Are bovine pericardium underlay xenograft and butterfly inlay autograft efficient for transcanal tympanoplasty?

Abstract

To evaluate the success rate and the surgical procedure of two different transcanal myringoplasty techniques using the Tutopatch(®) (Tutogen Medical, Inc., Alachua, FL, USA), a xenograft produced from bovine pericardium or the butterfly, an inlay tragal cartilage autograft. This is a retrospective study. We studied all cases of transcanal myringoplasty with Tutopatch and butterfly, performed by the same surgeon between April 2005 and May 2013. Perforations were secondary to chronic otitis media without cholesteatoma, perforation post ventilation tube or trauma. They were not exceeding one-third of the tympanic membrane surface for the Tutopatch and one quarter for the butterfly. We evaluated the anatomical success rate, complications and postoperative hearing results in both techniques. A total of 106 myringoplasties were performed: 66 with Tutopatch and 40 with butterfly with a mean follow-up of 16.5 and 5.2 months, respectively. Successful closure rates of Tutopatch and butterfly were 75.8% (P < 0.0001) and 85.0% (P < 0.0001), respectively. Myringitis controlled with topical antibiotics treatment occurred in 8 (12.1%) and 5 (12.5%) cases. Eighty percent of patients with Tutopatch had a mean residual air-bone gap within 10 dB, compared to 85.0% in patients with butterfly. When anatomically feasible, a transcanal approach myringoplasty with a Tutopatch(®) graft or butterfly appears to provide good anatomical and functional results. We show that both techniques provide good anatomical and functional results. The butterfly has the advantage to use an autograft, which is surgically easier because it does not require tympanomeatal flap elevation. We recommend the butterfly technique for non-marginal perforation not exceeding one quarter of the tympanic membrane after excision of the perforation edge and Tutopatch for bigger perforation or when standard autografts are not available. Myringitis is the only described complication without specific incidence.

A Comprehensive Comparison of Bovine and Porcine Decellularized Pericardia: New Insights for Surgical Applications

“…Decellularized xenogeneic pericardia of different species [18,19,21,30], preferentially bovine, have been demonstrated to offer similar advantages and overcome the restrictions of human and GA-treated heterologous tissues in reconstructive or substitutive surgery [22][23][24][25][26][27][28][29]. Yet, no comparative studies have thoroughly investigated the decellularization effects on tissues from different species.…”

“…Nowadays, the clinical experience with heterologous acellular pericardium is still restricted, with few indications being available on the real long-term performance. Xenogeneic commercial products, as Tutopatch TM [18], Cova TM [19], Jason® [8], Integra® [20], and Osteokor pericardia [21], were released to treat several defects, requiring dura mater plastics, myringoplasty, digestive tissue reconstructions, bone and dental surgeries, cardiac corrections, or soft tissue augmentation to ameliorate facial and breast esthetics [22][23][24][25][26][27][28][29]. To prevent zoonosis risks, as Creutzfeldt-Jacobs disease, bovine tissues are derived from prion-free certified herd.…”

“…Almost 40 years ago, Tutogen medical (Alachua, FL, USA) developed the Tutoplast®technology to generate the bovine pericardial scaffolds Tutopatch TM and Tutomesh TM . These devices were suitable in spinal dura mater reconstruction and in transcanal tympanoplasty [23,24,28]. PhotoFix®-a photo-fixed, decellularized bovine pericardial patch-revealed excellent performance in congenital cardiac surgery, similarly to autologous pericardium [30,31].…”

Investigation of Novel Grafts in Use for Pediatric Tympanoplasty

“…Other retrospective analyses in the literature have evaluated the performance of acellular dermal allograft versus natural autografts and demonstrated comparable outcomes among patients despite graft type. [19][20][21] Declau et al 22 analyzed the outcomes of xenograft versus human allograft materials, whereas de Dorlodot et al 23 looked at outcomes of xenografts compared with traditional human autografts. Neither found comparable differences in outcomes.…”

An alternative to skin graft for superficial surgical defect in oral cancer surgery

“…It has been used in different surgical reconstructions, but at the time of this writing its use in ENT surgery is limited to the repair of the tympanic membrane perforation. 2 , 3 According to the manufacturer’s instructions, Tutopatch® facilitates closure of the tissue defect by acting as a template for the repair mechanism: over weeks or months, depending on the characteristics of the surgical defect and the patient’s comorbidities, the graft is progressively absorbed and replaced by the patient’s autologous tissue.…”