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Wang Z, Hu K, Jiang Y, Zhang X, Zhao P, Li X, Ding F, Liu C, Yi S, Ren Z, Liu W, Ma B. Remodeling and Regenerative Properties of Fully Absorbable Meshes for Abdominal Wall Defect Repair: A Systematic Review and Meta-Analysis of Animal Studies. ACS Biomater Sci Eng 2024; 10:3968-3983. [PMID: 38788683 DOI: 10.1021/acsbiomaterials.4c00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Fully absorbable meshes can repair abdominal wall defects and effectively reduce the incidence of complications, but different types of fully absorbable meshes have different remodeling and regeneration effects. In order to investigate and compare the effects of different fully absorbable meshes on remodeling and regeneration in animals and reduce the biological risk of clinical translation, SYRCLE was adopted to evaluate the methodological quality of the included studies, and GRADE and ConQual were used to evaluate the quality of evidence. According to the inclusion and exclusion criteria, a total of 22 studies related to fully absorbable meshes were included in this systematic review. These results showed that fiber-based synthetic materials and fiber-based natural materials exhibited better restorative and regenerative effects indicated by infiltration and neovascularization, when compared with a porcine acellular dermal matrix. In addition, the human acellular dermal matrix was found to have a similar regenerative effect on the host extracellular matrix and scaffold degradation compared to the porcine acellular dermal matrix, porcine intestinal submucosa, and fiber-based natural materials, but it offered higher tensile strength than the other three. The quality of the evidence in this field was found to be poor. The reasons for downgrading were analyzed, and recommendations for future research included more rigor in study design, more transparency in result reporting, more standardization of animal models and follow-up time for better evaluation of the remodeling and regenerative performance of abdominal wall hernia repair meshes, and less biological risk in clinical translation.
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Affiliation(s)
- Zhe Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Kaiyan Hu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Yanbiao Jiang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xu Zhang
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing 100081, China
| | - Peng Zhao
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing 100081, China
| | - Xingzhi Li
- School of Basic Medicine, Xinxiang Medical University, Xinxiang 453000, China
| | - Fengxing Ding
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Chen Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Shaowei Yi
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Ziyu Ren
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Wenbo Liu
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing 100081, China
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Key Laboratory of Evidence-Based Medicine of Gansu Province, Lanzhou 730000, China
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Peró M, Casani L, Castells-Sala C, Pérez ML, Moga Naranjo E, Juan-Babot O, Alserawan De Lamo L, López-Chicón P, Vilarrodona Serrat A, Badimon L, Porta Roda O. Rabbit as an animal model for the study of biological grafts in pelvic floor dysfunctions. Sci Rep 2021; 11:10545. [PMID: 34006889 PMCID: PMC8131625 DOI: 10.1038/s41598-021-89698-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Abstract
The aims of this study were to evaluate the feasibility of the New Zealand White (NZW) rabbit for studying implanted biomaterials in pelvic reconstructive surgery; and to compare the occurrence of graft-related complications of a commercial polypropylene (PP) mesh and new developed human dermal matrix implanted at vaginal and abdominal level. 20 white female NZW rabbits were randomized into two groups, experimental group (human acellular dermal matrices-hADM-graft) and control group (commercial PP graft). In each animal, grafts were surgically implanted subcutaneously in the abdominal wall and in the vaginal submucosa layer for 180 days. The graft segments were then removed and the surgical and clinical results were analyzed. The main surgical challenges during graft implantation were: (a) an adequate vaginal exposure while maintaining the integrity of the vaginal mucosa layer; (b) to keep aseptic conditions; (c) to locate and dissect the breast vein abdominal surgery; and (d) to withdraw blood samples from the ear artery. The most abnormal findings during the explant surgery were found in the PP group (33% of vaginal mesh extrusion) in comparison with the hADM group (0% of vaginal graft extrusion), p = 0.015. Interestingly, macroscopic observation showed that the integration of the vaginal grafts was more common in the hADM group (40%) than in the PP group, in which the vaginal mesh was identified in 100% of the animals (p = 0.014). The NZW rabbit is a good model for assessing materials to be used as grafts for pelvic reconstructive surgery and vaginal surgery. Animals are easily managed during the procedures, including surgical intervention and vaginal mucosa approach. Additionally, hADM is associated with fewer clinical complications, as well as better macroscopic tissue integration, compared to PP mesh.
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Affiliation(s)
- Marta Peró
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer Sant Quintí, 89, 08041, Barcelona, Spain.
| | - Laura Casani
- Research Institute of the Hospital de Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Cristina Castells-Sala
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Maria Luisa Pérez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Esther Moga Naranjo
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Juan-Babot
- Research Institute of the Hospital de Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Leticia Alserawan De Lamo
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia López-Chicón
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Anna Vilarrodona Serrat
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Lina Badimon
- Research Institute of the Hospital de Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Oriol Porta Roda
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer Sant Quintí, 89, 08041, Barcelona, Spain
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Liu Z, Wei N, Tang R. Functionalized Strategies and Mechanisms of the Emerging Mesh for Abdominal Wall Repair and Regeneration. ACS Biomater Sci Eng 2021; 7:2064-2082. [PMID: 33856203 DOI: 10.1021/acsbiomaterials.1c00118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Meshes have been the overwhelmingly popular choice for the repair of abdominal wall defects to retrieve the bodily integrity of musculofascial layer. Broadly, they are classified into synthetic, biological and composite mesh based on their mechanical and biocompatible features. With the development of anatomical repair techniques and the increasing requirements of constructive remodeling, however, none of these options satisfactorily manages the conditional repair. In both preclinical and clinical studies, materials/agents equipped with distinct functions have been characterized and applied to improve mesh-aided repair, with the importance of mesh functionalization being highlighted. However, limited information exists on systemic comparisons of the underlying mechanisms with respect to functionalized strategies, which are fundamental throughout repair and regeneration. Herein, we address this topic and summarize the current literature by subdividing common functions of the mesh into biomechanics-matched, macrophage-mediated, integration-enhanced, anti-infective and antiadhesive characteristics for a comprehensive overview. In particular, we elaborate their effects separately with respect to host response and integration and discuss their respective advances, challenges and future directions toward a clinical alternative. From the vastly different approaches, we provide insight into the mechanisms involved and offer suggestions for personalized modifications of these emerging meshes.
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Affiliation(s)
- Zhengni Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Nina Wei
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Rui Tang
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
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Roth JS, Anthone GJ, Selzer DJ, Poulose BK, Pierce RA, Bittner JG, Hope WW, Dunn RM, Martindale RG, Goldblatt MI, Earle DB, Romanelli JR, Mancini GJ, Greenberg JA, Linn JG, Parra-Davila E, Sandler BJ, Deeken CR, Verbarg J, Salluzzo JL, Voeller GR. Prospective, multicenter study of P4HB (Phasix™) mesh for hernia repair in cohort at risk for complications: 3-Year follow-up. Ann Med Surg (Lond) 2021; 61:1-7. [PMID: 33363718 PMCID: PMC7750179 DOI: 10.1016/j.amsu.2020.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study represents a prospective, multicenter, open-label study to assess the safety, performance, and outcomes of poly-4-hydroxybutyrate (P4HB, Phasix™) mesh for primary ventral, primary incisional, or multiply-recurrent hernia in subjects at risk for complications. This study reports 3-year clinical outcomes. MATERIALS AND METHODS P4HB mesh was implanted in 121 patients via retrorectus or onlay technique. Physical exam and/or quality of life surveys were completed at 1, 3, 6,12, 18, 24, and 36 months, with 5-year (60-month) follow-up ongoing. RESULTS A total of n = 121 patients were implanted with P4HB mesh (n = 75 (62%) female) with a mean age of 54.7 ± 12.0 years and mean BMI of 32.2 ± 4.5 kg/m2 (±standard deviation). Comorbidities included: obesity (78.5%), active smokers (23.1%), COPD (28.1%), diabetes mellitus (33.1%), immunosuppression (8.3%), coronary artery disease (21.5%), chronic corticosteroid use (5.0%), hypo-albuminemia (2.5%), advanced age (5.0%), and renal insufficiency (0.8%). Hernias were repaired via retrorectus (n = 45, 37.2% with myofascial release (MR) or n = 43, 35.5% without MR), onlay (n = 8, 6.6% with MR or n = 24, 19.8% without MR), or not reported (n = 1, 0.8%). 82 patients (67.8%) completed 36-month follow-up. 17 patients (17.9% ± 0.4%) experienced hernia recurrence at 3 years, with n = 9 in the retrorectus group and n = 8 in the onlay group. SSI (n = 11) occurred in 9.3% ± 0.03% of patients. CONCLUSIONS Long-term outcomes following ventral hernia repair with P4HB mesh demonstrate low recurrence rates at 3-year (36-month) postoperative time frame with no patients developing late mesh complications or requiring mesh removal. 5-year (60-month) follow-up is ongoing.
