Results of Acellular Dermis Matrix Graft Used for Tympanoplasty in Guinea Pig Model

Document Type: Original

Authors

1 Otolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

2 Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Otolaryngology, School of Medicine, Hamadan University of Medical Sciences & Health Services, Hamadan, Iran.

4 Pediatric Urology Research Center, Children’s Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran.

5 Cancer Model Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction:
To describe the underlay tympanoplasty technique using an acellular dermal graft(AlloDerm) for tympanic membrane (TM) reconstruction in a guinea pig model and to demonstrate the feasibility of the technique using AlloDerm tissue harvested from the prepuce as a source of tissue for future grafting in human TM reconstruction.
 
Materials and Methods:
The prepuce was divided during circumcision and the acellular dermis was prepared using a number of standard processes. Two groups of guinea pigs were prepared. In the case group (20 guinea pigs and 40 ears) removal of TM was performed with tympanoplasty using AlloDerm, and in the control group (eight guinea pigs and 16 ears), removal of TM was performed without tympanoplasty. In each group, the TM was completely removed in one ear and partially removed on the other side, and the integrity of the TMs was re-evaluated after 8 weeks.
 
Results:
In the case group, the healing rates in the completely and partially removed TMs were 83.3% and 94.4%, respectively. The difference in healing rate (0% and 66.7%, respectively) was statistically significant (P<0.05).
 
Conclusion: 
The use of AlloDerm is safe and effective in the repair of TM perforations in a guinea pig model. Acceptable results of AlloDerm tympanoplasty in a guinea pig model may pave the way for the effective use of this material in human TM reconstructions.

Keywords

Main Subjects


1. Flint PW, Haughey BH, Lund VJ. Cummings otolaryngology head & neck surgery. 5th ed. Philadelphia: Meredith E. Adams and Hussam K. EI-Kashlan; 2010. Chapter 141, Tympanoplasty and Ossiculoplasty; p.1999-2008.

2. Mansour MH, Askar MH, Albirmawy OA. Repair of tympanic membrane perforation using a modified cartilage–perichondrium composite ring graft. Laryngology & Otology 2006;120(11):952-4.

3. Chang CYJ, Gray LC. Pressed scar tissue for tympanic membrane grafting in revision tympanoplasty. Otolaryngology–Head and Neck Surgery 2005;132(1):30–6.

4. Wieland AM, Sundback CA , Hart A, Kulig K, Masiakos PT, Hartnick CJ.et al. Poly (glycerol sebacate)-engineered plugs to repair chronic tympanic membrane perforations in a chinchilla model. Otolaryngology–Head and Neck Surgery 2010; 143(1):127–33.

5. Kim JH, Choi SJ, Park JS, Lim KT, Choung PH, Kim SW, et al. Tympanic Membrane Regeneration Using a Water-Soluble Chitosan Patch. Tissue engineering: 2010; 16(1): 225-32.

6. De Cock M, Andries L, Boedts D, Marquet J. A scanning electron microscope study of preserved allograft tympanic membranes: a comparison with autogenous grafts, xenografts and the normal eardrum. Arch Otorhinolaryngol 1988; 245:16–21.

7. Downey TJ, Champeaux AL, Silva AB. AlloDerm tympanoplasty of tympanic membrane perforations. Am J Otolaryngology 2003; 24(1): 6–13.

8. Ort SA, Ehrlich HA, Isaacson JE. Acellular porcine intestinal submucosa as fascial graft in an animal model: Applications for revision tympanoplasty. Otolaryngology-Head and Neck Surgery 2010;143:435–40.

9. Gaspar K, Erdei I, Peter Z, Dezso B, Hunyadi J, Juhasz I. Role of acellular dermal matrix allograft in minimal invasive coverage of deep burn wound with bone exposed-case report and histological evaluation. Int Wound J 2006;3(1):51–8.

10. Kontos AP, Qian Z, Urato NS, Hassanein A, Proper SA. AlloDerm grafting for large wounds after mohs micrographic surgery. Dermatologic Surgery 2009;35(4):692–8.

11. Lai P, Propst EJ, Papsin BC. Lateral graft type 1 tympanoplasty using AlloDerm for tympanic membrane reconstruction in children. Int J Pediatric Otorhinolaryngology2006;70(8):1423-29.

12. Fishman AJ, Marrinan MS, Huang TC, Kanowitz SJ. Total tympanic membrane reconstruction: AlloDerm versus temporalis fascia, Otolaryngol. Head Neck Surg 2005;132(6):906–15.

13. Brackmann DE. Tympanoplasty with mastoidectomy: canal wall up procedures. Am J Otol 1993;14(4):380–82.

14.  Deng Z, Wu J, Qiu J, Wang J, Tian Y, Li Y, Jin Y. Comparison of porcine acellular dermis and dura mater as natural scaffolds for bioengineering tympanic membranes. Tissue engineering 2009; 15(12): 3729-39.

15.  Livesey SA, Herndon DN, Hollyoak MA, et al. Transplanted acellular allograft dermal matrix. Transplantation 1995 60(1):1–9.

16. Wainwright D, Madden M, Luterman A, Hunt J, Monafo W, Heimbach D, et al. Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns. J Burn Care Rehabil 1996; 17(2):124–36.

17. Lattari V, Jones LM, Varcelotti JR, Latenser BA, Sherman H, Barrette R. The use of a permanent dermal allograft in full-thickness burns of the hand and foot: a report of three cases. J Burn Care Rehabil 1997; 18(2): 147–55.

18. Sheridan R, Choucair R, Donelan M, Lydon M, Petras L, Tompkins R. Acellular allodermis in burn surgery: 1-year results of a pilot trial. J Burn Care Rehabil 1998;19(6):528–30.

19. Achauer BM, Vanderkam VM, Celikoz B, Jacobson DG. Augmentation of facial soft-tissue

defects with alloderm dermal graft. Ann Plast Surg 1998; 41(5): 503–7.

20. Kridel RWH. AlloDerm lip augmentation techniques and problem avoidance. Am J Cosm Surg 1998; 15:251–58.

21. Rhee PH, Friedman CD, Ridge JA, Kusiak J. The use of processed allograft dermal matrix for intraoral resurfacing: an alternative to split-thickness skin grafts. Arch Otolaryngol Head Neck Surg 1998; 124(11): 1201–4.

22. Kridel RWH, Foda H, Lunde KC. Septal perforation repair with acellular human dermal allograft. Arch Otolaryngol Head Neck Surg 1998; 124(1):73-8.

 23. Fayad JN, Baino T, Parisier SC. Preliminary results with the use of AlloDerm in chronic otitis media. Laryngoscope 2003; 113(7):1228–30.

 24. Lai P, Propst EJ, Papsin BC. Lateral graft type 1 tympanoplasty using AlloDerm for tympanic membrane reconstruction in children Int J Pediatr Otorhinolaryngol 2006; 70(8):1423–9.

 25. Vos JD, Latev MD, Labadie RF, Cohen SM, Werkhaven JA, Haynes DS. Use of AlloDerm in type 1 tympanoplasty: a comparable with native tissue grafts. Laryngoscope 2005; 115(9):              1599–602.