A one stage versus two stage surgical technique. Tissue reaction to a percutaneous device provided with titanium fiber mesh applicable for peritoneal dialysis.

ABSTRACT

A percutaneous device, provided with a sintered titanium fiber web structure, was designed for implantation in soft tissue. The percutaneous device was inserted by a two stage surgical technique. Between the insertion of the subcutaneous and percutaneous part was an intervening healing period of 3 months. However, most clinicians prefer a one stage implant. Therefore, the authors wanted to investigate the soft tissue response to one stage and two stage percutaneous devices. The implants were inserted in the flanks of 12 goat. In each goat, one one stage and one two stage implant were placed and inspected on a regular base. It appeared that, during the experiments, significantly more one stage devices were extruded. Four months after the second surgical session, all successful implants with their surrounding tissues were retrieved for light microscopic and histomorphometric analysis. No difference in epidermal downgrowth and sulcus width was demonstrated between the implants. Furthermore, the fiber mesh was surrounded by a thin fibrous capsule free from inflammatory cells. Inside the fiber mesh structure, connective tissue was present with only scattered foci of inflammatory cells. An enhanced inflammatory tissue response was found inside the titanium mesh of one stage compared to two stage implants. This study showed that the two stage surgical procedure for implantation of a percutaneous device worked better than the one-stage surgical technique.