Reparação da parede abdominal com membranas acelulares de pericárdio bovino - Parte II - Análises histológicas e morfométricas

▪ RESUMO

Introdução:

Análise histológica é a principal ferramenta de avaliação de biopróteses acelulares, em sua maioria em caráter experimental. O objetivo é analisar histologicamente a matriz acelular de pericárdio bovino em reparações de parede abdominal implantada em humanos.

Método:

De uma série de 30 reparações com a membrana, 3 pacientes foram submetidas a revisão cirúrgica não relacionada aos implantes, aos 13, 22 e 23 meses de pós-operatório, obtendo-se biópsias das áreas previamente implantadas. Além da avaliação dos aspectos básicos de biocompatibilidade e neoformação tecidual, as lâminas foram digitalizadas e submetidas a análise computadorizada com o software ImageJ para quantificação da cinética de degradação das membranas, associada à análise da dimensão fractal das amostras. Os valores obtidos para porcentagens de membrana residual tiveram suas médias comparadas por análise de variância (ANOVA) e pelo teste T de Student não pareado, também utilizado para os valores da quantificação da dimensão fractal.

Resultados:

Foi demonstrada a biocompatibilidade do material, com neoformação tecidual, deposição de colágeno e tecido celularizado de aspecto normal, sem reações locais importantes. Fragmentos residuais da membrana foram quantificados em 40%±7% aos 13 meses, em 20%±6% aos 22 meses e em 17%±6% aos 23 meses de pós-operatório, com a análise da dimensão fractal indicando uma progressiva degradação dos implantes, com significância estatística entre 13 meses e as amostras tardias.

Conclusão:

Os resultados atestaram a funcionalidade do pericárdio bovino acelular sob diferentes níveis de estresse mecânico nas reparações da parede abdominal em humanos.

Descritores:

Matriz extracelular - Hérnia abdominal - Parede abdominal - Próteses e implantes - Telas cirúrgicas - Bioprótese - Pericárdio

Instituição: Clínica Spani Vendramin, Belém, PA, Brasil.