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Affiliation(s)
- John Scott Roth
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY, USA
| | - Gary J. Anthone
- Department of Surgery, Methodist Health System, Omaha, NE, USA
| | - Don J. Selzer
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin K. Poulose
- Center for Abdominal Core Health, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Richard A. Pierce
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James G. Bittner
- Department of Surgery, Saint Francis Hospital, Hartford, CT, USA
| | - William W. Hope
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Raymond M. Dunn
- Department of Surgery, University of Massachusetts Worcester, Worcester, MA, USA
| | | | - Matthew I. Goldblatt
- Department of Surgery, The Medical College of Wisconsin, Inc., Milwaukee, WI, USA
| | - David B. Earle
- Department of Surgery, New England Hernia Center, Lowell, MA, USA
| | - John R. Romanelli
- Department of Surgery, Baystate Medical Center, Springfield, MA, USA
| | - Gregory J. Mancini
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jacob A. Greenberg
- Department of Surgery, Board of Regents of the University of Wisconsin System, Madison, WI, USA
| | - John G. Linn
- Department of Surgery, North Shore University Health System, Evanston, IL, USA
| | | | - Bryan J. Sandler
- Department of Surgery, The Regents of the University of California, San Diego, CA, USA
| | | | | | | | - Guy R. Voeller
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
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Pulley Release and Reconstruction With Acellular Dermal Matrix After Zone 2 Flexor Tendon Injury. Tech Hand Up Extrem Surg 2020; 25:120-122. [PMID: 32925522 DOI: 10.1097/bth.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Zone 2 flexor tendon repair has been historically associated with poor outcomes, mainly due to stiffness. In an effort to minimize adhesions, accommodate flexor digitorum profundus and flexor digitorum superficialis bulk, and prevent bowstringing, we have developed a novel approach to flexor tendon repair that relies on aggressive flexor tendon pulley release and pulley reconstruction with acellular dermal matrix. This technique leverages the antiadhesive properties and high tensile strength of acellular dermal matrix to maximize gliding and prevent bowstringing. Here we describe the details of our technique and illustrate a case where this technique was employed.
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Ge F, Lu Y, Li Q, Zhang X. Decellularized Extracellular Matrices for Tissue Engineering and Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1250:15-31. [DOI: 10.1007/978-981-15-3262-7_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Application of Acellular Tissue Matrix for Enhancement of Weak Abdominal Wall in Animal Model. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3475289. [PMID: 32258114 PMCID: PMC7091519 DOI: 10.1155/2020/3475289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 12/16/2022]
Abstract
Background Abdominal wall weakness occurs when the strength of muscle decreases due to physiological reason or iatrogenic injury. However, the treatment of this disease is complicated. Aim To study the therapeutic effect of acellular tissue matrix (ACTM), compared with the polypropylene mesh. Methods An abdominal wall weakness model was established in rabbits through motor nerves cutting. The polypropylene mesh and ACTM were implanted in the left and right abdomen sides, respectively. Mechanical testing of abdominal wall muscle and histology and scanning electron microscopy (SEM) evaluation of abdominal tissue explants were performed. Results In animal model establishment, the abdominal length of healthy and weakened abdominal wall was 17.0 ± 0.7 cm and 19.0 ± 1.2 cm, respectively (P=0.022), and the weak abdominal wall group showed a significant decrease of 1.116 ± 0.221 MPa in tensile stress (P=0.022), and the weak abdominal wall group showed a significant decrease of 1.116 ± 0.221 MPa in tensile stress (P=0.022), and the weak abdominal wall group showed a significant decrease of 1.116 ± 0.221 MPa in tensile stress (P=0.022), and the weak abdominal wall group showed a significant decrease of 1.116 ± 0.221 MPa in tensile stress (P=0.022), and the weak abdominal wall group showed a significant decrease of 1.116 ± 0.221 MPa in tensile stress (P=0.022), and the weak abdominal wall group showed a significant decrease of 1.116 ± 0.221 MPa in tensile stress (P=0.022), and the weak abdominal wall group showed a significant decrease of 1.116 ± 0.221 MPa in tensile stress ( Conclusion The abdominal wall weakness model in rabbits was successfully established. ACTM is a promising biological material to be possibly further applied in clinical surgery in patients with abdominal wall weakness.
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Cornwell KG, Jessee CB, Adelman DM. Clinically available reinforcing materials for soft tissue reconstruction. Br J Hosp Med (Lond) 2020; 81:1-10. [PMID: 32240006 DOI: 10.12968/hmed.2018.0428b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Navigating the rapidly evolving field of materials for soft tissue reinforcement is challenging given the volume of clinically available options. Additionally, the current generally accepted classifications of these mesh materials confound the understanding of their utility by grouping disparate materials that have attributes overlapping category boundaries and that do not fully consider their clinically functionality. This review article highlights, from a materials science perspective, the most important attributes of these materials to improve the clinical decision-making process in the selection of the most appropriate features and design for the patient, surgery and clinical need. These characteristics include the physical attributes that directly impact the surgical procedure and immediate postoperative mechanical requirements as well as the post-implantation properties such as an adequate reinforcement time, strength of the resulting tissue and infection risk profile.
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Affiliation(s)
| | | | - David M Adelman
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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Powers SA, Burleson LK, Hannan JL. Managing female pelvic floor disorders: a medical device review and appraisal. Interface Focus 2019; 9:20190014. [PMID: 31263534 DOI: 10.1098/rsfs.2019.0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 02/07/2023] Open
Abstract
Pelvic floor disorders (PFDs) will affect most women during their lifetime. Sequelae such as pelvic organ prolapse, stress urinary incontinence, chronic pain and dyspareunia significantly impact overall quality of life. Interventions to manage or eliminate symptoms from PFDs aim to restore support of the pelvic floor. Pessaries have been used to mechanically counteract PFDs for thousands of years, but do not offer a cure. By contrast, surgically implanted grafts or mesh offer patients a more permanent resolution but have been in wide use within the pelvis for less than 30 years. In this perspective review, we provide an overview of the main theories underpinning PFD pathogenesis and the animal models used to investigate it. We highlight the clinical outcomes of mesh and grafts before exploring studies performed to elucidate tissue level effects and bioengineering considerations. Considering recent turmoil surrounding transvaginal mesh, the role of pessaries, an impermanent method, is examined as a means to address patients with PFDs.
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Affiliation(s)
- Shelby A Powers
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
| | - Lindsey K Burleson
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
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A biological or a synthetic mesh in immediate breast reconstruction? A cohort-study of long-term Health related Quality of Life (HrQoL). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:1812-1816. [PMID: 30905394 DOI: 10.1016/j.ejso.2019.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/14/2019] [Accepted: 03/10/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Meshes/matrices are commonly used in immediate breast reconstruction. There are few studies comparing biological and synthetic meshes and it is unknown what type of mesh gives the best long-term results. The aim of this study was to compare long-term health-related quality of life (HrQoL) and patient satisfaction in implant-based immediate breast reconstruction with a biological mesh (Surgisis®) with that of patients reconstructed with a synthetic mesh (TIGR ® Matrix Surgical Mesh). MATERIAL AND METHODS Both cohorts were prospectively included and consecutively operated. Clinical data was collected. HrQoL was evaluated with EuroQoL-5 dimension - 3 levels questionnaire (EQ-5D-3L) and the Hospital Anxiety and Depression Scale (HADS) and the Breast-Q. RESULTS AND CONCLUSION Seventy-one patients were operated on in the biological group and 49 in the synthetic group. The response rates were 75 and 84 per cent, respectively. Mean follow-up time was 74 months and 23 months, respectively. There were no statistical differences in satisfaction and quality of life between the two groups. Complications and radiation seem to lead to a lower satisfaction. Our findings could indicate that biological and synthetic meshes give an equal long-term result as regards patients' perceived quality of life.
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Wang D, Ji ZL, Wang JM, Tan YY. Bone morphogenetic protein-12 inducing tenogenic differentiation of mesenchymal stem cells enhances healing of linea alba incision. Exp Ther Med 2018; 16:5067-5072. [PMID: 30542461 PMCID: PMC6257649 DOI: 10.3892/etm.2018.6861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022] Open
Abstract
The objective of this study was to investigate the curative effects of mesenchymal stem cells' tenogenic differentiation on linea alba incision healing induced by bone morphogenetic protein-12. Mesenchymal stem cells were isolated and induced by 10 ng/ml of bone morphogenetic protein-12 for 48 h. Expression of scleraxis, collagen I and collagen III were examined at 48 h, 5 and 7 days to investigate the tenogenic differentiation. The expression of scleraxis increases continually even in the absence of bone morphogenetic protein-12 for 5 days (P<0.01). The expression of collagen I and III requires persistent inducing. Then fifty Sprague-Dawley rats were randomly divided into five groups: negative control, positive control, sham group, native mesenchymal stem cells and tenogenically differentiated mesenchymal stem cells. Tensiometric testing and modified semiquantitative histological analysis were performed to explore the curative effects. The tension levels in the positive control, sham, native mesenchymal stem cells and tenogenically differentiated mesenchymal stem cells were 44, 41.8, 51.6 and 69.7%, respectively, compared with the negative control. Tenogenically differentiated mesenchymal stem cells exhibited a greater increase in tension compared with positive control, sham and native mesenchymal stem cell groups (P<0.05). From the sections stained with Masson's Trichrome, collagen organization and amount of tenogenically differentiated mesenchymal stem cells was better than the other three groups (P<0.05). In conclusion, mesenchymal stem cells' tenogenic differentiation induced by bone morphogenetic protein-12 can enhance linea alba incision healing.
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Affiliation(s)
- Dong Wang
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Zhen-Ling Ji
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Jing-Min Wang
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Yu-Yan Tan
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, P.R. China
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12
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Integration of Biomechanical and Biological Characterization in the Development of Porous Poly(caprolactone)-Based Membranes for Abdominal Wall Hernia Treatment. INT J POLYM SCI 2018. [DOI: 10.1155/2018/2450176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aims. Synthetic meshes are the long-standing choice for the clinical treatment of abdominal wall hernias: the associated long-term complications have stimulated the development of a new generation of bioresorbable prostheses. In this work, polycaprolactone (PCL) porous membranes prepared by solvent casting/porogen leaching of PCL/poly(ethylene glycol) (PEG) blends with different compositions (different PCL/PEG weight ratios and PEG molecular weights) were investigated to be applied in the field. An optimal porous membrane structure was selected based on the evaluation of physicochemical, biomechanical, and in vitro biological properties, compared to a reference commercially available hernia mesh (CMC). Findings. Selected PCL7-2i membranes, derived from PCL/PEG 70/30 (PCL: Mw 70,000-90,000 Da; PEG: 35,000 Da), showed suitable pore size for the application, intermediate surface hydrophilicity, and biomimetic mechanical properties. In vitro cell tests performed on PCL7-2i membranes showed their cytocompatibility, high cell growth during 21 days, a reduced production of proinflammatory IL-6 with respect to CMC, and a significant secretion of collagen type I. Conclusions. PCL7-2i membranes showed biomimetic biomechanical properties and in vitro biological properties similar to or even better than - in the case of anti-inflammatory behavior and collagen production - CMC, a commercially available product, suggesting potentially improved integration in the host tissue.
