Volume 03 Issue 04-2023
95
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
95-99
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
To date, there is no consensus on the question of which tissues are more appropriate to use for tympanic membrane
plastic surgery. We decided to study the use of xenograft from sheep pericardium in tympanoplasty in rabbits in an
experiment with chronic dry mesotympanitis. Experimental morphological studies using a xenograft were carried out
in 28 rabbits. In the experiment, a positive result was obtained in 25 (89.3%), negative in 3 (10.7%) rabbits.
KEYWORDS
Xenograft, tympanoplasty, temporal muscle fascia, flap.
INTRODUCTION
Despite the significant progress made in reconstructive
and restorative surgery of the middle ear over the past
two to three decades, the problem of surgical
restoration of the integrity of the tympanic membrane
Research Article
MORPHOLOGICAL RESULTS WITH THE APPLICATION OF A XENOGRAFT
IN EXPERIMENTAL TYMPANOPLASTY
Submission Date:
April 14, 2023,
Accepted Date:
April 19, 2023,
Published Date:
April 24, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue04-14
K.M. Matkuliev
Researcher Tashkent Medical Academy, Uzbekistan
U.S. Khasanov
Researcher Tashkent Medical Academy, Uzbekistan
G.A. Rakhimjonova
Researcher Tashkent Medical Academy, Uzbekistan
Sh.K. Bakieva
Researcher Tashkent Medical Academy, Uzbekistan
N.N. Abdullaeva
Researcher Tashkent Medical Academy, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 04-2023
96
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
95-99
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
is still relevant. No less important is the problem of
choosing an effective plastic material for the formation
of the neotympanic membrane.
Most otosurgeons prefer the autofascia of the
temporal muscle, which is similar in nature to the
tympanic membrane and convenient to use [9].
However, it, like all soft tissue grafts, often atrophies,
which results in a recurrence of perforation or turns
into a flabby scar, which significantly reduces the
functional effect of the operation [11]. For this reason,
in recent years, more rigid, usually multi-layered grafts
have been used, which provide better morphological
results.
However, due to the use of several heterogeneous
tissues, the formed neotympanic membrane differs
from the natural one in its physical and acoustic
properties, which inevitably affects the functional
result of myringoplasty.
Thus, the current state of the problem of
reconstructive and restorative surgery of the middle
ear, in particular the plastics of tympanic membrane
defects, dictates the urgent need for further search for
both more adequate transplants and improvement of
methods of surgical interventions.
Achievements in reconstructive surgery and tissue
conservation have found their expression in the use of
flaps - homotransplants, mainly from connective tissue
[1] (pericardium, aortic valve, dura mater, sclera,
cornea, etc.). The most popular is the preserved dura
mater,
which
has
low
antigenicity,
good
revascularization, resistance to infections, and quickly
interacts with the receptive bed [4,8].
So V.I. Rodin et al.[5] using the preserved dura mater,
they achieved closure of the tympanic membrane
defect in 93% of patients, but according to M. Tos [7],
the dura mater is quite rigid, dense and thick material,
and this is one of its main drawbacks. Allografts were
also used for myringoplasty: the dura mater of an adult
and fetus [6], the tympanic membrane of an adult and
fetus. Allografts can be transmitters of such dangerous
infections as AIDS, hepatitis, syphilis, as well as genetic
diseases.
Many years of clinical experience with the use of these
grafts in surgical interventions on the middle ear
revealed a number of disadvantages: rejection of the
plastic material, recurrence of perforation in the
neotympanic membrane, the need for additional
operations to collect the graft, which negatively
affects the anatomical and functional results of
surgical treatment of patients . Therefore, in modern
otosurgery, the development of new highly effective
grafts for tympanic membrane defect repair is an
urgent and important problem.
Recently, many foreign authors have used xenografts
for myringoplasty [10,11]. In our republic, R.O.
Mukhamadiev created a xenograft [2] from the
pericardium of sheep (author's certificate No. 002-
03/145 dated March 28, 2003), which was used by the
author extrasclerally for various pathologies of the
organ of vision. The xenograft attracts attention due to
the availability and almost unlimited supply of plastic
material.
The purpose of our study is to experimentally
substantiate the effectiveness of the use of a
xenograft
from
the
sheep
pericardium
in
tympanoplasty.
MATERIAL AND METHODS
Experimental and morphological studies were carried
out on 28 rabbits using a xenograft from sheep
pericardium with dry mesotympanitis on the right ear
Volume 03 Issue 04-2023
97
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
95-99
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
(main group). The control group consisted of the same
rabbits (left ear), in which dry mesotympanitis was
modeled. Morphological features of xenograft
engraftment in experimental animals we made on the
3rd, 7th, 14th, 21st days, 1 month and 3 months after the
operation. In the period from 3 days to 3 months after
the operation, the animals were euthanized by air
embolism and subjected to post-mortem examination.
The extracted xenograft was studied macro- and
microscopically. The pieces were fixed in 10% neutral
formalin solution. After washing in running water,
dehydration was carried out in alcohol and chloroform,
and then they were filled with paraffin and wax.
Histological sections were stained with hematoxylin-
eosin. Collagen fibers were detected by the Vann-
Gieson method.
