Highlights
- •Congenital diaphragmatic hernias sometimes require patch repairs, but the optimal patch material is unknown.
- •We compared a biodegradable polyurethane patch to commercially available Gore-Tex™ in an animal model of diaphragmatic hernia.
- •We found that polyurethane allowed for greater diaphragmatic excursion than Gore-Tex™ and similar durability.
Summary
Introduction
Congenital diaphragmatic hernia (CDH) repair is an area of active research. Large
defects requiring patches have a hernia recurrence rate of up to 50%. We designed
a biodegradable polyurethane (PU)-based elastic patch that matches the mechanical
properties of native diaphragm muscle. We compared the PU patch to a non-biodegradable
Gore-Tex™ (polytetrafluoroethylene) patch.
Methods
The biodegradable polyurethane was synthesized from polycaprolactone, hexadiisocyanate
and putrescine, and then processed into fibrous PU patches by electrospinning. Rats
underwent 4mm diaphragmatic hernia (DH) creation via laparotomy followed by immediate
repair with Gore-Tex™ (n=6) or PU (n=6) patches. Six rats underwent sham laparotomy
without DH creation/repair. Diaphragm function was evaluated by fluoroscopy at 1 and
4 weeks. At 4 weeks, animals underwent gross inspection for recurrence and histologic
evaluation for inflammatory reaction.
Results
There were no hernia recurrences in either cohort. Gore-Tex™ had limited diaphragm
rise compared to sham at 4 weeks (1.3mm vs 2.9mm, p=0.003), but no difference was
found between PU and sham (1.7mm vs 2.9mm, p=0.09). There were no differences between
PU and Gore-Tex™ at any time point. Both patches formed an inflammatory capsule, with
similar thicknesses between cohorts on the abdominal (Gore-Tex™ 0.07mm vs. PU 0.13mm,
p=0.39) and thoracic (Gore-Tex™ 0.3 mm vs. PU 0.6 mm, p=0.09) sides.
Conclusion
The biodegradable PU patch allowed for greater diaphragmatic excursion compared to
Gore-Tex™. There were similar inflammatory responses to both patches. Further work
is needed to evaluate long-term functional outcomes and further optimize the properties
of the novel PU patch in vitro and in vivo.\
Level of Evidence
Level II, Prospective Comparative Study.
Keywords
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Article info
Publication history
Accepted:
January 8,
2023
Received:
January 6,
2023
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