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13
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Sidhwa F, Itani KMF. Discussion: Fight or Flight: The Role of Staged Approaches to Complex Abdominal Wall Reconstruction. Plast Reconstr Surg 2018; 142:45S-46S. [PMID: 30138265 DOI: 10.1097/prs.0000000000004848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Feroze Sidhwa
- From the Department of Surgery, VA Boston Health Care System; and Harvard Medical School
| | - Kamal M F Itani
- From the Department of Surgery, VA Boston Health Care System; and Harvard Medical School
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14
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Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1444-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Sadeghi R, Mahdavi P, Lee WS, Quan B, Sone E, Ganss B, McCulloch CA. A novel, cell-permeable, collagen-based membrane promotes fibroblast migration. J Periodontal Res 2018; 53:727-735. [DOI: 10.1111/jre.12557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 01/06/2023]
Affiliation(s)
- R. Sadeghi
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
- Department of Periodontics; Faculty of Dentistry; Shahed University; Tehran Iran
| | - P. Mahdavi
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - W. S. Lee
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - B. Quan
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto ON Canada
| | - E. Sone
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto ON Canada
| | - B. Ganss
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - C. A. McCulloch
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
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D'Amore A, Fazzari M, Jiang HB, Luketich SK, Luketich ME, Hoff R, Jacobs DL, Gu X, Badylak SF, Freeman BA, Wagner WR. Nitro-Oleic Acid (NO 2-OA) Release Enhances Regional Angiogenesis in a Rat Abdominal Wall Defect Model. Tissue Eng Part A 2018; 24:889-904. [PMID: 29187125 DOI: 10.1089/ten.tea.2017.0349] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Ventral hernia is often addressed surgically by the placement of prosthetic materials, either synthetic or from allogeneic and xenogeneic biologic sources. Despite advances in surgical approaches and device design, a number of postsurgical limitations remain, including hernia recurrence, mesh encapsulation, and reduced vascularity of the implanted volume. The in situ controlled release of angiogenic factors from a scaffold facilitating abdominal wall repair might address some of these issues associated with suboptimal tissue reconstruction. Furthermore, a biocomposite material that combines the favorable mechanical properties achievable with synthetic materials and the bioactivity associated with xenogeneic tissue sources would be desirable. In this report, an abdominal wall repair scaffold has been designed based on a microfibrous, elastomeric poly(ester carbonate)urethane urea matrix integrated with a hydrogel derived from decellularized porcine dermis (extracellular matrix [ECM] gel) and poly(lactic-co-glycolic acid) (PLGA) microspheres loaded with nitro-oleic acid (NO2-OA). NO2-OA is an electrophilic fatty acid nitro-alkene derivative that, under hypoxic conditions, induces angiogenesis. This scaffold was utilized to repair a rat abdominal wall partial thickness defect, hypothesizing that the nitro-fatty acid release would facilitate increased angiogenesis at the 8-week endpoint. The quantification of neovascularization was conducted by novel methodologies to assess vessel morphology and spatial distribution. The repaired abdominal wall defects were evaluated by histopathologic methods, including quantification of the foreign body response and cellular ingrowth. The results showed that NO2-OA release was associated with significantly improved regional angiogenesis. The combined biohybrid scaffold and NO2-OA-controlled release strategy also reduced scaffold encapsulation, increased wall thickness, and enhanced cellular infiltration. More broadly, the three components of the composite scaffold design (ECM gel, polymeric fibers, and PLGA microparticles) enable the tuning of performance characteristics, including scaffold bioactivity, degradation, mechanics, and drug release profile, all decisive factors to better address current limitations in abdominal wall repair or other soft tissue augmentation procedures.
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Affiliation(s)
- Antonio D'Amore
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 Fondazione RiMED , Palermo, Italy .,3 Dipartimento Innovazione Industriale e Digitale (DIID), Università di Palermo , Palermo, Italy
| | - Marco Fazzari
- 2 Fondazione RiMED , Palermo, Italy .,4 Department of Pharmacology and Chemical Biology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Hong-Bin Jiang
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Samuel K Luketich
- 5 Department of Chemical Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Michael E Luketich
- 5 Department of Chemical Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Richard Hoff
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Daniel L Jacobs
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Xinzhu Gu
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Stephen F Badylak
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Bruce A Freeman
- 4 Department of Pharmacology and Chemical Biology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - William R Wagner
- 1 Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,5 Department of Chemical Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania
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Chan JCY, Burugapalli K, Huang YS, Kelly JL, Pandit A. Cross-Linked Cholecyst-Derived Extracellular Matrix for Abdominal Wall Repair. Tissue Eng Part A 2018; 24:1190-1206. [PMID: 29448888 DOI: 10.1089/ten.tea.2017.0379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abdominal wall repair frequently utilizes either nondegradable or biodegradable meshes, which are found to stimulate undesirable biological tissue responses or which possess suboptimal degradation rate. In this study, a biologic mesh prototype made from carbodiimide cross-linked cholecyst-derived extracellular matrix (EDCxCEM) was compared with small intestinal submucosa (Surgisis®), cross-linked bovine pericardium (Peri-Guard®), and polypropylene (Prolene®) meshes in an in vivo rabbit model. The macroscopic appearance and stereological parameters of the meshes were evaluated. Tailoring the degradation of the EDCxCEM mesh prevents untimely degradation, while allowing cellular infiltration and mesh remodeling to take place in a slower but predictable manner. The results suggest that the cross-linked biodegradable cholecyst-derived biologic mesh results in no seroma formation, low adhesion, and moderate stretching of the mesh. In contrast to Surgisis, Peri-Guard, and Prolene meshes, the EDCxCEM mesh showed a statistically significant increase in the volume fraction (Vv) of collagen (from 34% to 52.1%) in the central fibrous tissue region at both day 28 and 56. The statistically high length density (Lv), of blood vessels for the EDCxCEM mesh at 28 days was reflected also by the higher cellular activity (high Vv of fibroblast and moderate Vv of nuclei) indicating remodeling of this region in the vicinity of a slowly degrading EDCxCEM mesh. The lack of mesh area stretching/shrinkage in the EDCxCEM mesh showed that the remodeled tissue was adequate to prevent hernia formation. The stereo-histological assays suggest that the EDCxCEM delayed degradation profile supports host wound healing processes including collagen formation, cellular infiltration, and angiogenesis. The use of cross-linked CEM for abdominal wall repair is promising.
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Affiliation(s)
- Jeffrey C Y Chan
- 1 Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway , Galway, Ireland .,2 CÚRAM, Centre for Research in Medical Devices, National University of Ireland , Galway, Ireland
| | - Krishna Burugapalli
- 3 Biomedical Engineering Department, Institute for Environment Health and Societies, Brunel University , Middlesex, United Kingdom
| | - Yi-Shiang Huang
- 2 CÚRAM, Centre for Research in Medical Devices, National University of Ireland , Galway, Ireland
| | - John L Kelly
- 1 Department of Plastic, Reconstructive and Hand Surgery, University Hospital Galway , Galway, Ireland .,2 CÚRAM, Centre for Research in Medical Devices, National University of Ireland , Galway, Ireland
| | - Abhay Pandit
- 2 CÚRAM, Centre for Research in Medical Devices, National University of Ireland , Galway, Ireland
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Balakrishnan-nair DK, Nair ND, Venugopal SK, Das VN, George S, Abraham MJ, Eassow S, Alison MR, Sainulabdeen A, Anilkumar TV. An Immunopathological Evaluation of the Porcine Cholecyst Matrix as a Muscle Repair Graft in a Male Rat Abdominal Wall Defect Model. Toxicol Pathol 2018; 46:169-183. [DOI: 10.1177/0192623317752894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
With the increasing use of animal-based biomaterials for regenerative medical applications, the need for their safety assessment is paramount. A porcine cholecyst-derived scaffold (CDS), intended as a muscle repair graft, prepared by a nondetergent/enzymatic method was engrafted in a rat abdominal wall defect model. Host tissue–scaffold interface samples were collected 2, 8, and 16 weeks postimplantation and evaluated by histopathology, immunohistochemistry, and electron microscopy. The nature of the tissue reaction was compared with those induced by a jejunum-derived scaffold (JDS) prepared by the same method and a commercial-grade small intestinal submucosa (CSIS) scaffold. A study of the immunopathological response in major lymphoid tissues and immunophenotyping for M1 and M2 macrophages was performed at the host tissue–scaffold interface. Further, “irritancy scores” for CDS and JDS were determined using CSIS as the reference material. Both CDS and JDS appeared to be potential biomaterials for muscle grafts, but the former stimulated a skeletal muscle tissue remodeling response predominated by M2 macrophages. The data support the notion that biomaterials with similar biocompatibility, based on local tissue response on implantation, may cause differential immunogenicity. Additionally, CDS compared to JDS and CSIS was found to be less immunotoxic.
