Porcine small intestine submucosa as a flexor tendon graft

An attractive strategy for tendon tissue engineering is the use of natural extracellular matrices as scaffold materials. One matrix that has been shown to promote healing and regeneration of neotissue in various applications is porcine-derived small intestinal submucosa. It was the objective of this study to investigate small intestinal submucosa for intrasynovial flexor tendon grafting in a canine model. We hypothesized that at 6 weeks small intestinal submucosa grafts would undergo host cell infiltration, neovascularization, and replacement by host neotendon. We also hypothesized that small intestinal submucosa grafts would be incorporated by the host without extensive adhesions to surrounding tissues and therefore maintain normal digit function. An intrasynovial tendon autograft was used as a gold standard. At 6 weeks the intrasynovial tendon autografts remained viable, contained normal numbers of cells along their length, and had minimal peritendinous adhesions. Four of six autografts had normal function as determined by rotation of the distal interphalangeal joint. Also at 6 weeks, the small intestinal submucosa grafts had host cell infiltration, neovascularization, and wavy, oriented tissue. However, ubiquitous adhesions together with impaired function in all cases suggest that small intestinal submucosa grafts in the configuration used are not suitable as full-length intrasynovial grafts in this tendon and animal model.     

Complications of porcine small intestine submucosa graft for Peyronie's disease

PURPOSE: We report outcomes and complications of the use of porcine small intestine submucosa for correcting penile curvature due to Peyronie's disease. MATERIALS AND METHODS: A retrospective study was performed in patients with severe penile curvature (greater than 60 degrees) requiring surgical correction for sexual function. Preoperatively all patients underwent evaluation, including history, physical and penile duplex ultrasound. Of these patients 19 underwent tunical grafting with 1-layer Surgisis small intestine submucosa. Postoperatively patients were evaluated with clinic visits and telephone interviews to assess results. RESULTS: A total of 19 patients 46 to 69 years old (mean age 54) were treated with tunical incision or excision and grafting with small intestine submucosa between March 2002 and July 2005. Average followup was 15 months (range 3 to 43). Patients reported less penile pain with intercourse after surgery. There was no difference in Sexual Health Inventory for Men scores. Preoperatively 12 men (63%) had erectile dysfunction, defined as Sexual Health Inventory for Men less than 21, while 10 (53%) reported postoperative erectile dysfunction. Seven of the 19 patients (37%) had recurrent penile curvature (greater than 10 degrees) and 5 (26%) had recurrent Peyronie's disease plaque. Our complication rate was 37%, including hematoma at the graft site in 5 cases (26%), graft infection in 1 (5%) and Peyronie's disease recurrence requiring plication in 1 (5%). CONCLUSIONS: Small intestine submucosa carries potential for grafting applications because it is easy to use and readily available. Our experience resulted in a 37% complication rate, which exceeds those previously reported with saphenous vein graft repair.     

Reinforcement of saphenous vein graft with ePTFE graft for axillocoronary bypass grafting

Arteriosclerosis in the ascending aorta is widely accepted as a strong risk factor for the occurrence of stroke after coronary artery bypass grafting (CABG). The aortic no-touch technique, with a variety of modifications, has been used to reduce the risk of post-CABG stroke. Saphenous vein grafts (SVGs) have been used for axillocoronary bypass grafting, a modification of the aortic no-touch technique. However, kinking or compression often occurs with SVGs. We report here the successful application of an 8-mm expanded polytetrafluoroethylene graft, of the external bead support type, that was used to cover an SVG during axillocoronary bypass grafting.     

Small intestine adenocarcinoma. Cause of mechanic obstruction through slide of intestine into the small intestine (clinical case)

It's present the case of a patient from nineteen years with acute abdominal pain with debut in the day of presentation. Biological investigations is negative, with exception VSH = 40 mm/h. The gynecological examination raise the doubt of a strangled and floating ovary balloon. It's operate in emergency--it's about a mechanic obstacle from the small intestine (adenocarcinoma) with slide the small intestine into the small intestine with three cylinders. Reduction the small intestine slide-segmental enterectomy. Recovery. The mechanic obstacle from the small intestine with slide the small intestine into the small intestine through a cancer, to young patients, is a rare disease. The small intestine adenocarcinoma is meeting particularly at grown-up and old patients (3-4% from the digestive cancers) (2). The case in face is alone in personal statistics.     

Evaluation of porcine-derived small intestine submucosa as a biodegradable graft for gastrointestinal healing

High-risk anastomoses in the gut may benefit from the application of a synthetic reinforcement to pre vent an enteric leak. Recently a porcine-derived small intestine submucosa (SIS) was tested as a bioscaffold in a number of organ systems. The aim of this study was to evaluate the effectiveness of SIS in stimulating healing in the stomach. Twelve rats underwent surgical removal of a full-thickness gastric defect (1 cm) and subsequent repair with a double-layer patch of porcine-derived SIS. The graft was secured with interrupted sutures placed within 1 mm of the edge of the graft. After 21 days, the animals were killed and their stomachs harvested for histologic examination. Cross sections were processed for paraffin embedding and 4-micron sections were stained with hematoxylin and eosin. All animals survived, gained weight, and demonstrated no signs of peritonitis over the 3-week postoperative period. On postmortem examination, the defect was completely closed in all animals by granulation tissue and early fibrosis. Although most of the luminal surface of the grafted areas remained ulcerated, early regeneration of normal gastric mucosa was seen at the periphery of the defect. SIS may act as an effective scaffolding agent for intestinal mucosa and may offer protection in high-risk anastomoses. Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California, May 19–22, 2002 (poster presentation).     

Segmental small intestine transplantation in dogs: comparison between a jejunal graft and an ileal graft]

The aim of this study was to compare segmental grafts of jejunum and ileum in a dog model. 14 segmental grafts, 8 ileal (Il. A) and 6 jejunal (Jej. A.), were successfully allografted as 120 cm-Thiry-Vella segments. Immunosuppressive therapy consisted of cyclosporin 25 mg/kg/day per os. Monitoring was performed by histology and absorption (maltose and xylose) studies as well as analysis of brush border enzymes. No cases of Graft-versus-host disease were observed. Six allografts (42.5 per cent) including 3 Jej. A. (50 per cent) and 3 Il. A. (37.5 per cent) were rejected during the first three months. Eight allografts (5 Il. A. and 3 Jej. A.) were tolerated for up to 3 months and were removed: 2 Il. A. and 2 Jej. A. were normal, while 2 Il. A. and one Jej. A presented with signs of chronic rejection and one Il. A. with advanced rejection. Jej. A. and Il. A. showed a similar course, by means of immunologic reactions as well as functional characteristics. It is concluded that there is no major difference between Jej. A. and Il. A. in the dog. Because of the specialized absorptive functions of the ileum and its adaptative properties, ileal segmental grafts should be preferred to jejunal grafts for the treatment of short-gut syndrome.     

Surgical treatment for dissecting aneurysm of the aorta using a double ringed graft

Since 1978 we have been using a new double ringed graft for the treatment for dissecting aneurysm of the aorta. This prosthesis is a segment of a woven Dacron graft with two stainless steel rings, fixed and sutured in place, 10 or 12 mm apart, at each end of the graft. The operative procedure is as follows: the graft is tied into the true lumen of the dissected aorta; tape is ligated around the aorta and fixed between the two rings; and suturing of the aortic layers is done over the inserted graft. This technique has been applied in 11 cases of dissecting aneurysm. Eight patients survived, and 3 died soon after surgery due to complications. The safety of this method was ascertained by experimental and pathohistological studies.