A New Elastic Porcine Acellular Dermal Matrix For Excellent Biointegration In A Breast Reconstruction Model With Radiation
Patrick S. Cottler, Naidi Sun, Jenna Thuman, Kendall Bielak, Lisa Salopek, Angela Pineros-Fernandez, Song Hu, Christopher Campbell.
University of Virginia, Charlottesville, VA, USA.
BACKGROUND: Ideal acellular dermal matrices (ADM) for breast reconstruction exhibit porosity for rapid biointegration and high elasticity for desired clinical outcomes. In a novel in vivo model of irradiated breast reconstruction, we demonstrate excellent biointegration of Artia®, a porcine product chemically prepared to mimic the elasticity of human ADM, with the natural porosity to encourage cellular ingrowth. METHODS: Utilizing the murine dorsal skinfold model, Artia® was implanted, n=8 (35Gy radiation) to the skin, and n=8 (0Gy radiation). Real-time photoacoustic microscopy (PAM) evaluations of vascular integration and oxygen saturation within the ADM were made over 14 days. At 21 days, vascular ingrowth (CD31), fibroblast scar tissue formation (smooth muscle actin, vimentin) and macrophage function (M2:M1 ratio) were evaluated. RESULTS: SEM demonstrates organized collagen fibrils with natural fenestrating pores to allow cellular ingrowth. Repeated PAM imaging demonstrated vascular ingrowth increasing over 14 days, with a commensurate increase in oxygen saturation within the ADM. By day 21, robust CD31 staining was seen with low SMA and vimentin fibrosis expression. M2 macrophages were over-represented in the macrophage population consistent with a remodeling physiology. CONCLUSIONS: Artia® demonstrates excellent incorporation, with increased oxygen saturation content by 14 days, consistent with other collagen substrates. CD31 and SMA histological values demonstrate appropriately high vascularity and modest fibrosis while SEM documents the porosity ideal for biointegration. Artia® performance in this model also demonstrates consistent performance in an irradiated skin envelope. Taken together with its enhanced elasticity and handling advantages, this porcine ADM product is well poised to be clinically applicable to breast reconstruction.
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