Failure pressures after repairs of 2-cm × 2.5-cm rhinologic dural defects in a porcine ex vivo model

• Published in: International forum of allergy & rhinology 2016-10, Vol.6 (10), p.1034-1039
• Main Authors: Lin, Ryan P., Weitzel, Erik Kent, Chen, Philip G., McMains, Kevin Christopher, Chang, Daniel R., Braxton, Ernest E., Majors, Jacob, Bunegin, Leon
• Format: Article
• Language: English
• Subjects: Adhesives; Animals; CSF leak repair; Disease Models, Animal; dura; Dura Mater - abnormalities; Dura Mater - physiology; Dura Mater - surgery; failure strength; Fascia Lata - transplantation; porcine; Pressure; Reconstructive Surgical Procedures; rhinology; Skull Base - abnormalities; Skull Base - physiology; Skull Base - surgery; skull-base; Swine; Transplants
• ISSN: 2042-6976; 2042-6984
• DOI: 10.1002/alr.21804

Background 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. Methods 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. Results 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). Conclusion 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.