Changing Lives through Tissue Donation

Bruce W. Stroever, President & CEO Musculoskeletal Transplant Foundation

MTF is an AATB accredited, non-profit tissue bank located in NJ

MTF provides over 400,000 grafts per year throughout the US

Partnered with Gift of Life Michigan for over 20 years in the recovery, processing and distribution of tissues to hospitals in Michigan

MTF is a non-profit service organization

dedicated to providing quality tissue

through a commitment to excellence in

education, research, recovery and care for

recipients, donors and their families.

MTF Mission Statement

Two Novel Tissue Forms

Flex HD – Acellular dermis

Trinity Evolution – Viable cryopreserved cellular bone matrix

Acellular Dermis

Used primarily for:Abdominal wall repairReconstruction following mastectomy

Essentially a sheet of human collagen processed from human skin

What Makes a Good Hernia Repair Material?

Strong enough to withstand physiological stress over a period of time

Conforms to the abdominal wall

Promotes strong host ingrowth, which mimics normal healing

Resists formation of bowel adhesions and erosion into visceral structures

Doesn’t induce allergic or foreign body reaction

Resists infection

What Makes a Good Hernia Repair Material?

Strong enough to withstand physiological stress over a period of time

Conforms to the abdominal wall

Promotes strong host ingrowth, which mimics normal healing

Resists formation of bowel adhesions and erosion into visceral structures

Doesn’t induce allergic or foreign body reaction

Resists infection

RevascularizationGross examination of acellular dermal matrix after 8 weeks in rabbit study revealed neovascularization around graft perimeter

Source: FlexHD Acellular Dermal Matrix. Histology: In Vitro and In Vivo Studies

Acellularity

Before Processing After Processing

• Processing removes cells and maintains matrix integrity

• Intact matrix structure allows for cell infiltration and revascularization

Source: FlexHD Acellular Dermal Matrix. Histology: In Vitro and In Vivo Studies

Preserved CollagenElastin, in conjunction with collagen, contributes to the

strength and structure of the dermal matrix scaffold

Source: FlexHD Acellular Dermal Matrix. Histology: In Vitro and In Vivo Studies

Magnification shows collagen fibrils in normal skin (left) and acellular dermis (right).

Abdominal Wall RepairWound dehiscence

Trauma

Infected sites

Source: T.N. Robinson et al, Major mesh-related complications following hernia repair: events reported to the Food and Drug Administration. Surgical Endoscopy 2005; 19:1556-1560.

Source: DermaMatrix Acellular Dermis brochure

General - Applications

Abdominal Wall Repair

Plastic - Applications

Source: DermaMatrix Acellular Dermis brochure

Breast Reconstruction – Post Mastectomy

10 monthsPost-OpPre-op

*All images and patient data owned by E. Parra-Davila, MD, permitted use by MTF only. Do not redistribute

Case Studies: Repair and Reconstruction

A Major Concern of the Surgeon is the Size of the Graft

Use of dermatomes – 8cm maximum widthShift to free hand dissection – 20 x 24cmSkill of the recovery team is key to

producing large grafts

Viable Cryopreserved Cellular Bone Matrix

Trinity Evolution

Trinity Evolution: Inception

Background:Stem cells are critical in facilitating bone repairBone marrow aspirates containing live stem cells often

taken from the patient during surgery and combined with bone graft for fusion/bone healing applications

Limitations include limited volume and second surgery site

Trinity Evolution concept:Novel tissue form containing viable stem cells inside an

allograft bone matrix

Bone Formation

Osteoconductive(Scaffold)

Osteoinductive(Growth Factors)

Osteogenic(Living Cells)

Autograft

Allograft

Synthetics

BMP

DBM

Trinity Evolution

Structure & Function

What are the key characteristics of Trinity Evolution?

Osteoconductive Matrix Osteoinductive Factors Osteogenic Cells

Stem Cell Characterization

CD166 positive Osteocalcin positive

Trinity Evolution contains stem cells that are capable of forming bone

Production in the Core

3 teams work around-the-clock Processing completed within 96

hours post mortem

Processing technology maintains:Cell viability Cell location within the matrix

Cryopreservation at MTF

Clinical Applications

To expedite the bone healing process for spinal and orthopaedic needs

Spinal Fusion

Critical Issues for Fresh/Viable Allografts

Time Time Time – the current shelf life of Trinity Evolution is about 6 monthsAll paperwork and testing must be expedited

for tissue to be usable

Sterile TechniqueThese tissues are processed at riskMore than 15% of all donors are rejected

following recoveryNo graft sterilization is possible

Thank You