RU2465654C1 - Method for simulating environment of replacing abdominal hernioplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: wound defect is reduced in layers that involves forming fragments of hernioprosthesis composite coated with a polymer composite to be implanted in any layer of the wound subcutaneously or intraperitoneally. The hernioprosthesis represents a mesh of warp structure of synthetic polymer untwisted pneumatically coupled non thermally fixed complex filaments. The polymer composite consists of a substance of poviargol and medical polyvinylpyrrolidone. Molecular weight of medical polyvinylpyrrolidone makes 13000-90000D at the relation, wt %; 45-55 : 45-55.

EFFECT: method enables studying tissue responses at simulating the environment of replacing hernioplasty with the use of the presented hernioprosthesis showing evident anti-inflammatory, anti-adhesion and reparative action.

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Description

The invention relates to experimental medicine and can be used to model the conditions of prosthetic hernioplasty of the anterior abdominal wall to study the course of inflammatory and reparative reactions in the wound and in the abdominal cavity, depending on the location of the hernioprosthesis.

In experimental surgery, methods for studying tissue reactions to hernioprostheses made of various polymeric materials are known (V.N. Egiev, D.V. Chizhov, N.V. Filatkina. Interaction of polypropylene endoprostheses with tissues of the anterior abdominal wall. Herniology. - 2. - 6. - 2005. - 41-49).

These methods characterize tissue reactions directly related to the irritating effect of various polymeric materials on periprosthetic tissues, including, depending on the location of the hernioprosthesis, above the aponeurosis or under the parietal peritoneum of the ventral wall. All hernioprostheses studied in this way did not have anti-inflammatory properties, which sharply increased the intensity of inflammatory reactions in the postoperative wound and prolonged the exudative phase of implantation of the hernioprosthesis to two weeks or more.

There is a method of simulating adhesions in the abdominal cavity when placing a hernioprosthesis from polypropylene, departing 1 cm from the laparotomy incision, while the reparative processes in the wound of the anterior abdominal wall have not been studied (V.A. Lipatov, E.S. Romanova, A . A. Netyaga, A. A. Martyntsev, V. A. Sinkov. The role of chronic aseptic granulomatous peritonitis http // medinfa.ru / article / 36/117797).

According to our own data, when using a hernioprosthesis that does not have anti-inflammatory and anti-adhesion properties, generalized inflammatory infiltration is observed, which does not allow for a differential layer-by-layer assessment of inflammatory reactions in a surgical wound of the anterior abdominal wall.

A known method of modeling the conditions of prosthetic hernioplasty of the anterior abdominal wall using a hernioprosthesis made of REPEREN synthetic material with the assessment of tissue reactions depending on the location of the hernioprosthesis over aponeuroses or intraperitoneally, at the time of implantation up to 90 days (httpHYPERLINK

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The method consists in placing a hernioprosthesis of synthetic material (reference) in the abdominal cavity or subcutaneously. In this case, only the tissue reaction to the hernioprosthesis at the site of its implantation was studied.

As a prototype for the closest technical essence, we have chosen a method for modeling the conditions of prosthetic hernioplasty of the anterior abdominal wall using a hernioprosthesis, which is a net of a warp knitted structure made of synthetic polymer polyester multifilament yarns. (Postrelov N.A., Afinogenov G.E., Basin B.Ya., Afinogenova A.G., Koltsov A.I., Klyuev A.N. Rationale for clinical use in hernioplasty of a mesh prosthesis with antimicrobial properties // Bulletin of Surgery . - 2009. - No. 6. - S.21-24).

The disadvantage of the prototype is that the method we chose as the prototype did not allow us to study reparative reactions in all layers of the wounds of the anterior abdominal wall, since the hernioprosthesis used in the prototype method did not have anti-inflammatory and anti-adhesion properties.

From the available literature, there is no known method for modeling the conditions of prosthetic hernioplasty of the anterior abdominal wall, which allows one to study reparative cancer not only in the subcutaneous or intraperitoneal location of the hernioprosthesis, but also in all layers of the wound of the anterior abdominal wall.

