Skin and bone integrated prosthetic pylon: A pilot animal study
| Autor: | Oleg V. Galibin, Protasov Mv, Grigory Raykhtsaum, Mark Pitkin, Irina G. Belyaeva, Julie V. Chihovskaya |
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| Rok vydání: | 2006 |
| Předmět: |
Male
Materials science Joint replacement medicine.medical_treatment Dermatologic Surgical Procedures chemistry.chemical_element Artificial Limbs Pilot Projects Skin infection Prosthesis Article Osseointegration Skin Physiological Phenomena medicine Animals Rats Wistar Rehabilitation Biomaterial medicine.disease Rats Amputation chemistry Models Animal Implant Biomedical engineering Titanium |
| Zdroj: | The Journal of Rehabilitation Research and Development. 43:573 |
| ISSN: | 0748-7711 |
| DOI: | 10.1682/jrrd.2005.05.0160 |
| Popis: | Direct skeletal attachment of limb prostheses is a viable alternative to traditional techniques that are based on a socket-residuum interface. Direct skeletal attachment may be a better or even the only method for patients with a very short residuum and high soft-tissue volume. The problem of integrating the prosthetic pylon with residual skin during direct skeletal attachment of a limb prosthesis has not been solved, and the use of a completely porous prosthetic pylon has not been the subject of focused, systematic research. In this in vivo study, we investigated cell (osteocyte, fibroblast, and keratinocyte) adhesion and penetration into the pores of a titanium pylon implanted in Wistar rats. The porous titanium pylon was implanted in the bone of the thigh residua of four rats. Electronic scanning and morphological analysis demonstrated integration of the pylon with the surrounding skin. These findings support the possibility of developing a natural barrier against the infection associated with direct skeletal attachment of limb prostheses. Key words: amputation, animal model, cell adhesion, osseointegration, porous titanium, prosthetic pylon, rehabilitation, residuum, skin infection, skin ingrowth. INTRODUCTION The technology of direct skeletal attachment of limb prostheses, called osseointegration, was introduced in the 1990s [1]. In osseointegration, a titanium fixture is inserted into the bone remnant of the residuum and a skin-penetrating abutment is used for attaching the prosthesis. Despite the promising integration of a titanium implant with residual bone, the problem of the device-skin interface where the implant penetrates the residual limb remains unsolved [2]. Attempts at optimizing the roughness of the abutment to achieve a reliable device-skin interface were unsuccessful [3], and ongoing subject trials use abutments with a smooth surface [4]. Without a reliable device-skin interface, the surrounding skin can move freely along the device, which causes the formation of a layer of pus between the skin and titanium fixture (Figure 1). A study on 11 patients who underwent this procedure in England revealed 46 episodes of superficial infection in 6 patients and deep infection in 1 [4]. [FIGURE 1 OMITTED] Infection on percutaneous devices in dentistry, joint replacement, and vascular surgery has been the subject of intense study. Implants may be colonized by airborne, skin, and/or surgeon-related bacteria during surgery despite use of closely monitored surgical techniques. After successful attachment on the biomaterial surface, bacteria multiply and form a "biofilm" community, which makes them much more resistant to antibiotic therapy and host immunity [5]. Strategies for reducing skin infection in direct skeletal attachment of limb prostheses include surface and shape modification of the percutaneous device [6-8], the addition of antimicrobials to the surface of the device, and chemical modifications, which reduce bacterial attachment [9]. Thus far, these strategies have been unsuccessful. For reduced risk of infection in the abutment-skin area, we proposed the use of a porous titanium structure and conducted in vitro and in vivo pilot studies with porous titanium pellets [10-12]. The pellets met the following specifications: (1) titanium grade American Society for Testing Materials (ASTM) F-67 unalloyed titanium for surgical implants, (2) average sphere size of 450 [micro]m, (3) porosity of 30 percent, (4) diameter of 1.6 mm, and (5) thickness of 0.32 cm. After sterilization, the pellets were seeded with human dermal fibroblasts and stromal cells of rabbit bone marrow and cultured for 7 days. The following pellet treatments were performed: (1) 1:1 mixture of collagen and histone, (2) histone, (3) collagen, and (4) nontreated (control). Human dermal fibroblasts were plated on the treated pellets in a concentration of 25 x 104 cells/mL and cultured for 7 days. … |
| Databáze: | OpenAIRE |
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