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01-02-2013 | Original Article

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

Authors: Matthew W. Ralls, Ryo Sueyoshi, Richard Herman, Brent Utter, Isabel Czarnocki, Jonathan Luntz, Diann Brei, Daniel H. Teitelbaum

Published in: Pediatric Surgery International | Issue 2/2013

Abstract

Background

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.

Methods

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^®, thick AlloDerm^®, or Strattice™ mesh to anchor the device.

Results

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^® failed to prevent erosion; however, it protected against gross contamination. Animals in which either thick AlloDerm^® or Strattice™ mesh was used survived complication free to the study endpoint. Both thick AlloDerm^® and Strattice™ prevented erosion and perforation allowing for an average of 10.85 cm expansion.

Conclusion

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

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Title: Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: use of reconstructive tissue matrix
Authors: Matthew W. Ralls
Ryo Sueyoshi
Richard Herman
Brent Utter
Isabel Czarnocki
Jonathan Luntz
Diann Brei
Daniel H. Teitelbaum
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 2/2013
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-012-3198-z

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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