The technical result of the invention is the possibility of studying reparative reactions when modeling the conditions of prosthetic hernioplasty of the anterior abdominal wall using a hernioprosthesis not only in the subcutaneous or intraperitoneal location of the hernioprosthesis, but also in all layers of the wound of the anterior abdominal wall.

The technical result of the invention is achieved by the fact that the method of modeling the conditions of prosthetic hernioplasty of the anterior abdominal wall consists in stitching the wound defect penetrating into the abdominal cavity in layers and forming implant fragments from the hernioprosthesis with subsequent implantation of these fragments into any of the wound layers subcutaneously or intraperitoneally. Fragments from a composite hernioprosthesis having anti-inflammatory and anti-adhesion properties and representing a net of a warp-knitted structure of synthetic polymer polyester complex yarns coated with a polymer composite consisting of a poviargol substance, which is a metal-polymer composition of highly dispersed metal polymer-stabilized metal polymer, are implanted. The multifilament yarn of the warp knitted structure is made of untwisted pneumoconnected non-thermofixed multifilament yarns. The molecular weight of medical polyvinylpyrrolidone is 13000-90000 D with a ratio of components, wt.%:

Poviargolum Substance 45-55

Medical polyvinylpyrrolidone 45-55.

The method is as follows.

To implement the method, a composite hernioprosthesis is used, which has anti-inflammatory and anti-adhesive properties and is a net of a warp-knit structure made of synthetic polymer polyester multifilament yarns, coated with a polymer composite, consisting of poviargol substance, which is a metal polymer composition of highly dispersed metallic silver, stabilized with a polydinilone synthetic polymer , moreover, the complex thread of the mesh ovovyazanoy structure made of non-woven air-entangled multifilament yarns netermofiksirovannyh, and the molecular weight of polyvinylpyrrolidone is medical 13000-90000 D at a ratio of components, wt.%:

Poviargolum Substance 45-55

Medical polyvinylpyrrolidone 45-55.

Fragments of a circular shape with a diameter of 15 mm are formed from this prosthesis, which are implanted through the median laparotomy wound of the anterior abdominal wall with a length of 20 mm. The implant is fixed with 5/0 proline suture to the parietal peritoneum of the ventral wall in the wound area or the hernioprosthesis is placed subcutaneously over the wound defect of the peritoneal muscle layer of the anterior abdominal wall that is wound. In all cases, the skin is sutured tightly. The method is carried out on experimental animals (guinea pigs, sexually mature males weighing 250-300 g). Operations are performed under conditions of contamination associated with non-compliance with the aseptic regime of the operating room.

Distinctive essential features of the proposed method are the following:

- fragments formed from a composite hernioprosthesis having anti-inflammatory and anti-adhesion properties and representing a metal-polymer composition of highly dispersed metallic silver stabilized with a synthetic collidone polymer and a polyvinylpyrrolidone medical compound with a non-knitted non-warp knitted fabric are implanted in the hernioplasty zone of the anterior abdominal wall. threads, and molecular weight medical polyvinylpyrrolidone is 13000-90000 D with a ratio of components, wt.%:

Poviargolum Substance 45-55

Medical polyvinylpyrrolidone 45-55.

(The application for utility model No. 2010132048/15 (045321) was filed, July 29, 2010. A prosthesis for hernioplasty / Basin B.Ya., Postrelov N.A., Basin A.B., Platonov S.M.

The decision to grant a patent for PM from 10/19/2010).

A causal relationship between the salient features and the result achieved is as follows:

- The finely dispersed silver, which is part of the polymer composite, in the form of nanoclusters, gives the hernioprosthesis antimicrobial properties of a wide spectrum of action, and the high molecular weight polymer ensures their prolongation up to 3 days. Due to the antimicrobial properties in the field of surgical intervention, there are no inflammatory reactions with the addition of infections, and the hernioprosthesis is not rejected through suppuration over time. In the presence of silver nanoclusters, the formation of a microbial biofilm and the development of an infectious complication around the hernioprosthesis are prevented, which creates conditions for studying reparative reactions not only in the subcutaneous or intraperitoneal location of the hernioprosthesis, but also in all layers of the wound of the anterior abdominal wall.

