Providing direction improves function: Comparison of a radial pore-orientated acellular collagen scaffold to clinical alternatives in a surgically induced rabbit diaphragmatic tissue defect model

Abstract

Gore-Tex® is a widely used durable patch for repair of congenital diaphragmatic defects yet may result in complications. We compared Gore-Tex with a composite of a radial pore-orientated collagen scaffold (RP-Composite) and clinically used porcine small intestinal submucosa (SIS; Surgisis®) in a rabbit model for diaphragmatic hernia. The growing rabbit mimics the rapid rib cage growth and reherniation rates seen in children. We created and immediately repaired left hemidiaphragmatic defects in 6-week-old rabbits with Gore-Tex, SIS, and an RP-Composite scaffold. An additional group of rabbits had a sham operation. At 90 days, survivors more than doubled in weight. We observed few reherniations or eventrations in Gore-Tex (17%) and RP-Composite (22%) implanted animals. However, SIS failed in all rabbits. Maximum transdiaphragmatic pressure was lower in Gore-Tex (71%) than RP-Composite implanted animals (112%) or sham (134%). Gore-Tex repairs were less compliant than RP-Composite, which behaved as sham diaphragm (p < 0.01). RP-Composite induced less foreign body giant cell reaction than Gore-Tex (p < 0.05) with more collagen deposition (p < 0.001), although there was a tendency for the scaffold to calcify. Unlike Gore-Tex, the compliance of diaphragms reconstructed with RP-Composite scaffolds were comparable with native diaphragm, whereas reherniation rates and transdiaphragmatic pressure measurements were similar.

Promoting endogenous repair of skeletal muscle using regenerative biomaterials

“…A similar composite scaffold with porcine SIS and radially poreoriented collagen was used to treat diaphragm defects in rabbits. 154 While a SIS scaffold failed in all rabbits, the composite scaffold only failed in 22% of animals. Furthermore, the diaphragms treated with these composite scaffolds behaved similarly to uninjured diaphragms (in terms of transdiaphragmatic pressure and compliancy) compared to a widely used Gore-Tex ® patch.…”

“…Compared to a similar scaffold with randomly aligned pores, the radially pore orientated scaffold showed increased cell infiltration and increase blood vessel migration. A similar composite scaffold with porcine SIS and radially pore‐oriented collagen was used to treat diaphragm defects in rabbits 154 . While a SIS scaffold failed in all rabbits, the composite scaffold only failed in 22% of animals.…”

“…(a) Surfaces with a 2D anisotropic topography (e.g., waves, channels/grooves and posts) can be created using photolithography. 153 (b) Microporous scaffolds, with randomly distributed (left) or anisotropic (right) pores.. 150,154 (c) Non-aligned (left) or aligned (right) nanofibrous scaffolds can recapitulate size-scale of skeletal muscle extracellular matrix (ECM) components. 61 Text in boxes provide examples of biomaterials under investigation for skeletal muscle regeneration stretching plays a role in modulating MuSC activation, glucose uptake and immune cell recruitment.…”

Polydopamine Functionalization: A Smart and Efficient Way to Improve Host Responses to e-PTFE Implants

“…Gore and Associates, Flasgstaff, AZ) usually shorten in expanded polytetrafluoroethylene (e-PTFE). This biomaterial is used in more than 80% of diaphragmatic replacements (Eastwood et al, 2018). e-PTFE is an inert porous and resistant material that it is suitable for surgery.…”

“…More recently, Deprest et al compared a radial pore oriented acellular collagen scaffold to two clinical used surgical meshes (Gore-Tex and Surgisis) in a surgically induced rabbit diaphragmatic tissue defect model (Eastwood et al, 2018). They found no differences in terms of hernia recurrence but a compliance closer to that of the native diaphragm for their scaffold compared to Gore-Tex.…”