Structural and biomechanical characteristics of the diaphragmatic tendon in infancy and childhood: an initial analysis

Steigman, Shaun A.; Oh, Jung-Tak; Almendinger, Nikki; Javid, Patrick; LaVan, David; Fauza, Dario

doi:10.1016/j.jpedsurg.2009.09.030

« Previous Next »Journal of Pediatric Surgery
Volume 45, Issue 7 , Pages 1455-1458, July 2010

Structural and biomechanical characteristics of the diaphragmatic tendon in infancy and childhood: an initial analysis☆

Shaun A. Steigman
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
Jung-Tak Oh
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
Nikki Almendinger
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
Patrick Javid
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
David LaVan
- Division of Health Sciences and Technology, Massachusetts Institute of Technology, Boston, MA 02115, USA
Dario Fauza
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
- Corresponding author. Tel.: +1 617 919 2966; fax: +1 617 730 0910.

Received 24 July 2009; received in revised form 18 September 2009; accepted 26 September 2009.

Abstract

Background

Engineered tendon grafts have been shown, experimentally, to be promising alternatives for partial diaphragmatic replacement. This study was aimed at determining the cellularity, extracellular matrix composition, and biomechanical characteristics of the diaphragmatic tendon in infants and children to be used as a reference for proper diaphragmatic graft engineering.

Methods

The left diaphragmatic tendon was procured at autopsy from 13 patients divided into 2 groups. Group I (n = 9) consisted of newborns and infants. Group II (n = 4) consisted of children and adolescents. Samples underwent quantitative assays for total DNA, glycosaminoglycans, collagen, and elastin contents. Biomechanical measurements included modular and ultimate tensile strength analyses. Statistical comparisons were by the 2-sample Student's t test.

Results

Group I showed significantly higher levels of total DNA, glycosaminoglycans, collagen, and elastin than group II. Conversely, group II tended to have higher modular and ultimate tensile strengths.

Conclusions

In neonates and infants, the diaphragmatic tendon has increased cell density and higher levels of major extracellular matrix components than in older children, in whom the diaphragmatic tendon tends to have higher tensile strength. Engineered diaphragmatic constructs should be tailored to the distinct anatomical, functional, and biomechanical characteristics of the diaphragmatic tendon at different age groups.

Key words: Congenital diaphragmatic hernia, Diaphragm, Diaphragmatic tendon, Tissue engineering, Engineered diaphragm