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Evaluation of a Biodegradable Polyurethane Patch for Repair of Diaphragmatic Hernia in a Rat Model: A Pilot Study

  • Christina M. Theodorou
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817
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  • Alan Taylor
    Affiliations
    Department of Bioengineering, University of Texas at Arlington, 500 UTA Blvd, Arlington, TX 76019
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  • Su Yeon Lee
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817
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  • Lia Molina Cortez
    Affiliations
    Department of Bioengineering, University of Texas at Arlington, 500 UTA Blvd, Arlington, TX 76019
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  • Huikang Fu
    Affiliations
    Department of Bioengineering, University of Texas at Arlington, 500 UTA Blvd, Arlington, TX 76019
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  • Christopher D. Pivetti
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817

    Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, 2425 Stockton Blvd, Sacramento, CA, 95817
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  • Chaoxing Zhang
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817

    Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, 2425 Stockton Blvd, Sacramento, CA, 95817
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  • Anastasiya Stasyuk
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817
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  • Dake Hao
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817

    Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, 2425 Stockton Blvd, Sacramento, CA, 95817
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  • Priyadarsini Kumar
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817

    Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, 2425 Stockton Blvd, Sacramento, CA, 95817
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  • Diana L. Farmer
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817

    Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, 2425 Stockton Blvd, Sacramento, CA, 95817
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  • Jun Liao
    Affiliations
    Department of Bioengineering, University of Texas at Arlington, 500 UTA Blvd, Arlington, TX 76019
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  • Erin G. Brown
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817
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  • Yi Hong
    Correspondence
    Corresponding author. Yi Hong, PhD, Department of Bioengineering, University of Texas at Arlington, Arlington, TX, 76019, USA.
    Affiliations
    Department of Bioengineering, University of Texas at Arlington, 500 UTA Blvd, Arlington, TX 76019
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  • Aijun Wang
    Correspondence
    Corresponding author. Aijun Wang, PhD, Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California, Davis, 4625 2nd Ave., Research II, Suite 3005, Sacramento, CA, 95817, USA.
    Affiliations
    Center for Surgical Bioengineering, Department of Surgery, School of Medicine, University of California Davis, 4625 2nd Avenue, Room 3001, Sacramento, CA, 95817

    Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children, 2425 Stockton Blvd, Sacramento, CA, 95817

    Department of Biomedical Engineering, University of California Davis, One Shields Ave, Davis, CA, 95616
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      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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