The antigenicity of fascia lata allografts

Multilevel Analysis of the Neovascularization and Integration Process of a Nonvascularized Rectus Fascia Transplantation

Background

Failure to close the abdominal wall after intestinal transplantation (ITx) or multivisceral Tx remains a surgical challenge. An attractive method is the use of nonvascularized rectus fascia (NVRF) in which both layers of the donor abdominal rectus fascia are used as an inlay patch without vascular anastomosis. How this graft integrates over time remains unknown. The study aims to provide a multilevel analysis of the neovascularization and integration process of the NVRF.

Methods

Three NVRF-Tx were performed after ITx. Clinical, radiological, histological, and immunological data were analyzed to get insights into the neovascularization and integration process of the NVRF. Moreover, cryogenic contrast-enhanced microfocus computed tomography (microCT) analysis was used for detailed reconstruction of the vasculature in and around the NVRF (3-dimensional histology).

Results

Two men (31- and 51-y-old) and 1 woman (49-y-old) underwent 2 multivisceral Tx and 1 combined liver-ITx, respectively. A CT scan showed contrast enhancement around the fascia graft at 5 days post-Tx. At 6 weeks, newly formed blood vessels were visualized around the graft with Doppler ultrasound. Biopsies at 2 weeks post-Tx revealed inflammation around the NVRF and early fibrosis. At 6 months, classical 2-dimensional histological analysis of a biopsy confirmed integration of the fascia graft with strong fibrotic reaction without signs of rejection. A cryogenic contrast-enhanced microCT scan of the same biopsy revealed the presence of microvasculature, enveloping and penetrating the donor fascia.

Conclusions

We showed clinical, histological, and microCT evidence of the neovascularization and integration process of the NVRF after Tx.

Long-Term Safety and Reliability of Using Tutoplast-Processed Fascia Lata to Refine the Nasal Dorsum in Primary and Revision Rhinoplasty

BACKGROUND

Tutoplast-processed fascia lata (TPFL) is an allograft substance employed alongside cartilaginous materials to achieve optimal augmentation in rhinoplasty. Alternatively, it can be utilized to conceal and smooth irregularities of the nasal dorsum during the procedure. Despite its application, there is limited available data on the extended safety of TPFL. Consequently, our objective was to assess the enduring long-term safety and reliability of TPFL in both primary and revision rhinoplasty.

METHODS

A retrospective cohort study was conducted on 300 patients who underwent primary and revision rhinoplasty with TPFL grafts. Baseline characteristics, types of surgical techniques, and surgical outcomes were evaluated. The surgical success and satisfaction rates were assessed as primary outcomes. The Statistical Package for Social Sciences (SPSS), version 27 for Windows, was used to conduct the statistical analysis.

RESULTS

TPFL was used in both primary and revision rhinoplasty, with septal cartilage being the most common conjunction graft material. The overall surgical success rate was 97.3%, with only 2.7% of patients experiencing complications. The satisfaction rate was 92.7%, with no significant difference between primary and revision cases. The highest satisfaction rate was found in patients who underwent the crushed cartilage in fascia technique (96.3%).

CONCLUSIONS

TPFL in conjunction with cartilaginous materials; is a safe and reliable option for dorsal augmentation and camouflage material in primary and revision rhinoplasty, with low complication and high patient satisfaction rates.

LEVEL OF EVIDENCE III

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Biocompatibility of allogenic canine fascia lata: In vitro evaluation and small case series

OBJECTIVE

To evaluate the biocompatibility of canine fascia lata (FL) in vitro and after FL allograft implantation in dogs with clinical disease.

STUDY DESIGN

In vitro experiment and small case series.

SAMPLE POPULATION

Six dogs treated with allogenic freeze-dried FL.

METHODS

Fibroblasts were cultured on disks of FL, polypropylene mesh (PM; negative control), and porcine small intestinal submucosa (SIS; positive control). Constructs were compared at 3, 7, and 14 days for water content, DNA amounts, scanning electron microscopy, and histology. Records of dogs treated with FL allografts with follow-up examination were reviewed for signalment, indication for surgery, surgical procedure, and outcomes. All owners were invited to complete a standardized questionnaire for long-term follow-up.

RESULTS

Water content was greater in FL and SIS than in PM (P = .03). Fascia lata constructs contained more DNA compared with PM constructs at days 7 and 14 (P < .05), whereas SIS constructs did not differ from FL or PM. Fibroblasts appeared spherical and distributed throughout FL constructs, whereas they appeared stellate and remained on the surface of SIS and PM. Fascia lata allografts were implanted in six dogs with surgical conditions. No incisional complications were noted. All dogs had good to excellent long-term outcomes, except one that experienced recurrence of a perineal hernia 2 years after repair.

