title: Development of a novel approach to safely couple the intestine to a distraction-induced device for intestinal growth: use of reconstructive tissue matrix.
abstract: BACKGROUND
  Distraction-induced intestinal growth may be a novel treatment for short bowel syndrome. Longitudinal, distractive tension created by the application of force creates a significant challenge: to produce adequate force, yet not cause perforation at the fixation points. This paper describes our development of a coupling strategy to allow for successful bowel lengthening.
  
  
  METHODS
  A curvilinear hydraulic device was implanted in an isolated Roux limb of small bowel in young Yorkshire pigs. Bowel was lengthened over a 2-week period. Study groups included: Group 1: Twelve silk transmural anchoring sutures into an engineered-coupling ring at the ends of each device. Group 2: Addition of felt pledgets to the coupling rings on the serosal surface of the small bowel. Group 3: Extraluminal use of either thin AlloDerm(®), thick AlloDerm(®), or Strattice™ mesh to anchor the device.
  
  
  RESULTS
  Group 1 (suture-only) resulted in a gradual pulling through the suture with increasing tension and no lengthening. Felt pledgets eroded in a similar fashion, causing abdominal sepsis. Thin AlloDerm(®) failed to prevent erosion; however, it protected against gross contamination. Animals in which either thick AlloDerm(®) or Strattice™ mesh was used survived complication free to the study endpoint. Both thick AlloDerm(®) and Strattice™ prevented erosion and perforation allowing for an average of 10.85 cm expansion.
  
  
  CONCLUSIONS
  This study demonstrates the use of either thick AlloDerm(®) or Strattice™ reconstructive tissue matrix which allows for safe and effective coupling. Further, we suggest this approach could be an adjunct to esophageal lengthening procedures.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery and the C.S, Mott Children's Hospital, University of Michigan, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI 48109-4211, USA.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Ralls
authors.forename: Ryo
authors.initials: R
authors.lastname: Sueyoshi
authors.forename: Richard
authors.initials: R
authors.lastname: Herman
authors.forename: Brent
authors.initials: B
authors.lastname: Utter
authors.forename: Isabel
authors.initials: I
authors.lastname: Czarnocki
authors.forename: Jonathan
authors.initials: J
authors.lastname: Luntz
authors.forename: Diann
authors.initials: D
authors.lastname: Brei
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
mesh_terms: D000818:Animals; D003094:Collagen; D007421:Intestine, Small / Q000601:surgery*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D013526:Surgical Mesh; D013552:Swine
chemical_list: C440568:Alloderm; D003094:Collagen