title: Permacol interposition graft as an alternative to vein in contaminated wounds using a rabbit model.
abstract: BACKGROUND
  Vascular injuries are common in trauma and often involve massive soft tissue injury and segmental arterial loss. Current practice uses either autogenous vein or polytetrafluorethylene (PTFE) for interposition grafting in arterial injuries. Decision making between autogenous or synthetic conduit pivots around the physiological state of the trauma patient. Vein is known to increase operative times in an already physiologically depleted patient, whereas synthetic graft can be simply pulled from the shelf. However, when used in contaminated wounds, PTFE is prone to chronic infection and subsequent graft failure. An alternative synthetic conduit resistant to infection would be ideal for such situations. Permacol (Tissue Science Laboratories, Inc, Andover, MA), a biosynthetic material, has demonstrated resistance to bacterial contamination in contaminated hernia repairs. When fashioned into a tubular structure, this material may be useful as an alternative vascular conduit in contaminated trauma wounds.
  
  
  METHODS
  New Zealand white rabbits were randomized to one of 4 groups: Permacol graft (P) without bacterial contamination (n = 9), Permacol graft with bacterial contamination (CP; n = 9), autogenous vein graft without bacterial contamination (V; n = 9), or autogenous vein with bacterial contamination (CV; n = 9). All groups then underwent interposition grafting of the right common carotid artery. Grafts were contaminated by applying Staphylococcus aureus (1 × 10(5) colonies/0.1 mL) directly to the exposed surface of the graft on completion of the arterial repair. Each graft was then excised at day 42, and segments were collected for histologic evaluation, bacterial counts, and real-time polymerase chain reaction.
  
  
  RESULTS
  Of the 36 rabbits used in this study, 3 animals in the CV group died within 72 hr of surgery. There was no difference in early mortality between P and V (0% vs. 0%; P = 1.0); however, early mortality was higher in the CV compared with the CP group (33% vs. 0%; P = 0.023). At 42 days, histologic evaluation of graft patency demonstrated no difference between P and V (67% vs. 33%; P = 0.157); however, patency was higher in CP than CV (56% vs. 12%; P = 0.040). In addition, no difference was found between the 2 contaminated groups in regard to the number of bacteria present on each graft material.
  
  
  CONCLUSIONS
  Permacol as an interposition graft is a feasible alternative to vein in a contaminated setting and shows resistance to infection in a rabbit model. Future studies are needed to evaluate this material in larger animal models.
authors.affiliation: Division of Vascular Surgery, Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: te.simon@yahoo.com.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Simon
authors.affiliation: Division of Vascular Surgery, Dwight D Eisenhower Army Medical Center, Fort Gordon, GA.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Johnson
authors.affiliation: Division of Vascular Surgery, Dwight D Eisenhower Army Medical Center, Fort Gordon, GA.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Naig
authors.affiliation: Division of Vascular Surgery, Dwight D Eisenhower Army Medical Center, Fort Gordon, GA.
authors.forename: Joel R
authors.initials: JR
authors.lastname: Brockmeyer
authors.affiliation: Department of Clinical Investigations, Dwight D Eisenhower Army Medical Center, Fort Gordon, GA.
authors.forename: Balakrishna M
authors.initials: BM
authors.lastname: Prasad
authors.affiliation: Division of Vascular Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Paul W
authors.initials: PW
authors.lastname: White
mesh_terms: D000818:Animals; D064592:Autografts; D058491:Bacterial Load; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D017536:Carotid Artery, Common / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D003094:Collagen; D020878:Device Removal; D004195:Disease Models, Animal; D005240:Feasibility Studies; D007601:Jugular Veins / Q000382:microbiology / Q000637:transplantation*; D008297:Male; D011474:Prosthesis Design; D011817:Rabbits; D013203:Staphylococcal Infections / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D013997:Time Factors
chemical_list: C422414:Permacol; D003094:Collagen