CONCLUSION

In vitro, canine FL allowed attachment and proliferation of fibroblasts throughout layers of the graft. Canine allogenic FL was clinically well tolerated in this small population of dogs.

CLINICAL SIGNIFICANCE

Allogenic FL is biocompatible and can be considered an alternative to SIS for soft tissue augmentation in dogs.

The use of a biostatic fascia lata thigh allograft as a scaffold for autologous human culture of fibroblasts--An in vitro study

The method for covering gingival recession defects and augmenting keratinized gingiva involves the use of autogenuous connective tissue grafts obtained from palatal mucosa in combination with various techniques of flap repositioning or tunnel techniques. In the case of multiple gingival recession defects the amount of connective tissue available for grafting is insufficient. Therefore, the use of substitutes is necessary. The most widely used material in recent years has been the acellular dermal matrix allograft. The disadvantage of its application lies in the absence of cells and blood vessels, which increases incorporation time. Primary cultured human autologic fibroblasts are commonly used to optimize the healing process. The aim of this study was to examine the in vitro biocompatibility of human fascia lata allograft as a new scaffold for primary cultured human autologic fibroblasts. For that, a fibroblast culture obtained from a fragment of gingival tissue taken from the hard palate mucosa of a subject was used. After 14 days the colony cells were inoculated on a fragment of human fascia lata allograft. After a further 7 days of incubation the material was frozen, cut and prepared for histochemical examination. After two weeks of incubation, and 7 days after inoculation on a fragment of fascia lata allograft numerous accumulations of the cultured fibroblast were found that had a typical structure and produced collagen fibres. A human fascia lata allograft can be used as a scaffold for primary cultured human autologic fibroblasts. Further studies should confirm the clinical efficacy of this solution.

Histomorphological Changes of Tutoplast-Processed Fascia Lata Grafts in a Rabbit Rhinoplasty Model

Objectives

Tutoplast-processed fascia lata (TPFL) is a commercially available homograft that has been successfully used as graft tissue for rhinoplasty. The present study evaluates the histomorphological changes of TPFL in a rabbit rhinoplasty model.

Study Design

Prospective study using a rabbit model.

Setting

Animal laboratory of the Asan Medical Center.

Subjects and Methods

The study used 15 New Zealand White rabbits. Each rabbit was implanted with a TPFL (experimental group) and autologous fascia lata (control group) graft of equal size into the nasal dorsum. Rabbits were killed at 1, 3, and 6 months, and the grafts were removed and microscopically assessed for fibroblast proliferation, neovascularization, inflammation, and thickness.

Results

For TPFL grafts, the degree of inflammation significantly decreased between 1 and 3 months ( P = .041). The degree of fibroblast proliferation continually increased over time. There was a mild degree of neovascularization for the TPFL graft at 1 month. The degree of neovascularization increased between 3 and 6 months ( P = .041). For the degree of inflammation, fibroblast proliferation, and neovascularization, there was no significant difference between TPFL and autologous fascia lata at 6 months. Mean thickness analysis showed that there was no significant thickness reduction in both TPFL and autologous fascia lata grafts at 6 months.

Conclusion

The TPFL grafts showed negligible resorption rates and favorable tissue reactions in the rabbit rhinoplasty model.

Tutoplast-processed fascia lata for dorsal augmentation in rhinoplasty

OBJECTIVE

Tutoplast-processed fascia lata (TPFL) is a commercially available homograft, which has been successfully used as human graft tissue for physical support procedures. The present report evaluates the use of TPFL in rhinoplasty.

STUDY DESIGN AND SETTING

The study involved a retrospective analysis of rhinoplasty cases using TPFL. The study population consisted of 69 patients (52 male and 17 female) and a minimum follow-up of 12 months.

RESULTS

TPFL was used as a smoothening graft after correction of deviated and hump noses, as a major dorsal contouring graft for saddle or flat noses, and in secondary rhinoplasty following silicone implant complications. TPFL alone was used in 41 cases and in combination with other material in 28 cases. The only complication was major resorption in three cases, with two being secondary rhinoplasty patients.

CONCLUSION

TPFL alone or in combination with other materials can be used as a dorsal augmentation material in rhinoplasty. TPFL was particularly useful for correction of dorsal irregularities and in cases requiring a minimal amount of augmentation.

Biologic grafts and synthetic meshes in pelvic reconstructive surgery

Despite the lack of evidence, augmenting pelvic organ prolapse surgery with biologic graft or synthetic mesh is increasing. The objective of this review is to examine the available grafts and meshes and discuss the current data addressing the use of these implants in correction of apical, anterior, and posterior prolapse. Most of the studies are retrospective with few randomized controlled trials. There is level I evidence suggesting that repair of apical prolapse with abdominal sacral colpopexy using synthetic mesh results in improved outcomes. However, most of the data concerning graft or mesh incorporation in anterior or posterior repairs do not support augmentation with prosthesis.

