1
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Fischer NG, Aparicio C. Junctional epithelium and hemidesmosomes: Tape and rivets for solving the "percutaneous device dilemma" in dental and other permanent implants. Bioact Mater 2022; 18:178-198. [PMID: 35387164 PMCID: PMC8961425 DOI: 10.1016/j.bioactmat.2022.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/14/2022] [Accepted: 03/12/2022] [Indexed: 02/06/2023] Open
Abstract
The percutaneous device dilemma describes etiological factors, centered around the disrupted epithelial tissue surrounding non-remodelable devices, that contribute to rampant percutaneous device infection. Natural percutaneous organs, in particular their extracellular matrix mediating the "device"/epithelium interface, serve as exquisite examples to inspire longer lasting long-term percutaneous device design. For example, the tooth's imperviousness to infection is mediated by the epithelium directly surrounding it, the junctional epithelium (JE). The hallmark feature of JE is formation of hemidesmosomes, cell/matrix adhesive structures that attach surrounding oral gingiva to the tooth's enamel through a basement membrane. Here, the authors survey the multifaceted functions of the JE, emphasizing the role of the matrix, with a particular focus on hemidesmosomes and their five main components. The authors highlight the known (and unknown) effects dental implant - as a model percutaneous device - placement has on JE regeneration and synthesize this information for application to other percutaneous devices. The authors conclude with a summary of bioengineering strategies aimed at solving the percutaneous device dilemma and invigorating greater collaboration between clinicians, bioengineers, and matrix biologists.
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Affiliation(s)
- Nicholas G. Fischer
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
| | - Conrado Aparicio
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
- Division of Basic Research, Faculty of Odontology, UIC Barcelona – Universitat Internacional de Catalunya, C/. Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), C/. Baldiri Reixac 10-12, 08028, Barcelona, Spain
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2
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Sartori M, Borsari V, Maglio M, Brogini S, Bragonzoni L, Zaffagnini S, Fini M. Skin adhesion to the percutaneous component of direct bone anchored systems: systematic review on preclinical approaches and biomaterials. Biomater Sci 2021; 9:7008-7023. [PMID: 34549759 DOI: 10.1039/d1bm00707f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Nowadays, direct bone anchored systems are an increasingly adopted approach in the therapeutic landscape for amputee patients. However, the percutaneous nature of these devices poses a major challenge to obtain a stable and lasting proper adhesion between the implant surface and the skin. A systematic review was carried out in three databases (PubMed, Scopus, Web of Science) to provide an overview of the innovative strategies tested with preclinical models (in vitro and in vivo) in the last ten years to improve the skin adhesion of direct bone anchored systems. Fifty five articles were selected after screening, also employing PECO question and inclusion criteria. A modified Cochrane RoB 2.0 tool for the in vitro studies and the SYRCLE tool for in in vivo studies were used to assess the risk of bias. The evidence collected suggests that the implementation of porous percutaneous structures could be one of the most favorable approach to improve proper skin adhesion, especially in association with bioactive coatings, as hydroxyapatite, and exploiting the field of nanostructure. Some issues still remain open as (a) the identification and characterization of the best material/coating association able to limit the shear stresses at the interface and (b) the role of keratinocyte turnover on the skin/biomaterial adhesion and integration processes.
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Affiliation(s)
- Maria Sartori
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Veronica Borsari
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Melania Maglio
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Silvia Brogini
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Laura Bragonzoni
- University of Bologna - Department for Life Quality Studies, Bologna, Italy
| | - Stefano Zaffagnini
- IRCCS - Istituto Ortopedico Rizzoli, II Orthopaedic and Traumatologic Clinic, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Milena Fini
- IRCCS - Istituto Ortopedico Rizzoli, Complex Structure of Surgical Sciences and Technologies, Via di Barbiano 1/10, 40136, Bologna, Italy.
