New concepts of reconstructive techniques with human amniotic membrane in pelvic floor surgery

Barski Dimitri
New concepts of reconstructive techniques with human amniotic membrane in pelvic floor surgery.
Doctoral thesis (PhD), University of Szeged.
(2018) (Unpublished)

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Abstract in foreign language

1. SUMMARY Due to the aging of society and the growing number of oncology cases, there is a need for new and efficient reconstruction techniques in urology. Native tissue is often not available or can be in bad condition after multimodal treatments with surgery and radio-chemotherapy. Various methods and materials have been developed to date to replace the damaged tissues. The possible indications embrace the partial or complete replacement of the ureter, bladder or urethra, repair of complex fistulas and protection of anastomoses. One of the strongest tissues in the human body and one with multiple growth factors, human amniotic membrane (HAM) could serve as a potential graft in reconstructive urology. Amniotic tissue can be easily harvested during Caesarean sections and is therefore broadly available. However, by now its application is limited to cornea replacement and burn therapy. Therefore, our first aim was to develop a manufacturer-independent, standardized in vitro process for the preparation of amnion grafts. In this line, we planned to develop a sterilization and storage technique for frozen and dried HAM with a preserved extracellular matrix. As a next step, we employed an in vivo xenologous model to test previously constructed multilayer HAM grafts and to investigate the capacity to repair small defects in the rat bladder and intestinal tract. HAM provided a durable graft with good functional and histological results for bladder grafting. The initial inflammatory reaction decreased, with no signs of degradation observed over six weeks of follow-up and only subtle signs of graft rejection detected. However, HAM was not suitable for intestinal reconstruction due to an increased rate of adhesions. Next, by following the steps in the Innovation, Development, Exploration, Assessment and Long-term Study for Devices (IDEAL-D) system of surgical innovation, we defined possible human indications. The first-inhuman stage of innovation involved clinical cases of complex fistulas, a vesico-vaginal fistula and a chronic wound with an entero-cutaneous fistula, which were treated successfully with HAM allografts. Based on the promising clinical data, further directions could be planned, targeting ureteral reconstruction or the protection of urethra anastomoses.

Item Type: Thesis (Doctoral thesis (PhD))
Creators: Barski Dimitri
Position, academic title, institution
MTMT author ID
Boros Mihály
tanszékvezető egyetemi tanár, az MTA doktora, SZTE ÁOK Sebészeti Műtéttani Intézet
Subjects: 03. Medical and health sciences > 03.01. Basic medicine
Divisions: Doctoral School of Multidisciplinary Medical Sciences
Discipline: Medicine > Theoretical Medicine
Language: English
Date: 2018. June 15.
Item ID: 9791
MTMT identifier of the thesis: 30611667
Date Deposited: 2018. May. 04. 12:12
Last Modified: 2020. Jun. 17. 10:06
Defence/Citable status: Defended.

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