The antimicrobial effect is associated not only with the antimicrobial effect of highly dispersed silver, which is part of the polymer composite in the form of nanoclusters, but also with the presence of medical polyvinylpyrrolidone in the antimicrobial composite.

- The execution of a multifilament yarn from untwisted pneumatically connected non-thermofixed multifilament yarns increases the porosity of the multifilament yarns, which improves their diffuse impregnation with the polymer composite, thereby increasing the content of silver nanoclusters in the mesh hernioprosthesis, and also blocking the interstitial spaces of the yarn, turning it into pseudomononite 350 microns thick with polymer coating, thereby preventing the penetration of infect into the pores of the mesh hernioprosthesis, which, in turn, strengthens it tivovospalitelnye properties.

- The molecular weight of polyvinylpyrrolidone 13000-90000 D secures the monolithicity of untwisted multifilament yarns and the skeleton structure of the pseudo-monofilament of the warp knitted structure of the hernioprosthesis, providing a high concentration of silver nanoclusters in the polymer composite covering the network, thereby providing anti-inflammatory properties of the hernioprosthesis.

- When the ratio of components, wt.%: The substance of poviargol 45-55, medical polyvinylpyrrolidone 45-55, the amount of metallic silver per gram of grid is 10-11 mg, which provides a clear anti-inflammatory effect, manifested in a sharp inhibition of the formation of adhesions in the free abdominal cavity with the intra-abdominal location of the hernioprosthesis.

- The gradual softening and dissolution of the composite in tissue fluid over time, while maintaining the prolongation of antimicrobial and anti-inflammatory properties, releases the filaments of the mesh prosthesis, creating favorable conditions for the earlier and effective germination of the porous matrix of the mesh by connective tissue.

The use of a hernioprosthesis that does not have anti-inflammatory and anti-adhesion properties, if the operating room is not aseptic, is accompanied by generalized inflammation of all layers of the laparotomy wound and the abdominal organs adjacent to the wound.

Implantation of a hernioprosthesis with anti-inflammatory and anti-adhesion properties under similar conditions sharply reduces the inflammatory reactions in the laparotomy wound and in the abdominal cavity and allows to determine their primary location, as well as the nature of the reparative process relative to the location of the hernioprosthesis.

The anti-inflammatory effect of the hernioprosthesis does not depend on its location inside the abdominal cavity. Anti-adhesive action is noted. In the subcutaneous muscle layer of the laparotomy wound, inflammatory tissue reactions are more pronounced than in the abdominal cavity. The favorable course of reparative implantation processes was also facilitated by the use of a lavsan porous network, which was transformed by impregnation of high molecular weight polyvinylpyrrolidone into a pseudo-single tissue.

The set of essential distinguishing features is new and allows us to study reparative reactions when modeling the conditions of prosthetic hernioplasty of the anterior abdominal wall not only in the area of the subcutaneous or intraperitoneal location of the hernioprosthesis, but also in all layers of the wound of the anterior abdominal wall.

Examples of specific performance of the method

Example 1 (the inventive method).

 Research No. 10. Guinea pig, male, weight 240 g. Nembutal narcosis intraperitoneally. A section through all layers of the anterior abdominal wall 20 mm long. A fragment of a hernioprosthesis with a diameter of 15 mm, which is a net of a warp knitted structure made of synthetic polymer polyester multifilaments, coated with a polymer composite, consisting of a substance of poviargol, which is a metal-polymer composition of highly dispersed metallic silver stabilized with a synthetic polymer collidone, and a polyvinylpyridovinyl pyrrolidone network made of untwisted pneumoconnected non-thermofixed complex 's threads, and the molecular weight of polyvinylpyrrolidone is medical 13000-90000 D at a ratio of components, wt.%:

Poviargol Essence 55

Medical polyvinylpyrrolidone 45.

