Biological materials for diaphragmatic repair: initial experiences with the PeriGuard Repair Patch®.
BACKGROUND
We sought to analyze the efficacy of a bovine pericardial patch (PeriGuard®) for diaphragmatic repair.


METHODS
Seven consecutive patients (6 males, median age 56 years) scheduled for diaphragmatic resection and/or repair were enrolled in this study. In all cases diaphragmatic repair was performed with a PeriGuard Repair Patch® (Synovis, St. Paul, MN, USA). At follow-up (median: 12 months; range: 6-18 months), quality of life, signs of reherniation and incorporation of mesh were assessed through clinical examination, blood samples and CT or MRT scan.


RESULTS
Diagnosis on admission included sarcoma (n = 2), mesothelioma (n = 1), squamous cell carcinoma (n = 1), parachordoma (n = 1) and large congenital or posttraumatic herniation (n = 2). At follow-up successful diaphragmatic repair with no signs of reherniation, graft dehiscence or seroma formation was confirmed for all patients. Recorded inflammatory markers [C-reactive protein (CRP), white blood cell count (WBC) and procalcitonin (PCT)] reached their peak values between postoperative day (POD) 4 and POD 7. Values ranged from 122-282 mg/L for CRP, 0.4-4.6 µg/L for PCT and 6.2-15.6 Tsd/µL for WBC. Overall oncological results were good and 5 out of 6 survivors reported a fully reestablished quality of life.


CONCLUSIONS
We consider the PeriGuard Repair Patch® a viable alternative to synthetic materials for diaphragm replacement. Moreover, we advise carrying out cautious follow-up in patients undergoing extensive oncological resection to learn more about the biological behavior of the bovine PeriGuard Repair Patch® after diaphragmatic repair.
Department of Thoracic Surgery and Lung Assist, Klinikum Ibbenbüren, Ibbenbüren, Germany. p.zardo@klinikum-ibbenbueren.de
P
P
Zardo
R
R
Zhang
B
B
Wiegmann
A
A
Haverich
S
S
Fischer
D000328:Adult; D000368:Aged; D000818:Animals; D001672:Biocompatible Materials; D002417:Cattle; D003964:Diaphragm / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013899:Thoracic Neoplasms / Q000601:surgery; D016896:Treatment Outcome
D001672:Biocompatible Materials