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3
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Shevtsov M, Gavrilov D, Yudintceva N, Zemtsova E, Arbenin A, Smirnov V, Voronkina I, Adamova P, Blinova M, Mikhailova N, Galibin O, Akkaoui M, Pitkin M. Protecting the skin-implant interface with transcutaneous silver-coated skin-and-bone-integrated pylon in pig and rabbit dorsum models. J Biomed Mater Res B Appl Biomater 2020; 109:584-595. [PMID: 32935912 DOI: 10.1002/jbm.b.34725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/20/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
Implant-associated soft tissue infections at the skin-implant interface represent the most frequent complications in reconstructive surgery and lead to implant failures and revisions. Titanium implants with deep porosity, called skin-and-bone-integrated-pylons (SBIP), allow for skin ingrowth in the morphologically natural direction, thus restoring a reliable dermal barrier and reducing the risk of infection. Silver coating of the SBIP implant surface using physical vapor deposition technique offers the possibility of preventing biofilm formation and exerting a direct antimicrobial effect during the wound healing phase. In vivo studies employing pig and rabbit dorsum models for assessment of skin ingrowth into the pores of the pylon demonstrated the safety of transcutaneous implantation of the SBIP system. No postoperative complications were reported at the end of the follow-up period of 6 months. Histological analysis proved skin ingrowth in the minipig model without signs of silver toxicity. Analysis of silver release (using energy dispersive X-ray spectroscopy) in the model of intramedullary-inserted silver-coated SBIP in New Zealand rabbits demonstrated trace amounts of silver after 3 months of in-bone implantation. In conclusion, selected temporary silver coating of the SBIP implant surface is powerful at preventing the periprosthetic infections without imparing skin ingrowth and can be considered for clinical application.
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Affiliation(s)
- Maxim Shevtsov
- Department of Radiation Immuno-Oncology, Center for Translational Cancer Research Technische Universität München (TranslaTUM), Klinikum Rechts der Isar, Munich, Germany.,Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia.,Department of Biotechnology, First Pavlov State Medical University of St.Petersburg, St. Petersburg, Russia.,Department of Pediatric Neurosurgery, Almazov National Medical Research Centre, Russian Polenov Neurosurgical Institute, St. Petersburg, Russia.,Laboratory of Biomedical Cell Technologies, Far Eastern Federal University, Vladivostok, Russia
| | - Dmitriy Gavrilov
- Federal State Budgetary Institution "Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht" of the Ministry of Labour and Social Protection of the Russian Federation, St. Petersburg, Russia
| | - Natalia Yudintceva
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Elena Zemtsova
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | - Andrei Arbenin
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | - Vladimir Smirnov
- Department of Solid State Chemistry, Saint Petersburg State University, St. Petersburg, Russia
| | | | - Polina Adamova
- Institute of Experimental Medicine, St. Petersburg, Russia
| | - Miralda Blinova
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Nataliya Mikhailova
- Center of Cell Technologies, Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Oleg Galibin
- Department of Biotechnology, First Pavlov State Medical University of St.Petersburg, St. Petersburg, Russia
| | | | - Mark Pitkin
- Tufts University, Boston, Massachusetts, USA.,Poly-Orth International, Sharon, Massachusetts, USA
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4
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Pawar DRL, Jeyapalina S, Bachus KN. Evaluation of soft-tissue response around laser microgrooved titanium percutaneous devices. J Biomed Mater Res B Appl Biomater 2020; 108:2031-2040. [PMID: 31889421 DOI: 10.1002/jbm.b.34543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/25/2019] [Accepted: 12/08/2019] [Indexed: 01/27/2023]
Abstract
Percutaneous devices are prone to epidermal downgrowth and sinus tract formation, which can serve as a nidus for bacterial colonization and increase the risk of peri-prosthetic infection. A laser microgrooved topography has been shown to limit gingival epidermal downgrowth around dental implants. However, the efficacy of this laser microgrooved topography to limit epidermal downgrowth around nongingival percutaneous devices is yet to be investigated. In this study, devices with a porous-coated subdermal component and a percutaneous post were designed and manufactured. The proximal 2 mm section of the percutaneous post were left smooth, or were textured with either a porous coating, or with the laser microgrooved topography. The smooth and porous topographies served as controls. The devices were tested in a hairless guinea pig back model, where 18 animals were randomly assigned into three groups, with each group receiving one implant type (n = 6/group). Four weeks postimplantation, the devices with surrounding soft-tissues were harvested and processed for histological analyses. Results indicated that the laser microgrooved topography failed to prevent epidermal downgrowth (23 ± 4%) around percutaneous posts in this model. Furthermore, no significant differences (p = 0.70) in epidermal downgrowth were present between the three topographies, with all the groups exhibiting similar measures of downgrowth. Overall, these findings suggest that the laser microgrooved topography may not halt downgrowth around percutaneous devices for dermal applications.