A fragment of the hernioprosthesis was administered intraperitoneally. Then they fixed it, sequentially stitching the wound edges in the middle of the abdominal wall incision with prolene thread through the cells of the hernioprosthesis in its center. Stitches to the skin. The postoperative period was uneventful. The animal is active, with a good appetite. The wound healed by primary intention. After 14 days, the animal was withdrawn from experience. Autopsy revealed no inflammatory changes in the abdominal cavity. A gernioprosthesis is fixed in the wound area without visible inflammatory changes. Figure 1, illustrating this example, confirms the absence of inflammatory reactions in the wound area.

Histological data also confirm the absence of inflammatory reactions in the wound area, which makes it possible to conduct a differentiated assessment in all layers of the anterior abdominal wall in connection with prosthetic hernioplasty with the location of the hernioprosthesis subcutaneously or intraperitoneally.

Example 2 (prototype).

Research No. 5. Guinea pig, male, weight 240 g. Nembutal narcosis intraperitoneally. A section through all layers of the anterior abdominal wall 20 mm long. A fragment of a hernioprosthesis with a diameter of 15 mm, which is a net of a warp knitted structure made of synthetic polymer polyester complex filaments, without coating with a polymer composite, was injected intraperitoneally. Then they fixed it, sequentially stitching the wound edges in the middle of the abdominal wall incision with prolene thread through the cells of the hernioprosthesis in its center. Stitches to the skin. The animal is inactive, weight loss is noted compared to the original, lethargy, loss of appetite. Clinically, signs of clinical intoxication were expressed. The skin wound healed by secondary intention. After 14 days, the animal was withdrawn from experience. When autopsy intra-abdominally in the wound area of the anterior abdominal wall was determined inflammatory infiltrate around the dacron mesh with the inclusion of the omentum, intestinal walls and liver (Figure 2).

When histological examination of the tissues of the anterior abdominal wall, including a hernioprosthesis, there is no possibility of a differentiated assessment of the severity of inflammatory reactions of anatomical structures in all layers of a wound of the anterior abdominal wall of a laboratory animal, regardless of the location of the hernioprosthesis - subcutaneously or intraperitoneally.

A total of 15 guinea pigs were operated on. 14 days after implantation of a hernioprosthesis, the subjects were withdrawn from the experiment by an overdose of ether. The control series consisted of 5 subjects who were implanted with a warp knitted mesh of synthetic polymer polyester multifilaments (dacron mesh without impregnation) with an anti-inflammatory anti-adhesion composition intra-abdominally.

The main group of researchers was represented by 10 animals that were implanted with a hernioprosthesis according to the claimed method, having anti-inflammatory anti-adhesion properties (5 - intra-abdominally, 5 - subcutaneously). Histological data confirm the absence of a pronounced inflammatory reaction in all layers of the wound.

General and local reactions to the intra-abdominal implantation of a hernioprosthesis in the control group were unambiguous. They were characterized by a complicated course of the postoperative period. All animals in the control group showed weight loss compared to the original, lethargy, loss of appetite. Clinically, signs of chronic intoxication were expressed. The skin wound healed by secondary intention, in 3 - under the scab. In autopsy, an inflammatory infiltrate was determined intraabdominally in the wound area of the anterior abdominal wall around the dacron mesh with the inclusion of the omentum, intestinal walls and liver. In the laparotomic wound, inflammatory infiltration was also expressed (Figure 2).

In all 10 animals that had a hernioprosthesis with anti-inflammatory and anti-adhesion properties according to the claimed method, the postoperative period was uneventful.

Animals were active, with good appetite. The skin wound of the anterior abdominal wall healed without significant inflammatory changes, in 4 - by primary intention. Autopsy revealed no inflammatory changes in the abdominal cavity. The fixation of a hernioprosthesis both in the abdominal cavity and subcutaneously, in the wound area from the side of the parietal peritoneum, was not accompanied by adhesion formation (Figure 1).

A comparative histological assessment of tissue reactions to the implantation of a hernioprosthesis without anti-inflammatory treatment and with anti-inflammatory anti-adhesion properties (according to the present method) is made.