RESULTS AND DISCUSSION
On the 3rd day after tympanoplasty in the zone and
circumference of the xenograft, dyscirculatory
changes were noted in the form of plethora of vessels
of the microcirculatory bed, diapedetic hemorrhage in
the perivascular zone, expansion of postcapillary
venules, and marginal location of white blood cells.
Directly in the circumference of the transplanted
pericardium, these changes were accompanied by
hemorrhages, loosening and fibrinoid necrosis of the
outer membrane of the pericardium. The fibrous
structures of the middle membranes of the
pericardium were subjected to edema, loosening and
moderate swelling. The above morphological and
functional changes in the soft tissues of the middle ear
indicate the development of acute discirculatory,
edematous-destructive changes in the surgical injury
and xenograft.
On the 7th day after tympanoplasty in the zone and
circumference of the xenograft, dyscirculatory
changes turn into response inflammatory processes in
the form of hyperemia of the vessels of the
microcirculatory bed, thinning of their walls and
migration of both polynuclear and mononuclear
leukocytes
into
the
perivascular
zones.
An
inflammatory infiltrate is formed on the border of the
pericardium and the surrounding tissue. On the part of
the xenograft, loosening and destruction of its outer
shell in the form of fibrinoid necrosis, in which
activated lymphoid and macrophage cells appear, was
noted. In the middle membrane of the pericardium,
against
the
background
of
loosening
and
homogenization of fibrous structures, the appearance
of active cells, both of the proper pericardial and
reactive origin, was noted.
On the 14th day after tympanoplasty, fusion of the
tissue structures of the pericardium with the
surrounding soft tissue and the bone base is noted
along the edges of the xenograft. At the same time, the
tissue structures of the pericardium are completely
destroyed and mixed with the surrounding structural
elements of both soft and bone tissue. From the side
of the skin of the external auditory canal, there was
also a complete fusion of the pericardium with the
structural elements of the skin. Only in the areas of the
surgical incision, the appearance of a small
proliferative infiltration, consisting of granulation
tissue and inflammatory cells, is observed.
21 days after tympanoplasty. There was a decrease in
the volume of destructive changes in the composition
of the xenograft. Maturation and differentiation of
young histiocytic cells of inflamed pericardial foci into
mature histiocytes and fibrocytes were observed with
the development of fibrous structures, which, merging
with the fibrous elements of the pericardium, form
dense and thick fibrillar structures. On the part of the
bone tissue, the appearance of a thin layer similar to
the
periosteum,
consisting
of
cellular-fibrous
Volume 03 Issue 04-2023
98
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
95-99
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
connective tissue, was determined. On the part of the
skin of the external auditory canal, the formation of a
mature connective tissue from the inflammatory-
granulation tissue and its fusion with the fibrous tissue
of the hypodermis and dermis was also noted.
One month after the experiment, the development of
regressive phenomena in the composition of
tympanoplasty and surrounding tissues was noted in
the form of the disappearance of inflammatory cells,
maturation and differentiation of cambial histiocytic
cells into mature histiocytes and fibrocytes. Moreover,
such a regressive differentiation of connective tissue
cells was accompanied by a decrease in their number.
The number of thin-walled vessels also decreased with
stabilization of hemodynamic and edematous
phenomena. Fibrous structures in the composition of
the newly formed connective tissue and pericardium
also decreased in volume, turned into separate
bundles, which were tightly and closely connected on
one side with bone tissue, and on the other with the
dermis of the skin.
3 months after tympanoplasty of the pericardium in
the surgical field, we saw the complete disappearance
of all types of general pathological, inflammatory and
regenerative changes. There was a complete fusion of
the pericardial tissue with the surrounding tissues and
microscopically, both in composition and in maturity,
did not differ from the local connective tissue. Only the
preservation of small areas with moderately
differentiated fibrocytic cells and signs of angiomatosis
was observed.
Macroscopic changes in the xenograft were assessed
using an otoscope and a microscope. According to the
results of experimental studies, it was noted: complete
rejection of the graft 1 (3.57%) 3-day, prolapse of the
graft in the tympanic cavity 1 (3.57%) 14-day, incomplete
healing of the graft 1 (3.57%) 21-day. In the rest of the
experimental animals, a positive macroscopic result
was obtained, that is, the healing rate of the xenograft
from the sheep pericardium during myringoplasty was
89.3%.
Conclusion. A positive macroscopic result of the
healing of a xenograft from the pericardium of a sheep
during tympanoplasty was obtained in 89.3% of rabbits.
When analyzing the above microscopic data, it can be
noted that in the early stages in the zone and
circumference
of
the
xenograft,
reactive
pathomorphological changes of a protective and
restorative nature develop in the form of
discirculation, edema, and loosening of tissue
structures. These changes in the nearest terms of the
experiment turn into an inflammatory-recovery
process in the form of the formation of inflammatory
granulation tissue at the border of the xenograft with
subsequent fusion with the tissue elements of the
pericardium, and from the side of the external auditory
canal it is covered with skin.
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International Journal of Medical Sciences And Clinical Research
(ISSN
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03
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04
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95-99
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(2021:
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Oscar Publishing Services
Servi
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