Evaluation of small intestine submucosa and acellular dermis as diaphragmatic prostheses

Background/Purpose: The repair of large congenital diaphragmatic defects in the neonate continues to be a challenge. Polytetrafluoroethylene (PTFE) is the synthetic material most widely used for reconstruction in instances of partial and complete diaphragmatic agenesis. Recurrent hernia is a frequen t complication, because this material does not grow with the infant. This s tudy evaluates two never materials; small intestine submucosa (SIS; Cook Bi otech, Lafayette, IN), and acellular dermis (AlloDerm; Lifecell Corp, The W oodland, TX) for diaphragm reconstruction in growing animals. Methods: Sprague-Dawley rats (100 g, n = 87) were anesthetized and underwen t laparotomy. The control group (n = 18) underwent a sham laparotomy with a left subcostal incision and closure. The other two groups underwent centra l excision of the left hemidiaphragm (50% loss) and reconstruction with eit her a SIS (n = 35) or AlloDerm (n = 19) patch sutured circumferentially wit h 6-0 prolene. Seventy-two animals survived the operation, and were killed at five separate time intervals (2 weeks, 1, 2, 3, and 4 months). Chest rad iographs were performed monthly and before death. Radiographs were reviewed in a blinded fashion by two observers as were the necropsies, and rib defo rmity was noted if present. Histological examination of the diaphragm patch was performed in each animal. Results: There was no evidence of rib deformity noted on gross examination at necropsy or on chest radiograph in either experimental group. At necrops y, all patches were intact without hernia, eventration, or contraction. His tology findings initially showed acute and chronic inflammatory changes in both patch materials that lessened at the 2-month time interval. Both prost hetic patches began to thin at 3 months and was most prominent in the SIS r ats. At 4 months, both SIS and AlloDerm remained viable without evidence of necrosis. Each patch showed evidence of fibroblastic incorporation and sma ll capillary ingrowth. These changes were more prominent in the AlloDerm gr oup. There was no evidence of skeletal muscle ingrowth. Conclusions: These data indicate SIS and AlloDerm may be useful materials f or prosthetic repair in instances of partial or total agenesis of the diaph ragm. Further investigation in a large animal model over a longer duration is indicated. J Pediatr Surg 34:167-171. Copyright (C) 1999 by W.B. Saunder s Company.