Providing direction improves function: Comparison of a radial pore‐orientated acellular collagen scaffold to clinical alternatives in a surgically induced rabbit diaphragmatic tissue defect model

摘要

Abstract Gore‐Tex? is a widely used durable patch for repair of congenital diaphragmatic defects yet may result in complications. We compared Gore‐Tex with a composite of a radial pore‐orientated collagen scaffold (RP‐Composite) and clinically used porcine small intestinal submucosa (SIS; Surgisis?) in a rabbit model for diaphragmatic hernia. The growing rabbit mimics the rapid rib cage growth and reherniation rates seen in children. We created and immediately repaired left hemidiaphragmatic defects in 6‐week‐old rabbits with Gore‐Tex, SIS, and an RP‐Composite scaffold. An additional group of rabbits had a sham operation. At 90?days, survivors more than doubled in weight. We observed few reherniations or eventrations in Gore‐Tex (17%) and RP‐Composite (22%) implanted animals. However, SIS failed in all rabbits. Maximum transdiaphragmatic pressure was lower in Gore‐Tex (71%) than RP‐Composite implanted animals (112%) or sham (134%). Gore‐Tex repairs were less compliant than RP‐Composite, which behaved as sham diaphragm ( p ??0.01). RP‐Composite induced less foreign body giant cell reaction than Gore‐Tex ( p ??0.05) with more collagen deposition ( p ??0.001), although there was a tendency for the scaffold to calcify. Unlike Gore‐Tex, the compliance of diaphragms reconstructed with RP‐Composite scaffolds were comparable with native diaphragm, whereas reherniation rates and transdiaphragmatic pressure measurements were similar.