Effectiveness of degradable and non-degradable implants to close large septal perforations in an experimental model

Abstract

Background Reparation of large nasal septum perforations continues to be challenging. Bipedicled mucoperichondrial and inter-positional grafts currently show the most promising results. New implants have emerged to be used as a support membrane to carry on the mucosal cells, taking advantage of the innate proliferative properties of the mucosal tissue. Objective To compare the effectiveness of two kinds of material; non-absorbable dimethylsiloxane (silicone elastomers) and absorbable porcine small intestinal submucosa (Surgisis), both used as an inter-positional graft without neighbouring flaps to close nasal septal perforations in an experimental model. Methods Fifteen dogs were divided into three groups. One group received Surgisis, the other sheets of dimethylsiloxane and the last group a sham group. The dogs were followed for 6 weeks. Results The initial perforation of the nasal septum showed complete mucosal closure in the dimethylsiloxane group. The Surgisis group, on the other hand, had a smaller reduction than that at the beginning (final mean area = 23.0 ± 5.4 mm² (p < 0.05); however, complete closure was not achieved. Sham animals showed an inconstant and slight reduction in dimension from 100 mm² to 70 ± 16 mm² of mucosa and cartilage, but closure was not achieved. A significantly higher number of capillaries were observed in the Surgisis group compared to the dimethylsiloxane group (p < 0.05) without differences in inflammation, fibrosis, or necrosis. Conclusions The non-absorbable implant; dimethylsiloxane facilitates a better closure of the nasal septum.

Keywords:

• Nasal septal perforation
• surgisis
• porcine small intestinal submucosa
• silicone elastomer

Acknowledgements

Surgisis^® GOLD™ was acquired from Cook Surgical Company, product number C-SAH-8P-7X10. Thin sheets of Dimethylsiloxane were designed of smooth breast implant acquired from Allergan Company. The protocol was reviewed and accepted by the bioethics and investigation local committee of the Cardiovascular Investigation Unit (registration code: CBO 20120302). Dolichocephalic dogs were provided by the Biotery of the University of Guadalajara.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.