Publication History

Received: 14 March 2023

Accepted: 05 December 2023

Article published online:
20 May 2025

• REFERÊNCIAS

• 1 Baumann DP, Butler CE. Bioprosthetic mesh in abdominal wall reconstruction. Semin Plast Surg 2012; 26 (01) 18-24
• 2 Panayi AC, Orgill DP. Current Use of Biological Scaffolds in Plastic Surgery. Plast Reconstr Surg 2019; 143 (01) 209-220
• 3 Brown BN, Badylak SF. Extracellular matrix as an inductive scaffold for functional tissue reconstruction. Transl Res 2014; 163 (04) 268-285
• 4 Sternlicht MD, Werb Z. How matrix metalloproteinases regulate cell behavior. Annu Rev Cell Dev Biol 2001; 17: 463-516
• 5 Blatnik J, Jin J, Rosen M. Abdominal hernia repair with bridging acellular dermal matrix--an expensive hernia sac. Am J Surg 2008; 196 (01) 47-50
• 6 Costa A, Naranjo JD, Londono R, Badylak SF. Biologic Scaffolds. Cold Spring Harb Perspect Med 2017; 7 (09) a025676
• 7 Smart NJ, Bloor S. Durability of biologic implants for use in hernia repair: a review. Surg Innov 2012; 19 (03) 221-229
• 8 Liang HC, Chang Y, Hsu CK, Lee MH, Sung HW. Effects of crosslinking degree of an acellular biological tissue on its tissue regeneration pattern. Biomaterials 2004; 25 (17) 3541-3552
• 9 Mestak O, Spurkova Z, Benkova K, Vesely P, Hromadkova V, Miletin J. et al. Comparison of Cross-linked and Non-Cross-linked Acellular Porcine Dermal Scaffolds for Long-term Full-Thickness Hernia Repair in a Small Animal Model. Eplasty 2014; 14: e22
• 10 Wotton FT, Akoh JA. Rejection of Permacol mesh used in abdominal wall repair: a case report. World J Gastroenterol 2009; 15 (34) 4331-4333
• 11 Cheung D, Brown L, Sampath R. Localized inferior orbital fibrosis associated with porcine dermal collagen xenograft orbital floor implant. Ophthalmic Plast Reconstr Surg 2004; 20 (03) 257-259
• 12 Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9 (07) 671-675
• 13 Backes AR, Bruno OM. Técnicas de estimativa de dimensão fractal aplicadas em imagens digitais. Relatórios Técnicos. São Carlos: Universidade de São Paulo; 2005. . Disponível em: http://repositorio.icmc.usp.br//handle/RIICMC/6846
• 14 Acellular Matrix Treatment Market – Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2021 – 2031. Disponível em: https://www.transparencymarketresearch.com/acellular-dermal-matrix-treatment-market.html
• 15 Knight RL, Wilcox HE, Korossis SA, Fisher J, Ingham E. The use of acellular matrices for the tissue engineering of cardiac valves. Proc Inst Mech Eng H 2008; 222 (01) 129-143
• 16 Iyyanki TS, Dunne LW, Zhang Q, Hubenak J, Turza KC, Butler CE. Adipose-derived stem-cell-seeded non-cross-linked porcine acellular dermal matrix increases cellular infiltration, vascular infiltration, and mechanical strength of ventral hernia repairs. Tissue Eng Part A 2015; 21 (3-4): 475-485
• 17 Friess W. Collagen--biomaterial for drug delivery. Eur J Pharm Biopharm 1998; 45 (02) 113-136
• 18 Robinson TN, Clarke JH, Schoen J, Walsh MD. Major mesh-related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc 2005; 19 (12) 1556-1560
• 19 Klosterhalfen B, Klinge U, Hermanns B, Schumpelick V. Pathology of traditional surgical nets for hernia repair after long-term implantation in humans. Chirurg 2000; 71 (01) 43-51 . German
• 20 Melman L, Jenkins ED, Hamilton NA, Bender LC, Brodt MD, Deeken CR. et al. Early biocompatibility of crosslinked and non-crosslinked biologic meshes in a porcine model of ventral hernia repair. Hernia 2011; 15 (02) 157-164
• 21 Connor J, McQuillan D, Sandor M, Wan H, Lombardi J, Bachrach N. et al. Retention of structural and biochemical integrity in a biological mesh supports tissue remodeling in a primate abdominal wall model. Regen Med 2009; 4 (02) 185-195
• 22 Brennan EP, Reing J, Chew D, Myers-Irvin JM, Young EJ, Badylak SF. Antibacterial activity within degradation products of biological scaffolds composed of extracellular matrix. Tissue Eng 2006; 12 (10) 2949-2955
• 23 Harth KC, Broome AM, Jacobs MR, Blatnik JA, Zeinali F, Bajaksouzian S. et al. Bacterial clearance of biologic grafts used in hernia repair: an experimental study. Surg Endosc 2011; 25 (07) 2224-2229
• 24 Badylak SF, Freytes DO, Gilbert TW. Extracellular matrix as a biological scaffold material: Structure and function. Acta Biomater 2009; 5 (01) 1-13
• 25 Boháč M, Danišovič Ľ, Koller J, Dragúňová J, Varga I. What happens to an acellular dermal matrix after implantation in the human body? A histological and electron microscopic study. Eur J Histochem 2018; 62 (01) 2873
