Effect of Cross-Linked and Non-Cross-Linked Acellular Dermal Matrices on the Expression of Mediators Involved in Wound Healing and Matrix Remodeling
1Department of General Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA 2Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii, USA. Plastic and Reconstructive Surgery
(Impact Factor: 2.99).
12/2012; 131(4). DOI: 10.1097/PRS.0b013e3182818a3d
Molecular mechanisms that direct the extent of the foreign body reaction to implanted biological meshes and their subsequent incorporation are poorly understood. The purpose of this study was to compare the influence of non-cross-linked human dermis (AlloDerm) with that of cross-linked porcine dermis (Permacol) on the expression of genes critical for wound healing and tissue remodeling in a rat ventral hernia model.
Full-thickness abdominal wall defects were repaired with AlloDerm, Permacol, or suture repair with no mesh (n = 10 rats per group). Explants were harvested 90 days after repair and divided for histologic, immunohistochemical, and gene expression analyses. Real-time quantitative polymerase chain reaction arrays were used to profile the expression of 84 wound healing-associated genes at the tissue/mesh interface.
Both meshes induced the differential expression (≥ 3-fold change relative to suture repair, p ≤ 0.01) of extracellular matrix components, remodeling enzymes, and inflammatory cytokines. Genes most markedly up-regulated included matrix metalloproteinase-9 (Permacol, 66-fold; AlloDerm, 19-fold) and chemokine (C-C motif) ligand 12 (Permacol, 24-fold; AlloDerm, 71-fold). Immunohistochemistry using antibodies against matrix metalloproteinase-9 and chemokine (C-C motif) ligand 12 confirmed differential expression at the protein level (p < 0.001). Histologically, AlloDerm demonstrated overall better remodeling characteristics than Permacol.
Permacol elicits increased protease expression and reduced cellular and vascular infiltration compared with AlloDerm 90 days after implantation, indicative of delayed remodeling induced by cross-linking. Increased understanding of the host response to implanted materials ultimately will enable the development of improved meshes with enhanced wound healing properties and fewer graft-related complications.
Available from: Jianhua Li
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ABSTRACT: With nearly 30 years of progress, tissue engineering has shown promise in developing solutions for tissue repair and regeneration. Scaffolds, together with cells and growth factors, are key components of this development. Recently, an increasing number of studies have reported on the design and fabrication of scaffolding materials. In particular, inspired by the nature of bone, polymer/ceramic composite scaffolds have been studied extensively. The purpose of this paper is to review the recent progress of the naturally derived biopolymers and the methods applied to generate biomimetic biopolymer/calcium phosphate composites as well as their biomedical applications in bone tissue engineering.
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Acellular dermal matrices (ADM) have been used frequently in therapeutic and prophylactic breast procedures. To date there have been no reports on vascularisation of ADMs and formation of tissue around them as seen with modern non-invasive imaging techniques such as contrast-enhanced ultrasound (CEUS). In this case series, we used CEUS to investigate the features of ADM in relation to vascular ingrowth and scaffold for "new" tissue formation. This is a retrospective evaluation of patients who underwent successful skin- and nipple-sparing mastectomy (SSM, NSM) with immediate IBBR using ADM from May 31, 2010, through December 28, 2012. Over a 24-month period, 16 patients, with an average age of 44 years (range 27-70 years), were evaluated with CEUS. No contrast agent allergies or side effects were reported for the ultrasound examination. After contrast agent injection (1-18 months postoperatively), homogeneous normal enhancement in the ADM and peripheral region with physiological tissue formation was seen in all patients. In this small study, the most obvious contribution of CEUS is the in vivo evaluation of vascular ingrowth and tissue formation after IBBR with ADM after follow-up of 1-18 months postoperatively.
Level of evidence iii:
Retrospective cohort or comparative study; case-control study; or systematic review of these studies.
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ABSTRACT: Soft tissue augmentation using acellular dermal matrix has gained popularity to overcome the shortcomings of autogenous and alloplastic materials. Sometimes it needs multilayered stacking to obtain enough volume. In this study, we investigated the efficacy of multilayered implantation using acellular dermal matrix (MatriDerm(®)) for soft tissue augmentation. MatriDerm was implanted subdermally on each side of the dorsum of nude mice (n = 20), stacked two layers thick in the control group and three layers thick in the experimental group. Alterations of thickness, degree of angiogenesis, and collagen and elastin fiber syntheses were observed over 40 days. Three-layered implantation with MatriDerm maintained its volume similarly as in two-layered implantation, although the thickness decreased after 30 days in both groups. At the early stage of implantation, angiogenesis and collagen and elastin fiber syntheses occurred fluently on the central portion, which is the farthest away from the surface in contact with the host tissue. Collagen and elastin fibers became more concentrated over time, and the original structure of MatriDerm could not be maintained due to being replaced with newly formed collagen and elastin fibers 40 days after implantation. Multilayered implantation with MatriDerm is considered appropriate for tissue ingrowth and can be used as a substitute for soft tissue augmentation.
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