Currently one of the most widely used prosthetic materials in the repair of abdominal wall defects, is expanded polytetrafluoroethylene (ePTFE). It has been suggested that its behavior with respect to the reparative process may depend on its structure. The aim of the present study was to evaluate the effect of the structure of 3 ePTFE prostheses on the scarring process in an abdominal-wall-defect experimental model. The prostheses employed were the Soft Tissue Patch (STP) which is laminar in structure, Mycro Mesh (MM) which is multilaminar with perforations, and the Dual Mesh (DM) prosthesis which has one non-porous surface. Abdominal wall defects (7 x 5 cm) were created in 36 New Zealand rabbits and repaired using fragments of STP, MM and DM. Follow-up periods were 14, 30, 60 and 90 days post-implant. At these times prostheses were macroscopically examined for the presence of infection and/or rejection and the formation of adhesions to abdominal viscera. Specimens were also taken for microscopic analysis (optical and scanning electron) and for immunohistochemical analysis using the rabbit macrophage-specific monoclonal antibody RAM-11. Labelled macrophage counts were performed at each follow-up session. No cases of infection or rejection were found. Loose adhesions between prosthesis and underlying viscera were observed in 2 of the STP, 4 of the MM and 2 of the DM implants. STP and DM implants were progressively encapsulated by organized connective tissue on both peritoneal and subcutaneous surfaces. Cellular colonization was observed on both STP surfaces and on the porous surface of the DM although no more than a third of the biomaterial was penetrated by cells in either case. Colonization was very slight at prosthesis anchorage points. MM implants differed only in the formation of connective tissue bridges in perforated areas, and cellular infiltration in interlaminar spaces. Macrophage response was similar in the 3 prostheses with a reduction in RAM-11 labelled cells (p < 0.05) between 14 and 90 days post-implant. We concludea) the 3 types of PTFE prosthesis induced low incidence of adhesion formation between biomaterial and viscera; b) integration mechanism of the 3 prostheses were similar and culminated with the encapsulation of the PTFE by the neoformed tissue; c) the macrophage response induced by the 3 prostheses was similar to that of any reparative process in the absence of biomaterial.

译文

目前在腹壁缺损修复中应用最广泛的假体材料之一是膨体聚四氟乙烯 (ePTFE)。有人建议,其在修复过程中的行为可能取决于其结构。本研究的目的是在腹壁缺损实验模型中评估3种ePTFE假体的结构对瘢痕形成过程的影响。使用的假体是层状结构的软组织贴片 (STP),多层带穿孔的Mycro网 (MM) 和具有一个无孔表面的双网 (DM) 假体。在36只新西兰兔中产生腹壁缺损 (7 × 5厘米),并使用STP、MM和DM片段修复。随访时间分别为植入后14、30、60和90天。在这些时候,对假体进行了宏观检查,以检查是否存在感染和/或排斥以及与腹部内脏粘连的形成。还将标本用于显微镜分析 (光学和扫描电子) 以及使用兔巨噬细胞特异性单克隆抗体RAM-11进行免疫组织化学分析。在每个随访阶段进行标记的巨噬细胞计数。没有发现感染或排斥的病例。在2个STP,4个MM和2个DM植入物中观察到假体与下方内脏之间的松动粘连。STP和DM植入物逐渐被腹膜和皮下表面有组织的结缔组织包裹。尽管在任何一种情况下,细胞都不超过三分之一的生物材料被细胞穿透,但在STP表面和DM的多孔表面上均观察到细胞定植。假体锚固点的定植非常轻微。MM植入物的不同之处仅在于穿孔区域结缔组织桥的形成以及层间空间中的细胞浸润。3个假体中的巨噬细胞反应相似,植入后14至90天之间RAM-11标记的细胞减少 (p <0.05)。我们得出结论) 3种类型的聚四氟乙烯假体导致生物材料与内脏之间形成粘附的发生率较低; b) 3种假体的整合机制相似,并最终以新生组织对聚四氟乙烯的包封而告终; c) 在没有生物材料的情况下,由3个假体诱导的巨噬细胞反应与任何修复过程相似。

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