Plaque incision and fascia lata grafting in the surgical management of Peyronie's disease

OBJECTIVE

To assess the outcome of using modified human fascia lata (Tutoplast, Mentor Corp, Santa Barbara, CA, USA) in the surgical management of Peyronie's disease (PD), as the penile deformity associated with PD can be corrected by plaque incision and saphenous vein grafting (Lue procedure).

PATIENTS AND METHODS

In all, 14 patients (mean age 51 years, range 34-59) with PD had their penile deformity corrected by plaque incision and Tutoplast grafting. Three patients had a previous unsuccessful Nesbit operation. The mean (range) penile deformity before surgery was 67.2 (20-90) degrees and the mean follow-up was 31 (17-37) months.

RESULTS

Using set criteria, 13 patients were satisfied (excellent or satisfactory) with the results of surgery. The penis was completely straight in 11 of 14 patients. One patient developed de novo erectile dysfunction after surgery. In 10 patients there was no penile shortening, whereas four reported penile shortening of >1 cm.

CONCLUSION

Fascia lata Tutoplast grafts provide a reliable and well tolerated biomaterial for penile reconstruction in PD. The outcome of using Tutoplast is similar to that from saphenous vein but without the morbidity associated with the donor site. However, there remains a significant risk of penile shortening and development of erectile dysfunction.

Classification and pathophysiology of skin grafts

Flaps and grafts are the 2 main surgical procedures to repair losses of skin tissue. A flap is a full-thickness portion of skin sectioned and isolated peripherally and in depth from the surrounding skin, except along one side, called the peduncle. A graft is a section of skin, of variable thickness and size, completely detached from its original site and moved to cover the zone to be repaired. According to their thickness, skin grafts are classified as split thickness (or partial) and full thickness. The former is further divided into thin, intermediate and thick. Split-thickness skin grafts usually take well, whereas a full-thickness graft only takes if it is relatively small. Grafts are also divided, on the basis of their origin, into the following: autografts, when the donor and recipient are the same individual; homografts, when the donor and recipient are different subjects belonging to the same species; hetero- or xenografts, when the donor and recipient belong to different species. Only autografts can take, whereas homo- and heterografts are rejected. Homo- and heterografts, however, can be useful in particular conditions, for example, extensive burns, because they temporarily ensure vital skin functions.

Time Dependent Variations in Biomechanical Properties of Cadaveric Fascia, Porcine Dermis, Porcine Small Intestine Submucosa, Polypropylene Mesh and Autologous Fascia in the Rabbit Model: Implications for Sling Surgery

PURPOSE

We investigated time dependent variations in tensile strength, stiffness, shrinkage and distortion in 6 materials commonly used for transvaginal anti-incontinence surgery.

MATERIALS AND METHODS

A total of 15 rabbits were randomized into 3 survival groups (2, 6 and 12 weeks, respectively). Each rabbit had human cadaveric fascia, porcine dermis, porcine small intestine submucosa, polypropylene mesh and autologous fascia implanted on the anterior rectus fascia. At harvest tensiometry and image analysis were performed on each sling. Results were compared to baseline for each sling type and the percent decrease from baseline was compared among sling types.

RESULTS

Each type of human cadaveric fascia and porcine allografts showed a marked decrease (60% to 89%) in tensile strength and stiffness from baseline. Polypropylene mesh and autologous fascia did not differ in tensile strength from baseline. Polypropylene mesh increased in stiffness from baseline. Autologous fascia and small intestinal submucosa demonstrated a 41% and 50% decrease in surface area, respectively, at 12 weeks.

CONCLUSIONS

To our knowledge the relative contribution of biomechanical properties of sling material to the success of anti-incontinence surgery is unknown. However, rapid loss of tensile strength and stiffness in porcine and cadaveric materials may contribute to the early re-emergence of symptoms following successful sling surgery. The results of this study add scientific validity to the increasing use of synthetics in anti-incontinence surgery. Urologists selecting a sling material should be aware of its time dependent biomechanical fate relative to other sling materials.

Use of cadaveric fascia lata for closure of bladder exstrophy with diplomyelia

We describe a technique for the repair of bladder exstrophy using cadaveric fascia lata. The graft is folded in a four-layer configuration, passed through the obturator foramina, and then wrapped and anchored in front of the pubis. The resultant ring-shaped graft is useful when complex deformities preclude proper apposition of the pelvis anteriorly.

Nonautologous sling materials

This article provides a comprehensive and updated review of the current nonautologous sling materials available for treatment of stress urinary incontinence. The various materials are described, relevant clinical studies are discussed, and newer materials are outlined. Complications arising from use of different materials also are described.