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Affiliation(s)
- Dhanush Krishna Balakrishnan-nair
- Department of Veterinary Pathology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - Narayanan Divakaran Nair
- Department of Veterinary Pathology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - Syam Kunnekkattu Venugopal
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - Vijayan Narayana Das
- Department of Veterinary Pathology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - Sisilamma George
- Department of Veterinary Biochemistry, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - Mammen John Abraham
- Department of Veterinary Pathology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - Saji Eassow
- Meat Products of India Ltd., Koothattukulam, Ernakulam District, Edayar, India
| | - Malcolm Ronald Alison
- Barts Cancer Institute, University of London, Charterhouse Square, London, United Kingdom
| | - Anoop Sainulabdeen
- Department of Veterinary Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Kerala, India
| | - Thapasimuthu Vijayamma Anilkumar
- Division of Experimental Pathology, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Poojappura, Thiruvananthapuram, India
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19
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Ji ZL, Wang D, Wang JM, Tan YY. Tenogenic differentiation of mesenchymal stem cells improves healing of linea alba incision. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2018. [DOI: 10.4103/ijawhs.ijawhs_5_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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A Meta-analysis of Outcomes Using Acellular Dermal Matrix in Breast and Abdominal Wall Reconstructions: Event Rates and Risk Factors Predictive of Complications. Ann Plast Surg 2017; 77:e31-8. [PMID: 22156884 DOI: 10.1097/sap.0b013e31822afae5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of acellular dermal matrix (ADM) has gained acceptance in breast and abdominal wall reconstructions. Despite its extensive use, there is currently a wide variation of reported outcomes in the literature. This study definitively elucidates the outcome rates associated with ADM use in breast and abdominal wall surgeries and identifies risk factors predisposing to the development of complications. METHODS A literature search was conducted using the Medline database (PubMed, US National Library of Medicine) and the Cochrane Library. A total of 464 articles were identified, of which 53 were eligible for meta-analysis. The endpoints of interest were the incidences of seroma, cellulitis, infection, wound dehiscence, implant failure, and hernia. The effects of various risk factors such as smoking, radiation, chemotherapy, and diabetes on the development of complications were also evaluated. RESULTS A majority of the studies were retrospective (68.6%) with a mean follow-up of 16.8 months (SD ± 10.1 months) in the breast group and 14.2 months (SD ± 7.8 months) in the abdominal wall reconstructive group. The overall risks and complications were as follows: cellulitis, 5.1%; implant failure, 5.9%; seroma formation, 8%; wound dehiscence, 8.1%; wound infection, 16.1%; hernia, 27.6%; and abdominal bulging, 28.1%. Complication rates were further stratified separately for the breast and abdominal cohorts, and the data were reported. This provides additional information on the associated abdominal wall morbidity in patients undergoing autologous breast reconstruction in which mesh reinforcement was considered as closure of the abdominal wall donor site. Radiation resulted in a significant increase in the rates of cellulitis (P = 0.021), and chemotherapy was associated with a higher incidence of seroma (P = 0.014). CONCLUSION This study evaluates the overall complication rates associated with ADM use by conducting a meta-analysis of published data. This will offer physicians a single comprehensive source of information during informed consent discussions as well as an awareness of the risk factors predictive of complications.
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Suzuhigashi M, Kaji T, Nakame K, Mukai M, Yamada W, Onishi S, Yamada K, Kawano T, Takamatsu H, Ieiri S. Abdominal wall regenerative medicine for a large defect using tissue engineering: an experimental study. Pediatr Surg Int 2016; 32:959-65. [PMID: 27476152 DOI: 10.1007/s00383-016-3949-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Treatment for a large abdominal wall defect remains challenging. The aim of this study was to optimize tissue engineering therapy of muscle constructs using a rat model. METHODS Experimental abdominal wall defects were created in Wister rats. The animal model was divided into three groups: collagen sponge (CS), hybrid scaffold (HS) and hybrid scaffold containing bone marrow liquid (HSBM). Hybrid scaffolds comprised collagen sponge and poly L-lactide (PLLA) sheets. Abdominal wall defects were covered by three kinds of sheets. Thereafter, the bone marrow liquid was spread onto the sheets. Rats were killed at 4, 8, and 16 weeks. Pathological examinations were performed using hematoxylin-eosin and desmin antibody staining. RESULTS The CS group showed abdominal hernia, whereas the HS and HSBM groups did not. Vascular formation was confirmed in all groups. Muscle tissue was recognized at the marginal area of the sheet only in the HSBM group. CONCLUSION The HS and HSBM groups show a greater intensity than the CS group. Muscle tissue regeneration is solely recognized in the HSBM group. Our experimental data suggest that the triad of scaffold, cell, and growth factor is fundamental for ideal biomaterials. The HSBM may be useful for reconstruction of abdominal wall defects.
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Affiliation(s)
- Masaya Suzuhigashi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kazuhiko Nakame
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Motoi Mukai
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hideo Takamatsu
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
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22
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Doxycycline alters collagen composition following ventral hernia repair. Surg Endosc 2016; 31:1659-1666. [DOI: 10.1007/s00464-016-5155-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/25/2016] [Indexed: 11/26/2022]
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23
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UDPA NATASHA, IYER SHAMA, MCDONOUGH SEANP, GAO YINGXIN. BIOMECHANICAL PROPERTIES OF MESHES FOLLOWING IMPLANTATION IN THE RAT ABDOMINAL WALL MODEL. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of our study was to (1) evaluate mesh strength and collagen incorporation after 4 and 12 weeks of implantation in a rat abdominal wall model and (2) determine the relationship between collagen deposition and mechanical strength of a chitosan-coated polypropylene mesh. We implanted 0.5% chitosan-coated polypropylene mesh (PPM), collagen-coated PPM (PelvitexTM; C.R. Bard), and PPM (Avaulta Solo[Formula: see text]; C.R. Bard) using a rat abdominal defect model. Mechanical properties were determined from uniaxial tensile testing and collagen deposition of each mesh was evaluated 4 and 12 weeks post-implantation. We found that after implantation, the neo tissue of Ch-PPM is stiffer than the commercially available meshes. We also observed no significant difference in the ratio of collagen types I/III between mesh samples at 4 weeks or 12 weeks. We found no relationship between the ratio of collagen types I/III and the mechanical strength of mesh samples after implantation. The increased stiffness with chitosan coating could be due to increased muscle tissue ingrowth.
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Affiliation(s)
- NATASHA UDPA
- Sibley School of Mechanical and Aerospace Engineering, Upson Hall, Cornell University, Ithaca, New York 14853, USA
| | - SHAMA IYER
- Sibley School of Mechanical and Aerospace Engineering, Upson Hall, Cornell University, Ithaca, New York 14853, USA
| | - SEAN P. MCDONOUGH
- The College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA
| | - YINGXIN GAO
- Sibley School of Mechanical and Aerospace Engineering, Upson Hall, Cornell University, Ithaca, New York 14853, USA
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Gnaneswaran N, Perera M, Jenkin A, Lau H, Presley R. Ventral hernia repair with lateral component separation and onlay Biodesign graft. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1188-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chauviere MV, Schutter RJ, Steigelman MB, Clark BZ, Grayson JK, Sahar DE. Comparison of AlloDerm and AlloMax tissue incorporation in rats. Ann Plast Surg 2016; 73:282-5. [PMID: 23644440 DOI: 10.1097/sap.0b013e31827a2d00] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human acellular dermal matrices (HADMs) are used in a variety of settings. AlloMax is a new HADM currently being used for breast reconstruction and hernia repair. We compared the in vivo tissue integration of AlloMax to AlloDerm, a well-studied HADM, in rats. METHODS We implanted AlloDerm and AlloMax patches into subcutaneous pockets on the backs of 32 male Sprague-Dawley rats. The animals were killed after either 4 or 8 weeks, and the patches were recovered and stained for histopathologic analyses. Microscopic end points included patch thickness, vascularization, tissue in-growth, fibroblast proliferation, and inflammation. RESULTS All animals completed the study without complications or infection. There were no significant differences in graft thicknesses at 4 and 8 weeks. Microscopically, at 4 weeks, AlloDerm sections had significantly more microvessels than AlloMax (P = 0.02). This disparity increased by 8 weeks (P < 0.01). Similarly, we found greater tissue in-growth and fibroblast proliferation in AlloDerm than AlloMax sections at 4 (P < 0.01) and at 8 (P < 0.01) weeks. Inflammatory infiltrates consisted of lymphocytes, histiocytes, eosinophils, and plasma cells. Deep graft infiltration by predominately lymphocytic inflammatory cells was significantly higher in AlloDerm than AlloMax grafts at 4 (P = 0.01) and 8 (P = 0.02) weeks. Graft necrosis was uncommon, but marginal fibrosis was similar in both. CONCLUSIONS AlloDerm grafts had greater neovascularization, tissue infiltration, fibroblast proliferation, and inflammatory reaction than AlloMax grafts when placed subcutaneously in rats. AlloDerm may be better incorporated than AlloMax when placed in vivo.
