A ONE-STAGE VERSUS 2-STAGE SURGICAL TECHNIQUE - TISSUE REACTION TO A PERCUTANEOUS DEVICE PROVIDED WITH TITANIUM FIBER MESH APPLICABLE FOR PERITONEAL-DIALYSIS

A percutaneous device, provided with a sintered titanium fiber web str ucture, was designed for implantation in soft tissue. The percutaneous device was inserted by a two stage surgical technique. Between the in sertion of the subcutaneous and percutaneous part was an intervening h ealing period of 3 months. However, most clinicians prefer a one stage implant. Therefore, the authors wanted to investigate the soft tissue response to one stage and two stage percutaneous devices. The implant s were inserted in the flanks of 12 goat. In each goat, one one stage and one two stage implant were placed and inspected on a regular base. It appeared that, during the experiments, significantly more one stag e devices were extruded. Four months after the second surgical session , all successful implants with their surrounding tissues were retrieve d for light microscopic and histomorphometric analysis. No difference in epidermal downgrowth and sulcus width was demonstrated between the implants. Furthermore, the fiber mesh was surrounded by a thin fibrous capsule free from inflammatory cells. Inside the fiber mesh structure , connective tissue was present with only scattered foci of inflammato ry cells. An enhanced inflammatory tissue response was found inside th e titanium mesh of one stage compared to two stage implants. This stud y showed that the two stage surgical procedure for implantation of a p ercutaneous device worked better than the one-stage surgical technique .