the proposed technique for all parameters except for the amount of keratinized tissue at 6 months. The proposed test technique is more suitable for root coverage procedures with ADMG, and the new parameter evaluated appears valuable for root coverage analysis. (Clinicaltrials.gov Identifier: NCT01175720).