Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: Use of reconstructive tissue matrix

Czarnocki, I.; Ralls, M. W.; Brei, D.; Teitelbaum, D. H.; Herman, R.; Luntz, J.; Sueyoshi, R.; Utter, Brent

Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: Use of reconstructive tissue matrix

Abstract

Distraction-induced intestinal growth may be a novel treatment for short bowel syndrome. Longitudinal, distractive tension created by the application of force creates a significant challenge: to produce adequate force, yet not cause perforation at the fixation points. This paper describes our development of a coupling strategy to allow for successful bowel lengthening.

A curvilinear hydraulic device was implanted in an isolated Roux limb of small bowel in young Yorkshire pigs. Bowel was lengthened over a 2-week period. Study groups included: Group 1: Twelve silk transmural anchoring sutures into an engineered-coupling ring at the ends of each device. Group 2: Addition of felt pledgets to the coupling rings on the serosal surface of the small bowel. Group 3: Extraluminal use of either thin AlloDerm(A (R)), thick AlloDerm(A (R)), or Strattice (TM) mesh to anchor the device.

Group 1 (suture-only) resulted in a gradual pulling through the suture with increasing tension and no lengthening. Felt pledgets eroded in a similar fashion, causing abdominal sepsis. Thin AlloDerm(A (R)) failed to prevent erosion; however, it protected against gross contamination. Animals in which either thick AlloDerm(A (R)) or Strattice (TM) mesh was used survived complication free to the study endpoint. Both thick AlloDerm(A (R)) and Strattice (TM) prevented erosion and perforation allowing for an average of 10.85 cm expansion.

This study demonstrates the use of either thick AlloDerm(A (R)) or Strattice (TM) reconstructive tissue matrix which allows for safe and effective coupling. Further, we suggest this approach could be an adjunct to esophageal lengthening procedures.

Title	Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: Use of reconstructive tissue matrix
Creator	Czarnocki, I.
	Ralls, M. W.
	Brei, D.
	Teitelbaum, D. H.
	Herman, R.
	Luntz, J.
	Sueyoshi, R.
	Utter, Brent
Publisher	Pediatric Surgery International
Academic Department	Mechanical Engineering
Division	Engineering
Organization	Lafayette College
Date Issued	February 2013
Date Available	2020-01-28
Type	Article
Language	English
Keyword	mechanotransduction
	intestine
	distraction-induced growth
	reconstructive tissue matrix
	short bowel syndrome
Bibliographic Citation	Ralls, M. W. (2013 Feb) "Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: Use of reconstructive tissue matrix." Pediatric Surgery International 29 (2): 151-156.
Standard Identifier	DOI 10.1007/s00383-012-3198-z
Standard Identifier	Handle 10385/h415pb01c
Permalink	http://hdl.handle.net/10385/h415pb01c
Rights Statement	In Copyright
Rights Holders	Springer-Verlag