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Affiliation(s)
- Matthew V Chauviere
- From the *Department of Surgery, †Department of Pathology, and ‡Clinical Investigation Facility, David Grant USAF Medical Center, Travis AFB, CA; and §Division of Plastic Surgery, UC Davis School of Medicine, Sacramento, CA
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Liu L, Petro C, Majumder A, Fayezizadeh M, Anderson J, Novitsky YW. The use of Vicryl mesh in a porcine model to assess its safety as an adjunct to posterior fascial closure during retromuscular mesh placement. Hernia 2016; 20:289-95. [PMID: 26886013 DOI: 10.1007/s10029-016-1469-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posterior component separation has become a common approach to complex abdominal wall reconstructions. This technique includes creation of an extraperitoneal retromuscular space for subsequent large synthetic mesh reinforcement. In certain cases, when complete restoration of "posterior" layer is precluded by significant tissue loss/damage, one proposed strategy is to replace the posterior fascia with an absorbable synthetic polyglactin (Vicryl) mesh. However, the safety of this strategy to prevent mesh-related visceral complication is unknown. Herein, we aimed to characterize mesh-viscera adhesion profiles and host tissue response of synthetic mesh either exposed directly to the viscera, or protected with Vicryl mesh. METHODS Using adult Yorkshire pigs, 5 × 5 cm pieces of mesh were secured to the intact peritoneum in each of the four quadrants (n = 6 pigs, 24 mesh samples). The study groups were Vicryl (V), Marlex (M), Softmesh (S), Marlex + Vicryl construct (MV), Softmesh + Vicryl construct (SV). The self-made composite meshes were then implanted with the Vicryl side facing the exposed viscera. The pigs were survived for 60 days. At necropsy, grossly, the extent and tenacity of visceral adhesions were evaluated using established scales. Histologically, all specimens for fibrous encapsulation on the visceral surface of the mesh were reviewed by an experienced pathologist blind to meshes used. RESULTS At necropsy, all Vicryl meshes were completely resorbed. The mean adhesion and tenacity scores for M and MV were 1.8 and 1.1 (P > 0.05), 2.0 and 1.5 (P > 0.05), respectively; while the mean adhesion extent scores and tenacity scores for S and SV were 2.0 and 1.2 (P > 0.05), 2.0 and 1.7 (P > 0.05). No significant difference in adhesion extent and tenacity was observed between Synthetic and Vicryl composite mesh groups. Histologically, Marlex + Vicryl mesh and Softmesh + Vicryl mesh constructs had thicker fibrous capsules than the corresponding unprotected Marlex and Soft mesh implants. Furthermore, visceral adhesions in the composite groups were noted to be to the fibrous capsule and not synthetic mesh itself. CONCLUSION Utilization of the absorbable polyglactin (Vicryl) mesh as a separating layer between a synthetic mesh and intestines, did not reduce adhesions across various mesh types and composites. Histologically, however, a thick fibrous capsule replaced the Vicryl mesh and may be an important layer to prevent intestinal erosion into retromuscular synthetic meshes.
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Affiliation(s)
- L Liu
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - C Petro
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - A Majumder
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - M Fayezizadeh
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - J Anderson
- Department of Pathology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Y W Novitsky
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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Decreased hernia recurrence using autologous platelet-rich plasma (PRP) with Strattice™ mesh in a rodent ventral hernia model. Surg Endosc 2015; 30:3239-49. [PMID: 26578432 PMCID: PMC4956706 DOI: 10.1007/s00464-015-4645-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/24/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recurrence after ventral hernia repair (VHR) remains a multifactorial problem still plaguing surgeons today. Some of the many contributing factors include mechanical strain, poor tissue-mesh integration, and degradation of matrices. The high recurrence rate witnessed with the use of acellular dermal matrices (ADM) for definitive hernia repair has reduced their use largely to bridging repair and breast reconstruction. Modalities that improve classic cellular metrics of successful VHR could theoretically result in improved rates of hernia recurrence; autologous platelet-rich plasma (PRP) may represent one such tool, but has been underinvestigated for this purpose. METHODS Lewis rats (32) had chronic ventral hernias created surgically and then repaired with Strattice™ mesh alone (control) or mesh + autologous PRP. Samples were harvested at 3 and 6 months postoperatively and compared for gross, histologic, and molecular outcomes of: neovascularization, tissue incorporation, peritoneal adhesions, hernia recurrence, and residual mesh thickness. RESULTS Compared to control at 3 months postoperatively, PRP-treated rats displayed significantly more neovascularization of implanted mesh and considerable upregulation of both angiogenic genes (vEGF 2.73-fold, vWF 2.21-fold) and myofibroblastic genes (αSMA 9.68-fold, FSP-1 3.61-fold, Col1a1 3.32-fold, Col31a1 3.29-fold). Histologically, they also showed enhanced tissue deposition/ingrowth and diminished chronic immune cell infiltration. Peritoneal adhesions were less severe at both 3 (1.88 vs. 2.94) and 6 months (1.63 vs. 2.75) by Modified Hopkins Adhesion Scoring. PRP-treated rats experienced decreased hernia recurrence at 6 months (0/10 vs. 7/10) and had significantly improved ADM preservation as evidenced by quantification of residual mesh thickness. CONCLUSIONS PRP is an autologous source of pro-regenerative growth factors and chemokines uniquely suited to soft tissue wound healing. When applied to a model of chronic VHR, it incites enhanced angiogenesis, myofibroblast recruitment and tissue ingrowth, ADM preservation, less severe peritoneal adhesions, and diminished hernia recurrence. We advocate further investigation regarding PRP augmentation of human VHR.
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Rodriguez-Unda N, Leiva S, Cheng HT, Seal SM, Cooney CM, Rosson GD. Low incidence of complications using polyglactin 910 (Vicryl) mesh in breast reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2015; 68:1543-9. [DOI: 10.1016/j.bjps.2015.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/06/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022]
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An in vivo analysis of Miromesh--a novel porcine liver prosthetic created by perfusion decellularization. J Surg Res 2015; 201:29-37. [PMID: 26850181 DOI: 10.1016/j.jss.2015.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/27/2015] [Accepted: 10/02/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Bioprosthetics derived from human or porcine dermis and intestinal submucosa have dense, homogenous, aporous collagen structures that potentially limit cellular penetration, undermining the theoretical benefit of a "natural" collagen scaffold. We hypothesized that Miromesh-a novel prosthetic derived from porcine liver by perfusion decellularization-provides a more optimal matrix for tissue ingrowth. METHODS Thirty rats underwent survival surgery that constituted the creation of a 4 × 1 cm abdominal defect and simultaneous bridged repair. Twenty rats were bridged with Miromesh, and 10 rats were bridged with non-cross-linked porcine dermis (Strattice). Ten Miromesh and all 10 Strattice were rinsed in vancomycin solution and inoculated with 10(4) colony-forming units of green fluorescent protein-labeled Staphylococcus aureus (GFP-SA) after implantation. Ten Miromesh controls were neither soaked nor inoculated. No animals received systemic antibiotics. All animals were euthanized at 90 d and underwent an examination of their gross appearance before being sectioned for quantitative bacterial culture and histologic grading. A pathologist scored specimens (0-4) for cellular infiltration, acute inflammation, chronic inflammation, granulation tissue, foreign body reaction, and fibrous capsule formation. RESULTS All but one rat repaired with Strattice survived until the 90-d euthanization. All quantitative bacterial cultures for inoculated specimens were negative for GFP-SA. Of nine Strattice explants, none received a cellular infiltration score >0, consistent with a poor tissue-mesh interface observed grossly. Of 10 Miromesh explants also inoculated with GFP-SA, seven of 10 demonstrated cellular infiltration with an average score of +2.7 ± 0.8, whereas sterile Miromesh implants received an average score of 0.8 ± 1.0. Two inoculated Miromesh implants demonstrated acute inflammation and infection on histology. CONCLUSIONS A prosthetic generated from porcine liver by perfusion decellularization provides a matrix for superior cellular infiltration compared with non-cross-linked porcine dermis.
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Tharappel JC, Harris JW, Zwischenberger BA, Levy SM, Puleo DA, Roth JS. Doxycycline shows dose-dependent changes in hernia repair strength after mesh repair. Surg Endosc 2015; 30:2016-21. [PMID: 26264696 DOI: 10.1007/s00464-015-4434-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ventral hernia is a commonly occurring surgical problem. Our earlier studies have shown that a 30 mg/kg dose of doxycycline can significantly impact the strength of polypropylene (PP) mesh in a rat hernia repair model at 6 and 12 weeks. The objective of the present study was to investigate the dose dependence of doxycycline treatment on hernia repair strengths in rats. STUDY DESIGN Fifty-six Sprague-Dawley rats underwent hernia repair with either PP mesh (n = 28) or sutures only (primary; n = 28); both groups were further divided into four doxycycline groups of seven animals each: control (0 mg/kg), low (3 mg/kg), medium (10 mg/kg), and high (30 mg/kg). One day before hernia repair surgery, animals received doxycycline doses by gavage and continued receiving daily until euthanasia. After 8 weeks, rats were euthanized and tissue samples from hernia repaired area were collected and analyzed for tensile strength using a tensiometer (Instron, Canton, MA, USA), while MMPs 2, 3, and 9, and collagen type 1 and 3 were analyzed by western blotting. RESULTS In mesh-repaired animals, medium and high doxycycline dose repaired mesh fascia interface (MFI) showed significant increase in tensile strength when compared to control. In the primary repaired animals, there was no significant difference in MFI tensile strength in any dose group. In medium-dose MFI, there was a significant reduction in MMPs 2, 3, and 9. In this animal group, MFI showed significant increase in collagen 1 and significant reduction in collagen type 3 when compared to control. CONCLUSION It is possible to improve the strength of mesh-repaired tissue by administering a significantly lower dose of the drug, which has implications for translation of the findings.
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Affiliation(s)
- Job C Tharappel
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, UKMC C-222, Lexington, KY, 40536-0298, USA
| | - Jennifer W Harris
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, UKMC C-222, Lexington, KY, 40536-0298, USA
| | - Brittany A Zwischenberger
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, UKMC C-222, Lexington, KY, 40536-0298, USA
| | - Salomon M Levy
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, UKMC C-222, Lexington, KY, 40536-0298, USA
| | - David A Puleo
- Department of Biomedical Engineering, University of Kentucky College of Medicine, Lexington, KY, USA
| | - J Scott Roth
- Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, UKMC C-222, Lexington, KY, 40536-0298, USA.