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Affiliation(s)
- Divya R L Pawar
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center & University of Utah Orthopaedic Center, Salt Lake City, Utah.,Department of Bioengineering, University of Utah, Salt Lake City, Utah
| | - Sujee Jeyapalina
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center & University of Utah Orthopaedic Center, Salt Lake City, Utah.,Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kent N Bachus
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center & University of Utah Orthopaedic Center, Salt Lake City, Utah.,Department of Bioengineering, University of Utah, Salt Lake City, Utah
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5
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Trent A, Van Dyke ME. Development and characterization of a biomimetic coating for percutaneous devices. Colloids Surf B Biointerfaces 2019; 182:110351. [DOI: 10.1016/j.colsurfb.2019.110351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/19/2019] [Accepted: 07/06/2019] [Indexed: 02/05/2023]
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6
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Jeyapalina S, Mitchell SJ, Agarwal J, Bachus KN. Biomimetic coatings and negative pressure wound therapy independently limit epithelial downgrowth around percutaneous devices. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:71. [PMID: 31183809 DOI: 10.1007/s10856-019-6272-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/25/2019] [Indexed: 06/09/2023]
Abstract
Biomimetic material coatings and negative pressure wound therapy (NPWT) have been shown independently to limit the epithelial downgrowth rates in percutaneous devices. It was therefore hypothesized that these techniques, in combination, could further limit the clinically observed epithelial downgrowth around these devices. In this study, we evaluated the efficacy of two biomimetic coatings, collagen and hydroxyapatite (HA), to prevent downgrowth when used with continuous NPWT. Using an established single-stage surgical protocol, collagen (n = 10) and HA (n = 10) coated devices were implanted subdermally on the back of hairless guinea pigs. Five animals from each group were subjected to continuous ~90 mmHg NPWT. Four weeks post-implantation, animals were sacrificed, and the devices and surrounding tissues were harvested, processed, and downgrowth was computed and compared to historical porous titanium coated controls. Data showed a significant reduction in downgrowth in NPWT treated animals (p ≤ 0.05) when compared to the untreated porous titanium controls. HA coated devices, without the NPWT treatment, also showed significantly decreased downgrowth compared to the untreated porous titanium controls.
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Affiliation(s)
- Sujee Jeyapalina
- Department of Veterans Affairs Medical Center, Orthopaedic Research Laboratory, Salt Lake City, UT, 84148, USA.
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA.
| | - Saranne J Mitchell
- Department of Veterans Affairs Medical Center, Orthopaedic Research Laboratory, Salt Lake City, UT, 84148, USA
- Orthopaedic Research Laboratory, University of Utah Orthopaedic Center, Salt Lake City, UT, 84108, USA
- Department of Bioengineering, University of Utah Salt Lake City, Salt Lake City, UT, 84112, USA
| | - Jayant Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Kent N Bachus
- Department of Veterans Affairs Medical Center, Orthopaedic Research Laboratory, Salt Lake City, UT, 84148, USA.
- Orthopaedic Research Laboratory, University of Utah Orthopaedic Center, Salt Lake City, UT, 84108, USA.
