title: Cross-linked xenogenic collagen implantation in the sheep model for vaginal surgery.
abstract: The properties of meshes used in reconstructive surgery affect the host response and biomechanical characteristics of the grafted tissue. Whereas durable synthetics induce a chronic inflammation, biological grafts are usually considered as more biocompatible. The location of implantation is another determinant of the host response: the vagina is a different environment with specific function and anatomy. Herein, we evaluated a cross-linked acellular collagen matrix (ACM), pretreated by the anti-calcification procedure ADAPT® in a sheep model for vaginal surgery. Ten sheep were implanted with a cross-linked ACM, and six controls were implanted with a polypropylene (PP; 56 g/m2) control. One implant was inserted in the lower rectovaginal septum, and one was used for abdominal wall defect reconstruction. Grafts were removed after 180 days; all graft-related complications were recorded, and explants underwent bi-axial tensiometry and contractility testing. Half of ACM-implanted animals had palpable induration in the vaginal implantation area, two of these also on the abdominal implant. One animal had a vaginal exposure. Vaginal ACMs were 63 % less stiff compared to abdominal ACM explants (p= 0.01) but comparable to vaginal PP explants. Seven anterior vaginal ACM explants showed areas of graft degradation on histology. There was no overall difference in vaginal contractility. Considering histologic degradation in the anterior vaginal implant as representative for the host, posterior ACM explants of animals with degradation had a 60 % reduced contractility as compared to PP (p= 0.048). Three abdominal implants showed histologic degradation; those were more compliant than non-degraded implants. Vaginal implantation with ACM was associated with graft-related complications (GRCs) and biomechanical properties comparable to PP. Partially degraded ACM had a decreased vaginal contractility.
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ; Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Endo
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ; Institute for Care of Mother and Child, Prague, Czech Republic.
authors.forename: Iva
authors.initials: I
authors.lastname: Urbankova
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ; Institute for Care of Mother and Child, Prague, Czech Republic.
authors.forename: Jaromir
authors.initials: J
authors.lastname: Vlacil
authors.affiliation: Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Siddarth
authors.initials: S
authors.lastname: Sengupta
authors.affiliation: Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deprest
authors.affiliation: Institute for Pathology, Düren Hospital, Düren, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Klosterhalfen
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Andrew
authors.initials: A
authors.lastname: Feola
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ; Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
keywords: Biological graft; Biomechanics; Contractility; Graft-related complication; Prolapse