Evaluation of a biodegradable polyurethane patch for repair of diaphragmatic hernia in a rat model: A pilot study.
Evaluation of a biodegradable polyurethane patch for repair of diaphragmatic hernia in a rat model: A pilot study.
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DOI：
10.1016/j.jpedsurg.2023.01.036
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发表时间：
2023-05
影响因子：
2.4
通讯作者：
Wang, Aijun
中科院分区：
文献类型：
--
作者：
Theodorou, Christina M.;Taylor, Alan;Lee, Su Yeon;Cortez, Lia Molina;Fu, Huikang;Pivetti, Christopher D.;Zhang, Chaoxing;Stasyuk, Anastasiya;Hao, Dake;Kumar, Priyadarsini;Farmer, Diana L.;Liao, Jun;Brown, Erin G.;Hong, Yi;Wang, Aijun
先天性腹股沟疝（CDH）修补术是一个活跃的研究领域。需要补片的大缺损疝复发率高达50%。我们设计了一种可生物降解的聚氨酯（PU）为基础的弹性贴片，符合天然膈肌的机械性能。我们将PU贴片与不可生物降解的Gore-Tex™（聚四氟乙烯）贴片进行了比较。以聚己内酯、己二异氰酸酯和腐胺为原料合成了可生物降解聚氨酯，并采用静电纺丝法将其加工成纤维状聚氨酯贴片。大鼠通过剖腹术产生4 mm疝（DH），然后立即用Gore-Tex™（n=6）或PU（n=6）补片修补。六只大鼠进行假剖腹术，没有DH创建/修复。在第1周和第4周通过透视评估膈肌功能。在4周时，对动物进行大体检查以确定复发情况，并对炎症反应进行组织学评价。两个队列均无疝复发。与假手术组相比，Gore-Tex™在4周时的膈肌升高有限（1.3mm vs 2.9mm，p=0.003），但PU组与假手术组之间无差异（1.7mm vs 2.9mm，p=0.09）。在任何时间点，PU和Gore-Tex™之间均无差异。两种补片均形成炎症囊，腹部（Gore-Tex™ 0.07 mm vs. PU 0.13 mm，p=0.39）和胸部（Gore-Tex™ 0.3 mm vs. PU 0.6 mm，p=0.09）侧的队列之间厚度相似。与Gore-Tex™相比，可生物降解的PU贴片允许更大的位移。两种贴剂的炎症反应相似。需要进一步的工作来评估长期的功能结果，并进一步优化体外和体内新型PU贴片的性能。
Congenital diaphragmatic hernia (CDH) repair is an area of active research. Large defects requiring patches have a hernia recurrence rate of up to 50%. We designed a biodegradable polyurethane (PU)-based elastic patch that matches the mechanical properties of native diaphragm muscle. We compared the PU patch to a non-biodegradable Gore-Tex™ (polytetrafluoroethylene) patch. The biodegradable polyurethane was synthesized from polycaprolactone, hexadiisocyanate and putrescine, and then processed into fibrous PU patches by electrospinning. Rats underwent 4mm diaphragmatic hernia (DH) creation via laparotomy followed by immediate repair with Gore-Tex™ (n=6) or PU (n=6) patches. Six rats underwent sham laparotomy without DH creation/repair. Diaphragm function was evaluated by fluoroscopy at 1 and 4 weeks. At 4 weeks, animals underwent gross inspection for recurrence and histologic evaluation for inflammatory reaction. There were no hernia recurrences in either cohort. Gore-Tex™ had limited diaphragm rise compared to sham at 4 weeks (1.3mm vs 2.9mm, p=0.003), but no difference was found between PU and sham (1.7mm vs 2.9mm, p=0.09). There were no differences between PU and Gore-Tex™ at any time point. Both patches formed an inflammatory capsule, with similar thicknesses between cohorts on the abdominal (Gore-Tex™ 0.07mm vs. PU 0.13mm, p=0.39) and thoracic (Gore-Tex™ 0.3 mm vs. PU 0.6 mm, p=0.09) sides. The biodegradable PU patch allowed for greater diaphragmatic excursion compared to Gore-Tex™. There were similar inflammatory responses to both patches. Further work is needed to evaluate long-term functional outcomes and further optimize the properties of the novel PU patch in vitro and in vivo.
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