Acellular porcine intestinal submucosa as fascial graft in an animal model: Applications for revision tympanoplasty

Abstract

Fascia regeneration may be possible with use of an acellular porcine intestinal submucosa graft in an animal model. Future studies may prove beneficial in restoring fascia in humans. Implications for potential advantages in tympanoplasty are discussed.

Investigation of Novel Grafts in Use for Pediatric Tympanoplasty

“…Further advantages of non-autogenous grafts include their suitability for minimally invasive endoscopic techniques, as well as a reduction in overall operative time, superior coverage for large perforations, and a theoretically reduced risk of infection transmission due to latent viruses or prior disease. 8,9,13,15,16…”

“…8 Furthermore, harvest of autologous graft does not always leave sufficient high-quality tissue for revisional and second-look surgeries. 9 More recently, autograft alternatives have been increasingly employed in pediatric tympanoplasty, [8][9][10][11][12][13][14] including porcine submucosal collagen graft (Biodesign; Cook Medical Inc., Bloomington, Indiana, USA) and allograft pericardium (Tutoplast; ENTrigue™ Biologics, San Antonio, Texas). Non-autogenous grafts obviate the need for an external incision to harvest graft material, resulting in a significant potential reduction in donor site morbidity.…”

“…Further advantages of non-autogenous grafts include their suitability for minimally invasive endoscopic techniques, as well as a reduction in overall operative time, superior coverage for large perforations, and a theoretically reduced risk of infection transmission due to latent viruses or prior disease. 8,9,13,15,16 Currently, few studies exist on the outcomes of these graft alternatives, and most of these are proof-of-concept studies which do not compare outcomes of non-autogenous grafts to autografts. Significant gaps remain in the literature regarding the effectiveness of both allografts and xenografts in the pediatric population and implications for the hospital system.…”

Tissue Engineering of the Tympanic Membrane

“…43 Other decellularized examples include porcine small intestine submucosa (Surgisis Ò ), porcine urinary bladder matrix (UBM), dura mater, and bovine pericardium (Tutopatch Ò ). 44,45 Surgisis, an acellular porcine small intestine submucosa composed of collagen (mainly Type 1), fibronectin, and glycosaminoglycans, 46 has been found to produce a trilaminar TM. However, inflammation and residual scaffold remnants remain a problem.…”

“…47 Nevertheless, Surgisis has successfully achieved fascia regeneration between the graft and muscle, raising the possibility of repeat harvest of neofascia in revision cases. 46 The UBM scaffold consists of a mucosa and lamina propria after a decellularization process, providing an intact basement membrane scaffold for epithelial migration. UBM patches readily integrated into the tissue and were completely degraded, leading to a healed trilaminar TM with a dense connective tissue layer.…”