Grafts in myringoplasty: utilizing a silk fibroin scaffold as a novel device.

Ear Science Institute Australia, Ear Sciences Centre, School of Surgery, The University of Western Australia, Sir Charles Gairdner Hospital, Perth, WA, Australia.
Expert Review of Medical Devices (Impact Factor: 2.43). 11/2009; 6(6):653-64. DOI: 10.1586/erd.09.47
Source: PubMed

ABSTRACT Chronic perforations of the eardrum or tympanic membrane represent a significant source of morbidity worldwide. Myringoplasty is the operative repair of a perforated tympanic membrane and is a procedure commonly performed by otolaryngologists. Its purpose is to close the tympanic membrane, improve hearing and limit patient susceptibility to middle ear infections. The success rates of the different surgical techniques used to perform a myringoplasty, and the optimal graft materials to achieve complete closure and restore hearing, vary significantly in the literature. A number of autologous tissues, homografts and synthetic materials are described as graft options. With the advent and development of tissue engineering in the last decade, a number of biomaterials have been studied and attempts have been made to mimic biological functions with these materials. Fibroin, a core structural protein in silk from silkworms, has been widely studied with biomedical applications in mind. Several cell types, including keratinocytes, have grown on silk biomaterials, and scaffolds manufactured from silk have successfully been used in wound healing and for tissue engineering purposes. This review focuses on the current available grafts for myringoplasty and their limitations, and examines the biomechanical properties of silk, assessing the potential benefits of a silk fibroin scaffold as a novel device for use as a graft in myringoplasty surgery.

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    ABSTRACT: OBJECTIVES/HYPOTHESIS: To evaluate the efficacy of silk fibroin scaffolds (SFS) and acellular collagen scaffolds (ACS) for the repair of tympanic membrane (TM) in a guinea pig acute perforation model. STUDY DESIGN: Experimental animal research. METHODS: Seventy-two albino guinea pigs underwent perforation of the right TM and were divided into four experimental groups (n = 18). The perforations were repaired with SFS, ACS, and paper patch using onlay myringoplasty, or they were allowed to heal spontaneously (control). An additional group of 10 guinea pigs without perforation or scaffold was allocated as a normal TM group. Guinea pigs in each experimental group (n = 6) were evaluated at 7, 14, and 28 days following surgery. TM structural healing was evaluated by otomicroscopy and histology, and functional hearing was analyzed by auditory brainstem responses (ABR). Prior to the study, mechanical properties of SFS and ACS were investigated. RESULTS: Tensile strength and elasticity of SFS and ACS were within the known range for human TM. Based on otologic and histologic evaluation, TMs treated with SFS or ACS showed complete closure of the perforation at an earlier stage, with a trilaminar structure and more uniform thickness compared to paper patch and control treated groups. ABR assessment demonstrated that SFS or ACS treatment facilitated a faster restoration of hearing function compared to paper patch and control groups. CONCLUSION: The results of this study show that SFS and ACS are effective graft materials and may be utilized as alternatives to current grafts for TM repair. LEVEL OF EVIDENCE: N/A. Laryngoscope, 2012.
    The Laryngoscope 03/2013; · 2.03 Impact Factor
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    ABSTRACT: Silk contains a fibre forming protein, fibroin, which is biocompatible, particularly after removing the potentially immunogenic non-fibroin proteins. Silk can be engineered into a wide range of materials with diverse morphologies. Moreover, it is possible to regenerate fibroin with a desired amount of crystallinity, so that the biodegradation of silk materials can be controlled. These advantages have sparked new interest in the use of silk fibroin for biomedical applications, including tissue engineering scaffolds and carriers for sustained release of biologically active molecules. This article summarizes the current research related to the formation of silk materials with different morphologies, their biocompatibility, and examples of their biomedical applications. Recent work on the preparation of silk particles by mechanical milling and their applications in silk composite scaffolds is also discussed.
    Journal of Fiber Bioengineering and Informatics 03/2010;
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    ABSTRACT: Tissue engineering (TE) is a multidisciplinary field that aims at the in vitro engineering of tissues and organs by integrating science and technology of cells, materials and biochemical factors. Mimicking the natural extracellular matrix is one of the critical and challenging technological barriers, for which scaffold engineering has become a prime focus of research within the field of TE. Amongst the variety of materials tested, silk fibroin (SF) is increasingly being recognized as a promising material for scaffold fabrication. Ease of processing, excellent biocompatibility, remarkable mechanical properties and tailorable degradability of SF has been explored for fabrication of various articles such as films, porous matrices, hydrogels, nonwoven mats, etc., and has been investigated for use in various TE applications, including bone, tendon, ligament, cartilage, skin, liver, trachea, nerve, cornea, eardrum, dental, bladder, etc. The current review extensively covers the progress made in the SF-based in vitro engineering and regeneration of various human tissues and identifies opportunities for further development of this field.
    Advanced healthcare materials. 07/2012; 1(4):393-412.


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Jun 4, 2014