• 26 Katerinaki E, Zanetto U, Sterne GD. Histological appearance of Strattice tissue matrix used in breast reconstruction. J Plast Reconstr Aesthet Surg 2010; 63 (12) e840-1
• 27 Salzberg CA, Dunavant C, Nocera N. Immediate breast reconstruction using porcine acellular dermal matrix (Strattice™): long-term outcomes and complications. J Plast Reconstr Aesthet Surg 2013; 66 (03) 323-328
• 28 Costa A, Naranjo JD, Turner NJ, Swinehart IT, Kolich BD, Shaffiey SA. et al. Mechanical strength vs. degradation of a biologically-derived surgical mesh over time in a rodent full thickness abdominal wall defect. Biomaterials 2016; 108: 81-90
• 29 Carey LE, Dearth CL, Johnson SA, Londono R, Medberry CJ, Daly KA. et al. In vivo degradation of 14C-labeled porcine dermis biologic scaffold. Biomaterials 2014; 35 (29) 8297-8304
• 30 de Castro Brás LE, Shurey S, Sibbons PD. Evaluation of crosslinked and non-crosslinked biologic prostheses for abdominal hernia repair. Hernia 2012; 16 (01) 77-89
• 31 Badylak S, Kokini K, Tullius B, Whitson B. Strength over time of a resorbable bioscaffold for body wall repair in a dog model. J Surg Res 2001; 99 (02) 282-287
• 32 López Cano M, Armengol Carrasco M, Quiles Pérez MT, Arbós Vía MA. Biological implants in abdominal wall hernia surgery. Cir Esp 2013; 91 (04) 217-223
• 33 Lotan AM, Cohen D, Nahmany G, Heller L, Babai P, Freier-Dror Y. et al. Histopathological Study of Meshed Versus Solid Sheet Acellular Dermal Matrices in a Porcine Model. Ann Plast Surg 2018; 81 (05) 609-614
• 34 Limpert JN, Desai AR, Kumpf AL, Fallucco MA, Aridge DL. Repair of abdominal wall defects with bovine pericardium. Am J Surg 2009; 198 (05) e60-5
• 35 Shieh MK. Bovine Pericardium in Complex Abdominal Wall Reconstruction in Patients with Obesity or Morbid Obesity. Bariatric Times 2014; 11 (09) 14-18
• 36 Keane TJ, Londono R, Turner NJ, Badylak SF. Consequences of ineffective decellularization of biologic scaffolds on the host response. Biomaterials 2012; 33 (06) 1771-1781
• 37 Tierney CM, Haugh MG, Liedl J, Mulcahy F, Hayes B, O’Brien FJ. The effects of collagen concentration and crosslink density on the biological, structural and mechanical properties of collagen-GAG scaffolds for bone tissue engineering. J Mech Behav Biomed Mater 2009; 2 (02) 202-209
• 38 Badylak SF. Decellularized allogeneic and xenogeneic tissue as a bioscaffold for regenerative medicine: factors that influence the host response. Ann Biomed Eng 2014; 42 (07) 1517-1527
• 39 Cavallo JA, Roma AA, Jasielec MS, Ousley J, Creamer J, Pichert MD. et al. Remodeling characteristics and collagen distribution in biological scaffold materials explanted from human subjects after abdominal soft tissue reconstruction: an analysis of scaffold remodeling characteristics by patient risk factors and surgical site classifications. Ann Surg 2015; 261 (02) 405-415
• 40 Ventral Hernia Working Group. Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF. et al. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 2010; 148 (03) 544-558
• 41 Reece IJ, van Noort R, Martin TR, Black MM. The physical properties of bovine pericardium: a study of the effects of stretching during chemical treatment in glutaraldehyde. Ann Thorac Surg 1982; 33 (05) 480-485
• 42 Schmidt CE, Baier JM. Acellular vascular tissues: natural biomaterials for tissue repair and tissue engineering. Biomaterials 2000; 21 (22) 2215-2231
• 43 Jayakrishnan A, Jameela SR. Glutaraldehyde as a fixative in bioprostheses and drug delivery matrices. Biomaterials 1996; 17 (05) 471-484
• 44 Gorman SP, Scott EM, Russell AD. Antimicrobial activity, uses and mechanism of action of glutaraldehyde. J Appl Bacteriol 1980; 48 (02) 161-190
• 45 Freytes DO, Stoner RM, Badylak SF. Uniaxial and biaxial properties of terminally sterilized porcine urinary bladder matrix scaffolds. J Biomed Mater Res B Appl Biomater 2008; 84 (02) 408-414
• 46 Faleris JA, Hernandez RM, Wetzel D, Dodds R, Greenspan DC. In-vivo and in-vitro histological evaluation of two commercially available acellular dermal matrices. Hernia 2011; 15 (02) 147-156
• 47 Freytes DO, Tullius RS, Valentin JE, Stewart-Akers AM, Badylak SF. Hydrated versus lyophilized forms of porcine extracellular matrix derived from the urinary bladder. J Biomed Mater Res A 2008; 87 (04) 862-872
• 48 Bottino MC, Jose MV, Thomas V, Dean DR, Janowski GM. Freeze-dried acellular dermal matrix graft: effects of rehydration on physical, chemical, and mechanical properties. Dent Mater 2009; 25 (09) 1109-1115