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: Regeneration of tissues using cells, scaffolds and appropriate growth factors is a key approach in the treatments of tissue or organ failure. Silk protein can be effectively used as a scaffolding material in these treatments. Silk fibres are obtained from diverse sources such as spiders, silkworms, scorpions, mites and flies. Among them, silkworm silk is a good source for biomedical device development. It possesses good biocompatibility, very good mechanical properties, and is produced in bulk in the textile sector. The unique combination of elasticity and strength along with mammalian cell compatibility makes silk fibroin an attractive material for tissue engineering. The present article discusses the processing of silk fibroin into different forms of biomaterials and their uses in regeneration of a wide range of tissues. Applications of silk for engineering bone, vascular, neural, skin, cartilage, ligaments, tendons, cardiac, ocular, bladder and dental tissues have been discussed. The advantages and limitations of silk systems as scaffolding materials in the context of biocompatibility, biodegradability and tissue specific requirements are also covered.
    Advanced drug delivery reviews 11/2012; · 11.96 Impact Factor
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    ABSTRACT: Tympanic membrane (TM) perforations lead to significant hearing loss and result in possible infection of the middle ear. Myringoplasty is commonly performed to repair chronic perforations. Although various grafts and materials have been used to promote TM regeneration, all have associated limitations. The aim of this study was to evaluate the efficacy and feasibility of two graft materials, silk fibroin scaffold (SFS) and porcine derived acellular collagen type I/III scaffold (ACS), compared to two commonly used graft materials (paper patch and Gelfoam) for the promotion of TM regeneration. These scaffolds were implanted using on-lay myringoplasty in an acute TM perforation rat model. Surface morphology of the scaffolds was observed with scanning electron microscopy. The morphology of the TM was assessed at various time points post-implantation using otoscopy, light and electron microscopy, and functional outcomes by auditory brainstem responses. We found that SFS and ACS significantly accelerated the TM perforation closure, obtained optimal TM thickness, and resulted in better trilaminar morphology with well-organized collagen fibers and early restoration of hearing. However, paper patch and Gelfoam lost their scaffold function in the early stages and showed an inflammatory response, which may have contributed to delayed healing. This study indicates that compared to paper patch and Gelfoam, SFS and ACS are more effective in promoting an early TM regeneration and an improved hearing, suggesting that these scaffolds may be potential substitutes for clinical use.
    Tissue Engineering Part A 10/2012; · 4.64 Impact Factor
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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.
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Jan 24, 2013