Failure pressures after repairs of 2-cm × 2.5-cm rhinologic dural defects in a porcine ex vivo model.
The objective of this study was to determine failure pressures of 6 rhinologic repair techniques of large skull base/dural defects in a controlled, ex vivo model.



Failure pressures of 6 dural repairs in a porcine model were studied using a closed testing apparatus; 24-mm × 19-mm dural defects were created; 40-mm × 34-mm grafts composed of porcine Duragen (Integra), fascia lata, and Biodesign (Cook) were used either with or without Tisseel (Baxter International Inc.) to create 6 repairs: Duragen/no glue (D/NG), Duragen/Tisseel (D/T), fascia lata/no glue (FL/NG), fascia lata/Tisseel (FL/T), Biodesign/no glue (B/NG), and Biodesign/Tisseel (B/T). Saline was infused at 30 mL/hour, applying even force to the underside of the graft until repair failure. Five trials were performed per repair type for a total of 30 repairs.



Mean failure pressures were as follows: D/NG 1.361 ± 0.169 cmH2O; D/T 9.127 ± 1.805 cmH2O; FL/NG 0.200 ± 0.109 cmH2O; FL/T 7.833 ± 2.657 cmH2O; B/NG 0.299 ± 0.109 cmH2O; and B/T 2.67 ± 0.619 cmH2O. There were statistically significant differences between glued (Tisseel) and non-glued repairs for each repair category (p < 0.05).



All glued repairs performed better than non-glued repairs. Both D/T and FL/T repairs performed better than B/T repairs. No repair tolerated pressures throughout the full range of adult supine intracranial pressure.
Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, TX.|Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX.|Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, TX.
Ryan P
RP
Lin
Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, TX.
Erik Kent
EK
Weitzel
Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX. p_g_chen@hotmail.com.
Philip G
PG
Chen
Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, TX.
Kevin Christopher
KC
McMains
Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX.
Daniel R
DR
Chang
Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, TX.
Ernest E
EE
Braxton
Uniformed Services University of Health Sciences and San Antonio Uniformed Health Sciences Educational Consortium, Joint Base San Antonio, TX.
Jacob
J
Majors
Department of Anesthesiology, University of Texas Health Science Center San Antonio, San Antonio, TX.
Leon
L
Bunegin
D000269:Adhesives; D000818:Animals; D004195:Disease Models, Animal; D004388:Dura Mater / Q000002:abnormalities / Q000502:physiology / Q000601:surgery; D005206:Fascia Lata / Q000637:transplantation; D011312:Pressure; D019651:Plastic Surgery Procedures; D019291:Skull Base / Q000002:abnormalities / Q000502:physiology / Q000601:surgery; D013552:Swine; D019737:Transplants
D000269:Adhesives
CSF leak repair; dura; failure strength; porcine; rhinology; skull-base