- Department of Bioengineering, University of Utah Salt Lake City, Salt Lake City, UT, 84112, USA.
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7
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Jeyapalina S, Colombo JS, Beck JP, Agarwal JP, Schmidt LA, Bachus KN. Epidermal growth factor receptor genes are overexpressed within the periprosthetic soft-tissue around percutaneous devices: A pilot study. J Biomed Mater Res B Appl Biomater 2019; 108:527-537. [PMID: 31074946 DOI: 10.1002/jbm.b.34409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/20/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022]
Abstract
Epidermal downgrowth around percutaneous devices produce sinus tracts, which then accumulate bacteria becoming foci of infection. This mode to failure is epidermal-centric, and is accelerated by changes in the chemokines and cytokines of the underlying periprosthetic granulation tissue (GT). In order to more fully comprehend the mechanism of downgrowth, in this 28-day study, percutaneous devices were placed in 10 Zucker diabetic fatty rats; 5 animals were induced with diabetes mellitus II (DM II) prior to the surgery and 5 animals served as a healthy, nondiabetic cohort. At necropsy, periprosthetic tissues were harvested, and underwent histological and polymerase chain reaction (PCR) studies. After isolating GTs from the surrounding tissue and extracting ribonucleic acids, PCR array and quantitative-PCR (qPCR) analyses were carried-out. The PCR array for 84 key wound-healing associated genes showed a five-fold or greater change in 31 genes in the GTs of healthy animals compared to uninjured healthy typical skin tissues. Eighteen genes were overexpressed and these included epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR). Thirteen genes were underexpressed. When GTs of DM II animals were compared to healthy animals, there were 8 genes overexpressed and 25 genes underexpressed; under expressed genes included EGF and EGFR. The qPCR and immunohistochemistry data further validated these observations. Pathway analysis of genes up-regulated 15-fold or more indicated two, EGFR and interleukin-10, centric clustering effects. It was concluded that EGFR could be a key player in exacerbating the epidermal downgrowth, and might be an effective target for preventing downgrowth.
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Affiliation(s)
- Sujee Jeyapalina
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - John S Colombo
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,The School of Dentistry, University of Utah School of Medicine, Salt Lake City, Utah
| | - James P Beck
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Orthopaedic Research Laboratories, University of Utah Orthopaedic Center, Salt Lake City, Utah
| | - Jayant P Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Linda A Schmidt
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Kent N Bachus
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Orthopaedic Research Laboratories, University of Utah Orthopaedic Center, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
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8
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Pawar DRL, Jeyapalina S, Hafer K, Bachus KN. Influence of negative pressure wound therapy on peri-prosthetic tissue vascularization and inflammation around porous titanium percutaneous devices. J Biomed Mater Res B Appl Biomater 2019; 107:2091-2101. [PMID: 30629801 DOI: 10.1002/jbm.b.34302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/20/2018] [Accepted: 12/01/2018] [Indexed: 01/11/2023]
Abstract
Negative Pressure Wound Therapy (NPWT) has been shown to limit downgrowth around percutaneous devices in a guinea pig model. However, the influence of NPWT on peri-prosthetic tissue characteristics leading to limited downgrowth is still unclear. In order to investigate this, 12 CD hairless rats were assigned into two groups, NPWT and Untreated (n = 6/group). Each animal was implanted with a porous coated titanium percutaneous device and was dressed with a gauze and semi-occlusive base dressing. Post-surgery, animals in the NPWT Group received a regimen of NPWT treatment (-70 to -90 mmHg). After 4 weeks, tissue was collected over the device and stained with CD31 and CD68 to quantify blood vessel density and inflammation, respectively. The device with the surrounding tissue was also collected to quantify downgrowth. NPWT treatment led to a 1.6-fold increase in blood vessel densities compared to untreated tissues (p < 0.05). NPWT treatment also resulted in half the downgrowth as the Untreated Group, although not statistically significant (p = 0.19). Additionally, the results showed a trend toward increased CD68 cell densities in the NPWT Group compared to the Untreated Group (p = 0.09). These findings suggest that NPWT may influence wound healing responses in percutaneous devices by increasing blood vessel densities, limiting downgrowth and potentially increasing inflammation. Overall, NPWT may enhance tissue vascularity around percutaneous devices, especially in patients with impaired wound healing. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2091-2101, 2019.