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Meyer R, Häge A, Zimmermann M, Bruch HP, Keck T, Hoffmann M, Schlöricke E. Is laparoscopic treatment of incisional and recurrent hernias associated with an increased risk for complications? Int J Surg 2015; 19:121-7. [PMID: 26038293 DOI: 10.1016/j.ijsu.2015.05.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/22/2015] [Accepted: 05/21/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hernias of the ventral abdominal wall can be treated with an intraperitoneal onlay mesh (IPOM). The aim of this cohort study was to analyze the complications and recurrence rates after laparoscopic ventral hernia repair focusing especially on incisional and recurrent hernias. METHODS The study population comprised 149 patients with a hernia of the abdominal wall, which was treated with an IPOM between January 2006 and January 2011. RESULTS Fifty-one patients had a primary hernia (group I) and 98 patients had preceding abdominal surgery (group II). In group II 64 patients had an incisional hernia and 34 patients had a recurrent hernia. The median body mass index was 30.3 kg/m(2) (14.8-69.1) without any significance in sub-group comparison. The mean duration of surgery and the length of stay were significantly longer in group II (p < 0.05). The overall rate of minor complications was 18.1%. There were significantly more minor complications in group II (7.8% vs. 23.5%, p = 0.02). Notably, there were also significantly more major complications in group II (14.3% vs. 2.0%; p = 0.02). The recurrence rate was significantly higher in group II (group I: 3.9% vs. group II: 16.3%, p < 0.05). There were no early recurrences in group I, but 5 early recurrences in group II. CONCLUSION Laparoscopic treatment of complex hernias as incisional hernias, recurrent hernias and hernias with interenteric and enteroperitoneal adhesions is associated with high rates of minor and major complications. A high level of expertise of the surgeon and the camera-guiding assistant is therefore needed.
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Affiliation(s)
- Rüdiger Meyer
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
| | - Anna Häge
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Markus Zimmermann
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Hans-Peter Bruch
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Martin Hoffmann
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Erik Schlöricke
- Department of General, Visceral, Thoracic and Vascular Surgery, Westküstenklinikum Heide, Esmarchstraße 50, D-25746 Heide, Germany
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Kumar V, Gangwar AK, Kumar N. Evaluation of the Murine Dermal Matrix as a Biological Mesh in Dogs. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s40011-015-0543-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gigliobianco G, Roman Regueros S, Osman NI, Bissoli J, Bullock AJ, Chapple CR, MacNeil S. Biomaterials for pelvic floor reconstructive surgery: how can we do better? BIOMED RESEARCH INTERNATIONAL 2015; 2015:968087. [PMID: 25977927 PMCID: PMC4419215 DOI: 10.1155/2015/968087] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/19/2014] [Indexed: 12/21/2022]
Abstract
Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are major health issues that detrimentally impact the quality of life of millions of women worldwide. Surgical repair is an effective and durable treatment for both conditions. Over the past two decades there has been a trend to enforce or reinforce repairs with synthetic and biological materials. The determinants of surgical outcome are many, encompassing the physical and mechanical properties of the material used, and individual immune responses, as well surgical and constitutional factors. Of the current biomaterials in use none represents an ideal. Biomaterials that induce limited inflammatory response followed by constructive remodelling appear to have more long term success than biomaterials that induce chronic inflammation, fibrosis and encapsulation. In this review we draw upon published animal and human studies to characterize the changes biomaterials undergo after implantation and the typical host responses, placing these in the context of clinical outcomes.
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Affiliation(s)
| | | | - Nadir I. Osman
- Material Science Engineering, University of Sheffield, Sheffield S1 3JD, UK
- Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Julio Bissoli
- Hospital das Clínicas da Faculdade de Medicina, Universidade de Sao Paulo, 05410-020 São Paulo, Brazil
| | - Anthony J. Bullock
- Material Science Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | | | - Sheila MacNeil
- Material Science Engineering, University of Sheffield, Sheffield S1 3JD, UK
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Vicryl mesh in expander/implant breast reconstruction: long-term follow-up in 38 patients. Plast Reconstr Surg 2015; 134:892-899. [PMID: 25347625 DOI: 10.1097/prs.0000000000000610] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acellular dermal matrix has proven to be a useful adjunct in tissue expander or direct-to-implant breast reconstruction. Although versatile, acellular dermal matrix adds considerable cost. Vicryl (polyglactin) mesh has an established track record in many fields of surgery, and is considerably less costly than acellular dermal matrix. This study examines the use and long-term follow-up of Vicryl mesh in breast reconstruction. METHODS Vicryl mesh was used in 46 breast reconstructions (38 patients; 35 immediate and three delayed). The mesh was used along the inframammary fold to maintain position of the inferior pectoral edge, and/or along the lateral border to maintain expander position and prevent lateral migration. Eight breasts received adjuvant radiation therapy. RESULTS Mean follow-up at the time of review was 43 months. In the nonirradiated group (38 breasts), there was one postoperative infection (2.6 percent), which required expander removal. In the irradiated group, there were three complications requiring expander removal (37.5 percent): two infections and one device exposure after irradiation. Significant malposition was not observed in any breast where Vicryl mesh was used, and no visible mesh remained at the time of implant placement. The incidence of symptomatic capsular contracture in nonirradiated breasts was 3.2 percent. At latest follow-up, nonirradiated breasts had an average Baker capsule grade of 1.1, compared with 1.5 in the irradiated group. CONCLUSIONS Vicryl mesh is an effective alternative to acellular dermal matrix in nonirradiated breast reconstruction and is available at approximately one-twentieth the cost. Acellular dermal matrix or full muscle coverage may be preferable in irradiated reconstructions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Tharappel JC, Bower CE, Whittington Harris J, Ramineni SK, Puleo DA, Roth JS. Doxycycline administration improves fascial interface in hernia repair. J Surg Res 2014; 190:692-8. [DOI: 10.1016/j.jss.2014.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/23/2014] [Accepted: 05/02/2014] [Indexed: 02/01/2023]
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Peacock O, Simpson JA, Tou SI, Hurst NG, Speake WJ, Tierney GM, Lund JN. Outcomes after biological mesh reconstruction of the pelvic floor following extra-levator abdominoperineal excision of rectum (APER). Tech Coloproctol 2014; 18:571-7. [PMID: 24435472 DOI: 10.1007/s10151-013-1107-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/09/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Extra-levator abdominoperineal excision of the rectum (ELAPER) for low rectal cancer is used to avoid the adverse oncological outcomes of inadvertent perforation and a positive circumferential resection margin associated with the conventional APER technique. This wider excision creates a large defect requiring pelvic floor reconstruction, and there is still controversy regarding the best method of closure. The aim of this study is to present outcomes of biological mesh pelvic floor reconstruction following ELAPER. METHODS Prospective data on consecutive patients having ELAPER for low rectal cancer at a single UK institution between October 2008 and March 2013 were collected. The perineum was reconstructed using a biological mesh and the short-term outcomes were evaluated, focusing particularly on perineal wound complications and perineal hernias. RESULTS Thirty-four patients were included [median age 62 years, range 40-72 years, 27 males (79 %)]. The median operative time was 248 min (range 120-340 min). The median length of hospital stay was 9 days (range 4-20 days). There were three perineal complications (9 %) requiring surgical intervention, but no meshes were removed. There were no perineal hernias. The median length of follow-up was 21 months (range 1-54 months). The overall mortality was 9 % from distant metastases. CONCLUSIONS Our series adds to the increasing evidence that good outcomes can be achieved for pelvic floor reconstruction with biological mesh following ELAPER without the additional use of myocutaneous flaps. The low serious complication rate, good outcomes in perineal wound healing and the absence of perineal hernias demonstrates that this is a safe and feasible procedure.
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Affiliation(s)
- O Peacock
- Division of Surgery, School of Graduate Entry Medicine and Health, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3DT, UK,
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Mestak O, Matouskova E, Spurkova Z, Benkova K, Vesely P, Mestak J, Molitor M, Pombinho A, Sukop A. Mesenchymal Stem Cells Seeded on Cross-Linked and Noncross-Linked Acellular Porcine Dermal Scaffolds for Long-Term Full-Thickness Hernia Repair in a Small Animal Model. Artif Organs 2013; 38:572-9. [DOI: 10.1111/aor.12224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ondrej Mestak
- Department of Plastic Surgery; 1st Faculty of Medicine; Charles University in Prague; Bulovka Hospital; Prague Czech Republic
| | - Eva Matouskova
- Laboratory of Cell Biology; Prague Burn Centre; 3rd Faculty of Medicine; Charles University in Prague; Prague Czech Republic
| | - Zuzana Spurkova
- Department of Pathology; Bulovka Hospital; Prague Czech Republic
| | - Kamila Benkova
- Department of Pathology; Bulovka Hospital; Prague Czech Republic
| | - Pavel Vesely
- Department of Plastic Surgery; 1st Faculty of Medicine; Charles University in Prague; Bulovka Hospital; Prague Czech Republic
| | - Jan Mestak
- Department of Plastic Surgery; 1st Faculty of Medicine; Charles University in Prague; Bulovka Hospital; Prague Czech Republic
| | - Martin Molitor
- Department of Plastic Surgery; 1st Faculty of Medicine; Charles University in Prague; Bulovka Hospital; Prague Czech Republic
| | - Antonio Pombinho
- Laboratory of Cell Differentiation; Institute of Molecular Genetics; Czech Academy of Sciences; Prague Czech Republic
| | - Andrej Sukop
- Department of Plastic Surgery; 3rd Faculty of Medicine; Charles University in Prague; University Hospital Kralovske Vinohrady; Prague Czech Republic
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Kumar VA, Caves JM, Haller CA, Dai E, Li L, Grainger S, Chaikof EL. Collagen-Based Substrates with Tunable Strength for Soft Tissue Engineering. Biomater Sci 2013; 1:10.1039/C3BM60129C. [PMID: 24349707 PMCID: PMC3857634 DOI: 10.1039/c3bm60129c] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Through the use of mechanical reinforcement of collagen matrices, mechanically strong and compliant 3D tissue mimetic scaffolds can be generated that act as scaffolds for soft tissue engineering. Collagen has been widely used for the development of materials for repair, augmentation or replacement of damaged or diseased tissue. Herein we describe a facile method for the layer-by-layer fabrication of robust planar collagen fiber constructs. Collagen gels cast in a phosphate buffer were dried to form dense collagen mats. Subsequent gels were layered and dried atop mats to create multilayer constructs possessing a range of tunable strengths (0.5 - 11 MPa) and stiffness (1 - 115 MPa). Depending on processing conditions and crosslinking of constructs, strain to failure ranged between 9 to 48%. Collagen mats were constructed into hernia patches that prevented hernia recurrence in Wistar rats.
