Effect of suture material on tensile strength and complication rate in abdominal fascial defects repaired with acellular dermal matrix

Burst inflation test for measuring biomechanical properties of rat abdominal walls

PURPOSE

Evaluation of potential grafts to improve upon current strategies for abdominal wall (AW) repair in small animal models typically involves mechanical testing using methods that currently are inadequate to assess physiologically relevant parameters. This study introduces burst inflation testing as a more relevant assessment of the mechanical integrity of the AW compared to traditional tensile testing.

METHODS

AWs were excised from 14 healthy adult Fischer 344 rats and tested using either a custom burst inflation device or an Instron tensile testing system. Modulus outcomes from both testing methods were compared.

RESULTS

Mechanical analyses of native AW using burst and tensile testing methods resulted in similar average tissue moduli, but with the burst test, there was significantly less variability among specimens.

CONCLUSIONS

The burst test had greater repeatability compared to tensile testing and has the ability to test repaired AWs without compromising the integrity of the repair site, making it a useful tool for assessing graft repairs.

A modified approach to component separation using biologic graft as a load-sharing onlay reinforcement for the repair of complex ventral hernia

BACKGROUND

Components separation has been proposed as a means to close large ventral hernia without undue tension. We report a modification on open components separation that allows for the incorporation of onlaid noncrosslinked porcine acellular dermal matrix (Strattice, LifeCell Corp, Branchburg, NJ) as a load-sharing structure.

METHODS

This was a retrospective case series including all cases using Strattice from July 2008 through December 2009. Data evaluated included patient demographics, comorbidities associated with risk of recurrence, hernia grade, and postoperative complications. The primary outcomes were hernia recurrence and surgical site occurrences.

RESULTS

There were 58 patients; 60.8% presented with a recurrent incisional hernia. Average length of follow-up was 384 days. There were 4 hernia recurrences (7.9%). Complications included surgical site infection (20.7%), seroma (15.5%), and hematoma (5%) requiring intervention. Four deaths occurred in the series due to causes unrelated to the hernia repair, only 1 within 30 days of operation.

CONCLUSIONS

This series demonstrates that components separation reinforced with noncrosslinked porcine acellular dermal matrix onlay is an efficacious, single-stage repair with a low rate of recurrence and surgical site occurrences.