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Affiliation(s)
- Divya R L Pawar
- Orthopaedic Research Laboratories, George E. Wahlen Department of Veterans Affairs Medical Center, and University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
| | - Sujee Jeyapalina
- Orthopaedic Research Laboratories, George E. Wahlen Department of Veterans Affairs Medical Center, and University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, 84132
| | - Kelli Hafer
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
| | - Kent N Bachus
- Orthopaedic Research Laboratories, George E. Wahlen Department of Veterans Affairs Medical Center, and University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
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9
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Pawar DRL, Mitchell SJ, Jeyapalina S, Hawkes JE, Florell SR, Bachus KN. Peri-prosthetic tissue reaction to discontinuation of negative pressure wound therapy around porous titanium percutaneous devices. J Biomed Mater Res B Appl Biomater 2018; 107:564-572. [PMID: 29732684 DOI: 10.1002/jbm.b.34148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023]
Abstract
Negative pressure wound therapy (NPWT) has been reported to limit epithelial downgrowth, one of the failure mechanisms of percutaneous devices. In a previous study, when NPWT was applied for 4 weeks (NPWT Group) to porous coated titanium percutaneous devices, downgrowth (5 ± 4%; mean ± one SD) was significantly reduced compared to untreated controls (Untreated Group) (16 ± 6%; p ≤ 0.01). However, it was unclear whether this beneficial effect was sustained when NPWT was discontinued. In order to test this, porous coated titanium percutaneous devices were implanted into 6 hairless guinea pigs. Post-surgery, animals received 4 weeks of NPWT treatment followed by 4 weeks of no treatment (Discontinued Group). At necropsy, the devices and surrounding tissues were harvested and processed. Quantitative downgrowth measurements and qualitative analyses of tissue characteristics were performed, and compared to historical controls (NPWT and Untreated Groups). The Discontinued Group, at 8 weeks, had significantly more downgrowth than the NPWT Group at 4 weeks (23 ± 3% vs. 5 ± 4%; p ≤ 0.01). At 8 weeks, the Discontinued Group qualitatively appeared to exhibit reduced numbers of blood vessels and increased degree of fibrosis compared to the NPWT Group at 4 weeks. This study suggests that NPWT will only be an effective treatment for limiting downgrowth if used continuously. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 564-572, 2019.
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Affiliation(s)
- Divya R L Pawar
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center, University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
| | - Saranne J Mitchell
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
| | - Sujee Jeyapalina
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center, University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, 84132
| | - Jason E Hawkes
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah, 84132
| | - Scott R Florell
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah, 84132
| | - Kent N Bachus
- Orthopaedic Research Laboratories, George E. Wahlen, Department of Veterans Affairs Medical Center, University of Utah Orthopaedic Center, Salt Lake City, Utah, 84148.,Department of Bioengineering, University of Utah, Salt Lake City, Utah, 84112
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10
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Jeyapalina S, Beck JP, Agarwal J, Bachus KN. A 24-month evaluation of a percutaneous osseointegrated limb-skin interface in an ovine amputation model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:179. [PMID: 28980174 DOI: 10.1007/s10856-017-5980-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/01/2017] [Indexed: 06/07/2023]
Abstract
Percutaneous osseointegrated (OI) prostheses directly connect an artificial limb to the residual appendicular skeleton via a permanently implanted endoprosthesis with a bridging connector that protrudes through the skin. The resulting stoma produces unique medical and biological challenges. Previously, a study using a large animal amputation model indicated that infection could be largely prevented, for at least a 12-month period, but the terminal epithelium continued to downgrow. The current study was undertaken to test the longer-term efficacy of this implant construct to maintain a stable skin-implant interface for 24 months. Using the previously successful amputation and implantation surgical procedure, a total of eight sheep were fitted with a percutaneous OI prosthesis. Two animals were removed from the study due to early complications. Of the remaining six sheep, one (16.7%) became infected at 15-months post-implantation and five remained infection-free for the intended 24 months. The histological data of the remaining animals further confirmed the grossly observable epithelial downgrowth. Albeit a receding interface, it was clear that all animals that survived to the end of the study had residual fibrous soft-tissue ingrowth into, and debris within, the exposed titanium porous-coated surface. Overall, the data demonstrated that the porous coated subdermal barrier offered initial protection against infection. However, the fibrous skin attachment was continuously lysed over time by the down-growing epithelium.