When using a hernioprosthesis that does not have an anti-inflammatory effect, a pronounced inflammatory reaction was detected in the laparotomy wound from the peritoneum. The exudate was purulent in nature and was represented by a significant number of polymorphonuclear leukocytes. Also found areas of necrosis, hemorrhage, forming granulation tissue. The histological picture in the laparotomic wound is presented in Figure 3 (a - leukocytes, b - areas of necrosis, c - focal hemorrhages, d - granulation; env. Hematoxylin-eosin, enlarged × 100).

A similar histological picture also occurred in tissues located more superficially. Massive neutrophilic infiltrate was also found in the dermis, adipose tissue, and between the striated muscles, hemorrhages and immature granulations were detected. The histological picture in the adipose tissue and between the fibers of the striated muscle is shown in Figure 4 (a - purulent exudate, b - focal hemorrhage, c - immature granulation; env. Hematoxylin-eosin, uv. × 100).

Around the hernioprosthesis itself, the exudative reaction was also significantly pronounced. Immature granulation tissue and massive infiltration by polymorphonuclear leukocytes were found in tissues adjacent directly to the foreign body. The exudative reaction around the hernioprosthesis is presented in Figure 5. (a - hernioprosthesis, b - granulation tissue, c - leukocyte infiltration; env. hematoxylin-eosin, enlarged × 100).

Upon implantation of a prosthesis with anti-inflammatory and anti-adhesion effects under similar conditions, minimal infiltration by polymorphonuclear leukocytes with an admixture of lymphocytes, plasmocytes and macrophages was detected in the tissue adjacent to the hernioprosthesis. Granulation tissue of various degrees of maturity was also found. The cell reaction in the laparotomic wound is shown in Fig. 6 (a - stratified squamous epithelium, b - lymphoplasmacytic and neutrophilic infiltration, c - granulation; okrug hematoxylin-eosin, enlarged × 400).

In the dermis and in the underlying adipose tissue, the cellular reaction was less pronounced. Focal moderate lymphoplasmocytic infiltration, single macrophages and small focal hemorrhages were detected (a - focal lymphoplasmacytic infiltration, b - small focal hemorrhages; hematoxylin-eosin okr., × 100). (Fig.7).

Around the hernioprosthesis, the formation of thin layers of connective tissue, minimal focal lymphoplasmocytic infiltration, single giant cells such as cells of foreign bodies were revealed. A similar histological picture was observed at different locations of the hernioprosthesis, both when it was located in the abdominal cavity and when it was introduced into the abdominal wall. The cell response around the hernioprosthesis when it is located in the abdominal cavity is shown in Fig. 8 (a is a hernioprosthesis, b is lymphoplasmacytic infiltration, c is a giant cell of foreign bodies, d is a layer of connective tissue; okrug hematoxylin-eosin, enlarged × 100).

The cellular reaction around the hernioprosthesis when it is located in the abdominal cavity is also shown in Fig. 9 (a - hernioprosthesis, b - lymphoplasmacytic infiltration; env. Hematoxylin-eosin, enlarged × 400).

Thus, the claimed method, in contrast to the prototype method, allows one to study reparative reactions when modeling the conditions of prosthetic hernioplasty of the anterior abdominal wall not only in the subcutaneous or intraperitoneal location of the hernioprosthesis, but also in all layers of the wound of the anterior abdominal wall.

Claims (1)

A method for modeling the conditions of prosthetic hernioplasty of the anterior abdominal wall, which consists in layer-by-layer restoration of a wound defect, including the formation of fragments from a hernioprosthesis, which is a mesh of a warp-knitted structure from synthetic polymer polyester complex threads, followed by implantation of these fragments into any of the wound layers subcutaneously or intraperitoneally, that implant fragments from a composite hernioprosthesis with anti-inflammatory and anti-adhesions properties and coated with a polymer composite consisting of the substance of poviargol, which is a metal-polymer composition of highly dispersed metallic silver, stabilized with a synthetic polymer collidone, and medical polyvinylpyrrolidone, and the multifilament non-twisted pneumoconnected non-thermo-fixed polyolefin molecular weight complex is 13 -90000D when the ratio of components, wt.%:
Poviargol Substance 45-55 Medical polyvinylpyrrolidone 45-55

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