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Affiliation(s)
- Vivek A. Kumar
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215
- Wyss Institute of Biologically Inspired Engineering of Harvard University, Boston, MA 02215
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA 30332
| | - Jeffrey M. Caves
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215
- Wyss Institute of Biologically Inspired Engineering of Harvard University, Boston, MA 02215
| | - Carolyn A. Haller
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215
- Wyss Institute of Biologically Inspired Engineering of Harvard University, Boston, MA 02215
| | - Erbin Dai
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215
| | - Liying Li
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215
| | - Stephanie Grainger
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215
- Wyss Institute of Biologically Inspired Engineering of Harvard University, Boston, MA 02215
| | - Elliot L. Chaikof
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215
- Wyss Institute of Biologically Inspired Engineering of Harvard University, Boston, MA 02215
- Department of Biomedical Engineering, Georgia Institute of Technology/Emory University, Atlanta, GA 30332
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Doxycycline impacts hernia repair outcomes. J Surg Res 2013; 184:699-704. [PMID: 23830364 DOI: 10.1016/j.jss.2013.05.101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 05/23/2013] [Accepted: 05/30/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Incisional hernias occur commonly in up to 20% of all abdominal operations. Incisional hernia formation has been associated with increased levels of matrix metalloproteinases (MMPs), reduced collagen 1, and increased collagen 3 expression. Doxycycline, a nonspecific inhibitor of MMPs, has been shown to beneficially reduce MMP levels in both cancer and aneurysm models. This study evaluates the impact of doxycycline upon MMP expression, collagen subtypes, and hernia repair distraction forces in an animal model of incisional hernia repair. MATERIALS AND METHODS Twenty-four Sprague Dawley rats underwent incisional hernia creation and subsequent repair with polypropylene mesh. Animals were administered doxycycline or saline daily beginning 1 d prior to hernia repair and survived for 1, 2, or 4 wk. Serum and tissue were evaluated for MMP content and collagen subtyping utilizing enzyme-linked immunosorbent assay and Western blot. Tensiometric properties of the native abdominal wall after hernia repair were measured with an Instron Corp. (Canton, MA) mechanical testing system. RESULTS There were no differences in control and experimental groups 1 and 2 wk following hernia repair; 4 wk following hernia repair, doxycycline treated animals demonstrated reduced serum MMP-2 and MMP-9 levels, reduced tissue levels of MMP-2, MMP-3, and MMP-9, and increased collagen 1 to 3 ratios. Distraction forces required to disrupt the hernia repair were increased in the doxycycline treated group compared with controls. CONCLUSIONS Doxycycline administration is associated with improved hernia repair strength with concomitant reduction of MMP levels with increased collagen 1 deposition. Longer term studies are required to better understand the impact of this treatment.
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Characterization of the Mechanical Strength, Resorption Properties, and Histologic Characteristics of a Fully Absorbable Material (Poly-4-hydroxybutyrate-PHASIX Mesh) in a Porcine Model of Hernia Repair. ISRN SURGERY 2013; 2013:238067. [PMID: 23781348 PMCID: PMC3679684 DOI: 10.1155/2013/238067] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/23/2013] [Indexed: 11/18/2022]
Abstract
Purpose. Poly-4-hydroxybutyrate (P4HB) is a naturally derived, absorbable polymer. P4HB has been manufactured into PHASIX Mesh and P4HB Plug designs for soft tissue repair. The objective of this study was to evaluate mechanical strength, resorption properties, and histologic characteristics in a porcine model. Methods. Bilateral defects were created in the abdominal wall of n = 20 Yucatan minipigs and repaired in a bridged fashion with PHASIX Mesh or P4HB Plug fixated with SorbaFix or permanent suture, respectively. Mechanical strength, resorption properties, and histologic characteristics were evaluated at 6, 12, 26, and 52 weeks (n = 5 each). Results. PHASIX Mesh and P4HB Plug repairs exhibited similar burst strength, stiffness, and molecular weight at all time points, with no significant differences detected between the two devices (P > 0.05). PHASIX Mesh and P4HB Plug repairs also demonstrated significantly greater burst strength and stiffness than native abdominal wall at all time points (P < 0.05), and material resorption increased significantly over time (P < 0.001). Inflammatory infiltrates were mononuclear, and both devices exhibited mild to moderate granulation tissue/vascularization. Conclusions. PHASIX Mesh and P4HB Plug demonstrated significant mechanical strength compared to native abdominal wall, despite significant material resorption over time. Histological assessment revealed a comparable mild inflammatory response and mild to moderate granulation tissue/vascularization.
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Pascual G, Rodríguez M, Sotomayor S, Moraleda E, Bellón JM. Effects of collagen prosthesis cross-linking on long-term tissue regeneration following the repair of an abdominal wall defect. Wound Repair Regen 2012; 20:402-13. [PMID: 22564232 DOI: 10.1111/j.1524-475x.2012.00781.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Collagen prostheses used to repair abdominal wall defects, depending on their pretreatment (noncross-linked vs. cross-linked), besides repair may also achieve tissue regeneration. We assessed the host tissue incorporation of different bioprostheses using a new tool that combines immunofluorescence confocal microscopy with differential interference contrast images, making it possible to distinguish newly formed collagen. Partial hernial defects in the abdominal wall of rabbits were repaired using cross-linked/noncross-linked bioprostheses. Expanded polytetrafluoroethylene (ePTFE) was used as control. After 14/30/90/180 days of implant, specimens were taken for microscopy, immunohistochemistry, and quantitative-reverse transcription-polymerase chain reaction to determine host tissue ingrowth and collagen I/III protein and 1a1/3a1 gene expression. Shrinkage and stress resistance were also examined. At 14 days, cross-linked prostheses had suffered significantly less shrinkage than ePTFE or noncross-linked prostheses. Significantly higher shrinkage was recorded for ePTFE in the longer term. Microscopy revealed encapsulation of ePTFE by neoformed tissue, while the bioprostheses became gradually infiltrated by host tissue. Noncross-linked prosthesis showed better tissue ingrowth, more intense inflammatory reaction and more rapid degradation than the cross-linked prostheses. At 14 days, cross-linked prostheses induced up-regulated collagen 1a1 and 3a1 gene expression, while noncross-linked only showed increased collagen III protein expression at 90 days postimplant. At 6 months, the tensile strengths of cross-linked prostheses were significantly greater compared with ePTFE. Our findings demonstrate that despite the cross-linked collagen prostheses promoting less tissue ingrowth than the noncross-linked meshes, they became gradually replaced by good quality host tissue and were less rapidly degraded, leading to improved stress resistance in the long term.
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Affiliation(s)
- Gemma Pascual
- Department of Medical Specialities, University of Alcala, Madrid, Spain
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Histologic and Biomechanical Evaluation of Biologic Meshes following Colonization with Pseudomonas aeruginosa. J Surg Res 2012; 175:e35-42. [DOI: 10.1016/j.jss.2011.10.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/30/2011] [Accepted: 10/27/2011] [Indexed: 11/21/2022]
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Beres A, Christison-Lagay ER, Romao RLP, Langer JC. Evaluation of Surgisis for patch repair of abdominal wall defects in children. J Pediatr Surg 2012; 47:917-9. [PMID: 22595572 DOI: 10.1016/j.jpedsurg.2012.01.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Abdominal wall defects in children are not always amenable to primary repair and may require a patch. The ideal material has yet to be established. We sought to evaluate our experience using the bioabsorbable material Surgisis (Cook Surgical, Bloomington, IN) for abdominal closure. METHODS A retrospective chart review of abdominal wall defects repaired with Surgisis in our institution from 2000 to 2010 was performed. Data extracted included cause of defect, age at operation, possibility of skin coverage, recurrence, length of follow-up, and rate of wound infection. RESULTS Thirteen patients were identified. Cause of defect was gastroschisis (n = 2), ventral hernia after diaphragmatic hernia repair (n = 2), and omphalocele (n = 9). At median follow-up of 60 months (range, 10-90), 5 (38%) of 13 patients recurred, and 1 patient recurred twice. All recurrences required subsequent patch closure. Six instances of wound infection required antibiotics. None required patch removal. There was a trend toward more frequent recurrence among infants undergoing patch repair (3/4 recurrences in this group) than neonates (1/4 recurrences) or children older than 18 months (1/5 recurrences). CONCLUSION Our data suggest that Surgisis is moderately successful in the repair of pediatric abdominal wall defects. We noted a trend toward a higher recurrence rate in infants. Further studies investigating timing of repair and alternative biosynthetic materials are warranted.