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Affiliation(s)
- Sujee Jeyapalina
- Orthopaedic Research Laboratories, University of Utah Orthopaedic Center and Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84108, USA
- Department of Surgery, Division of Plastic Surgery, University of Utah, Salt Lake City, UT, 84112, USA
| | - James Peter Beck
- Orthopaedic Research Laboratories, University of Utah Orthopaedic Center and Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84108, USA
| | - Jayant Agarwal
- Department of Surgery, Division of Plastic Surgery, University of Utah, Salt Lake City, UT, 84112, USA
| | - Kent N Bachus
- Orthopaedic Research Laboratories, University of Utah Orthopaedic Center and Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84108, USA.
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA.
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11
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Abdallah MN, Badran Z, Ciobanu O, Hamdan N, Tamimi F. Strategies for Optimizing the Soft Tissue Seal around Osseointegrated Implants. Adv Healthc Mater 2017; 6. [PMID: 28960892 DOI: 10.1002/adhm.201700549] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/12/2017] [Indexed: 12/20/2022]
Abstract
Percutaneous and permucosal devices such as catheters, infusion pumps, orthopedic, and dental implants are commonly used in medical treatments. However, these useful devices breach the soft tissue barrier that protects the body from the outer environment, and thus increase bacterial infections resulting in morbidity and mortality. Such associated infections can be prevented if these devices are effectively integrated with the surrounding soft tissue, and thus creating a strong seal from the surrounding environment. However, so far, there are no percutaneous/permucosal medical devices able to prevent infection by achieving strong integration at the soft tissue-device interface. This review gives an insight into the current status of research into soft tissue-implant interface and the challenges associated with these interfaces. Biological soft/hard tissue interfaces may provide insights toward engineering better soft tissue interfaces around percutaneous devices. In this review, focus is put on the history and current findings as well as recent progress of the strategies aiming to develop a strong soft tissue seal around osseointegrated implants, such as orthopedic and dental implants.
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Affiliation(s)
- Mohamed-Nur Abdallah
- Division of Biomedical Sciences; Faculty of Dentistry; McGill University; Montreal H3A 1G1 QC Canada
- Division of Orthodontics; Faculty of Dentistry; Toronto University; Toronto M5G 1G6 ON Canada
| | - Zahi Badran
- Division of Biomedical Sciences; Faculty of Dentistry; McGill University; Montreal H3A 1G1 QC Canada
- Department of Periodontology (CHU/Rmes Inserm U1229/UIC11); Faculty of Dental Surgery; University of Nantes; Nantes 44042 France
| | - Ovidiu Ciobanu
- Division of Biomedical Sciences; Faculty of Dentistry; McGill University; Montreal H3A 1G1 QC Canada
| | - Nader Hamdan
- Department of Dental Clinical Sciences; Faculty of Dentistry; Dalhousie University; Halifax B3H 4R2 NS Canada
| | - Faleh Tamimi
- Division of Biomedical Sciences; Faculty of Dentistry; McGill University; Montreal H3A 1G1 QC Canada
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