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Affiliation(s)
- Alana Beres
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Development of novel electrospun absorbable polycaprolactone (PCL) scaffolds for hernia repair applications. Surg Endosc 2012; 26:2717-28. [PMID: 22538673 DOI: 10.1007/s00464-012-2258-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 03/10/2012] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Permanent/nonresorbable hernia repair materials rely on profibrotic wound healing, and repair sites are commonly composed of disorganized tissue with inferior mechanical strength and risk of reherniation. Resorbable electrospun scaffolds represent a novel class of biomaterials, which may provide a unique platform for the design of advanced soft tissue repair materials. These materials are simple, inexpensive, nonwoven materials composed of polymer fibers that readily mimic the natural extracellular matrix. The primary goal of the present study was to evaluate the physiomechanical properties of novel electrospun scaffolds to determine their suitability for hernia repair. Based on previous experimentation, scaffolds possessing ≥ 20 N suture retention strength, ≥ 20 N tear resistance, and ≥ 50 N/cm tensile strength are appropriate for hernia repair. METHODS Six novel electrospun scaffolds were fabricated by varying combinations of polymer concentration (10-12 %) and flow rate (3.5-10 mL/h). Briefly, poly(ε-caprolactone) (PCL) was dissolved in a solvent mixture and electrospun onto a planar metal collector, yielding sheets with randomly oriented fibers. Physiomechanical properties were evaluated through scanning electron microscopy, laser micrometry, and mechanical testing. RESULTS Scanning electron micrographs demonstrated fiber diameters ranging from 1.0 ± 0.1 μm (10 % PCL, 3.5 mL/h) to 1.5 ± 0.2 μm (12 % PCL, 4 mL/h). Laser micrometry demonstrated thicknesses ranging from 0.72 ± 0.07 mm (12 % PCL, 10 mL/h) to 0.91 ± 0.05 mm (10 % PCL, 3.5 mL/h). Mechanical testing identified two scaffolds possessing suture retention strengths ≥ 20 N (12 % PCL, 10 mL/h and 12 % PCL, 6 mL/h), and no scaffolds possessing tear resistance values ≥ 20 N (range, 4.7 ± 0.9 N to 10.6 ± 1.8 N). Tensile strengths ranged from 35.27 ± 2.08 N/cm (10 % PCL, 3.5 mL/h) to 81.76 ± 15.85 N/cm (12 % PCL, 4 mL/h), with three scaffolds possessing strengths ≥ 50 N/cm (12 % PCL, 10 mL/h; 12 % PCL, 6 mL/h; 12 % PCL, 4 mL/h). CONCLUSIONS Two electrospun scaffolds (12 % PCL, 10 mL/h and 12 % PCL, 6 mL/h) possessed suture retention and tensile strengths appropriate for hernia repair, justifying evaluation in a large animal model. Additional studies examining advanced methods of fabrication may further improve the unique properties of these scaffolds, propelling them into applications in a variety of clinical settings.
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López Cano M, Armengol Carrasco M, Quiles Pérez MT, Arbós Vía MA. [Biological implants in abdominal wall hernia surgery]. Cir Esp 2012; 91:217-23. [PMID: 22541448 DOI: 10.1016/j.ciresp.2012.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 02/18/2012] [Accepted: 03/04/2012] [Indexed: 12/29/2022]
Abstract
Permanent synthetic materials are currently of choice for abdominal wall hernia repair. However, they are not ideal as short- and long-term complications with these have been reported. Extracellular matrix-derived biological implants (EMDBI) have emerged as a result of research and development into new materials. Several types of EMDBI have appeared in the last few years, each with its own manufacture characteristics and different from the rest. The current panorama of the xenogeneic EMDBI available in Spain is analysed, their complications, the unknown factors arising in the long-term, and the clinical experience available on incisional and inguinal hernias.
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Affiliation(s)
- Manuel López Cano
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain.
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Biological mesh reconstruction of perineal wounds following enhanced abdominoperineal excision of rectum (APER). Int J Colorectal Dis 2012; 27:475-82. [PMID: 22006494 DOI: 10.1007/s00384-011-1325-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2011] [Indexed: 02/08/2023]
Abstract
INTRODUCTION An abdominoperineal excision of rectum (APER) may be required for rectal tumours less than 6 cm from the anal verge. Recently, the cylindrical APER has been used to prevent the "surgical waist" and so decrease margin involvement. However, removal of the levators leaves a large defect. Myocutaneous flaps [e.g. vertical rectus abdominis (VRAM)] are often used to fill the cylindrical resection defect, but have disadvantages associated with operative time, expertise and morbidity. We report our early experience of pelvic floor reconstruction with a biological mesh following cylindrical APER. METHODS Data on consecutive patients having cylindrical APER between January 2008 and November 2010 were collected. Outcomes were compared between a VRAM reconstruction group and a mesh group. RESULTS In 15 consecutive patients with low rectal cancer, five patients had VRAM pelvic floor reconstruction prior to ten patients having biosynthetic mesh repairs. The median operative time for the VRAM cohort was 405 min, compared with 259 min for the mesh (p = 0.0013). The median length of postoperative stay was 20 days for VRAM and 10 days for the mesh group (p = 0.067). There were four early complications for the VRAM group compared with seven for the mesh cohort (p = 0.37). The median cost per patient for the VRAM cohort was £11,075 compared to a median cost of £6,513 for the Mesh (p = 0.0097). CONCLUSION The use of a biological mesh for pelvic floor reconstruction following cylindrical APER is feasible with morbidity comparable to VRAM reconstruction. There is significant cost-saving using a biosynthetic mesh, mainly due to reduced length of stay.
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Macrophage phenotype as a predictor of constructive remodeling following the implantation of biologically derived surgical mesh materials. Acta Biomater 2012; 8:978-87. [PMID: 22166681 DOI: 10.1016/j.actbio.2011.11.031] [Citation(s) in RCA: 527] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/23/2011] [Accepted: 11/24/2011] [Indexed: 12/14/2022]
Abstract
Macrophages have been classified as having plastic phenotypes which exist along a spectrum between M1 (classically activated; pro-inflammatory) and M2 (alternatively activated; regulatory, homeostatic). To date, the effects of polarization towards an M1 or M2 phenotype have been studied largely in the context of response to pathogen or cancer. Recently, M1 and M2 macrophages have been shown to play distinct roles in tissue remodeling following injury. In the present study, the M1/M2 paradigm was utilized to examine the role of macrophages in the remodeling process following implantation of 14 biologically derived surgical mesh materials in the rat abdominal wall. In situ polarization of macrophages responding to the materials was examined and correlated to a quantitative measure of the observed tissue remodeling response to determine whether macrophage polarization is an accurate predictor of the ability of a biologic scaffold to promote constructive tissue remodeling. Additionally the ability of M1 and M2 macrophages to differentially recruit progenitor-like cells in vitro, which are commonly observed to participate in the remodeling of those ECM scaffolds which have a positive clinical outcome, was examined as a possible mechanism underlying the differences in the observed remodeling responses. The results of the present study show that there is a strong correlation between the early macrophage response to implanted materials and the outcome of tissue remodeling. Increased numbers of M2 macrophages and higher ratios of M2:M1 macrophages within the site of remodeling at 14 days were associated with more positive remodeling outcomes (r(2)=0.525-0.686, p<0.05). Further, the results of the present study suggest that the constructive remodeling outcome may be due to the recruitment and survival of different cell populations to the sites of remodeling associated with materials that elicit an M1 vs. M2 response. Both M2 and M0 macrophage conditioned media were shown to have higher chemotactic activities than media conditioned by M1 macrophages (p<0.05). A more thorough understanding of these issues will logically influence the design of next generation biomaterials and the development of regenerative medicine strategies for the formation of functional host tissues.
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Bellows CF, Wheatley BM, Moroz K, Rosales SC, Morici LA. The effect of bacterial infection on the biomechanical properties of biological mesh in a rat model. PLoS One 2011; 6:e21228. [PMID: 21698179 PMCID: PMC3116894 DOI: 10.1371/journal.pone.0021228] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 05/24/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use of biologic mesh to repair abdominal wall defects in contaminated surgical fields is becoming the standard of practice. However, failure rates and infections of these materials persist clinically. The purpose of this study was to determine the mechanical properties of biologic mesh in response to a bacterial encounter. METHODS A rat model of Staphylococcus aureus colonization and infection of subcutaneously implanted biologic mesh was used. Samples of biologic meshes (acellular human dermis (ADM) and porcine small intestine submucosa (SIS)) were inoculated with various concentrations of methicillin-resistant Staphylococcus aureus [10(5), 10(9) colony-forming units] or saline (control) prior to wound closure (n = 6 per group). After 10 or 20 days, meshes were explanted, and cultured for bacteria. Histological changes and bacterial recovery together with biomechanical properties were assessed. Data were compared using a 1-way ANOVA or a Mann-Whitney test, with p<0.05. RESULTS The overall rate of staphylococcal mesh colonization was 81% and was comparable in the ADM and SIS groups. Initially (day 0) both biologic meshes had similar biomechanical properties. However after implantation, the SIS control material was significantly weaker than ADM at 20 days (p = 0.03), but their corresponding modulus of elasticity were similar at this time point (p>0.05). After inoculation with MRSA, a time, dose and material dependent decrease in the ultimate tensile strength and modulus of elasticity of SIS and ADM were noted compared to control values. CONCLUSION The biomechanical properties of biologic mesh significantly decline after colonization with MRSA. Surgeons selecting a repair material should be aware of its biomechanical fate relative to other biologic materials when placed in a contaminated environment.
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Affiliation(s)
- Charles F Bellows
- Department of Surgery, Tulane University Health Sciences Center, New Orleans, Louisiana, United States of America.
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Crapo PM, Gilbert TW, Badylak SF. An overview of tissue and whole organ decellularization processes. Biomaterials 2011; 32:3233-43. [PMID: 21296410 DOI: 10.1016/j.biomaterials.2011.01.057] [Citation(s) in RCA: 2213] [Impact Index Per Article: 170.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 01/19/2011] [Indexed: 12/13/2022]
Abstract
Biologic scaffold materials composed of extracellular matrix (ECM) are typically derived by processes that involve decellularization of tissues or organs. Preservation of the complex composition and three-dimensional ultrastructure of the ECM is highly desirable but it is recognized that all methods of decellularization result in disruption of the architecture and potential loss of surface structure and composition. Physical methods and chemical and biologic agents are used in combination to lyse cells, followed by rinsing to remove cell remnants. Effective decellularization methodology is dictated by factors such as tissue density and organization, geometric and biologic properties desired for the end product, and the targeted clinical application. Tissue decellularization with preservation of ECM integrity and bioactivity can be optimized by making educated decisions regarding the agents and techniques utilized during processing. An overview of decellularization methods, their effect upon resulting ECM structure and composition, and recently described perfusion techniques for whole organ decellularization techniques are presented herein.
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Affiliation(s)
- Peter M Crapo
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
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