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Shi H, Wang R, Dong W, Yang D, Song H, Gu Y. Synthetic Versus Biological Mesh in Ventral Hernia Repair and Abdominal Wall Reconstruction: A Systematic Review and Recommendations from Evidence-Based Medicine. World J Surg 2023; 47:2416-2424. [PMID: 37268782 DOI: 10.1007/s00268-023-07067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/04/2023]
Abstract
AIM To compare the efficacy and safety of synthetic and biological meshes in ventral hernia repair (VHR) and abdominal wall reconstruction (AWR). METHODS We screened all clinical trials that reported the application of synthetic and biological meshes in VHR and AWR using Medline, Web of Science, and Embase (Ovid). Only comparative studies with similar baselines such as age, sex, body mass index, degree of wound contamination, and hernia defects between the intervention and control groups were included. Effect sizes with 95% confidence were pooled using a random- or fixed-effects model based on the size of heterogeneity. A sensitivity analysis was performed to test the stability of the results. RESULTS Ten studies with 1305 participants were included. Biological meshes were associated with significantly higher recurrence rate (OR, 2.09; 95% CI 1.42-3.08; I2 = 50%), surgical site infection (OR, 1.47; 95% CI 1.10-1.97; I2 = 30%), higher re-admission rate (OR, 1.51; 95% CI 1.05-2.17; I2 = 50%), and longer length of hospital stay (SMD, 0.37; 95% CI 0.10-0.65; I2 = 72%). Similar surgical site occurrence, re-operation rate, and mesh explantation rate were observed among biological and synthetic meshes. Biological meshes have no difference in recurrence rate as compared to synthetic meshes, between the clean-contaminated, and contamination-infected fields (OR, 1.41; 95% CI 0.41-4.87 vs 3.00; 95% CI 1.07-8.46; P = 0.36). CONCLUSION Synthetic meshes are a safe alternative to biological meshes for VHR and AWR. Considering the high cost of biological meshes, synthetic meshes are more appropriate for the VHR and AWR.
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Affiliation(s)
- Hekai Shi
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Rui Wang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Wenpei Dong
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Dongchao Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Heng Song
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China
| | - Yan Gu
- Department of General Surgery, Fudan University Affiliated Huadong Hospital, No. 221, West Yan'an Road, Jing'an District, Shanghai, 200040, People's Republic of China.
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2
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Schlosser KA, Warren JA. Hernia Mesh Complications: Management of Mesh Infections and Enteroprosthetic Fistula. Surg Clin North Am 2023; 103:1029-1042. [PMID: 37709388 DOI: 10.1016/j.suc.2023.04.011] [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: 09/16/2023]
Abstract
The potential consequences of mesh infection mandate careful consideration of surgical approach, mesh selection, and preoperative patient optimization when planning for ventral hernia repair. Intraperitoneal mesh, microporous or laminar mesh, and multifilament mesh typically require explantation, whereas macroporous, monofilament mesh in an extraperitoneal position is often salvageable. Delayed presentation of mesh infection should raise the suspicion for enteroprosthetic fistula when intraperitoneal mesh is present. When mesh excision is necessary, the surgeon must carefully consider both the risk of recurrent infection as well as hernia recurrence when deciding on single-stage definitive reconstruction versus primary closure with delayed reconstruction.
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Affiliation(s)
- Kathryn A Schlosser
- Department of Surgery, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA. https://twitter.com/KT_Schlosser
| | - Jeremy A Warren
- Department of Surgery, Division of Minimal Access Surgery, University of South Carolina School of Medicine Greenville, Prisma Health, 701 Grove Road, Support Tower 3, Greenville, SC 29605, USA.
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3
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Ortega-Deballon P. Time is up for biological parietal prostheses. J Visc Surg 2022; 159:265-266. [PMID: 35753937 DOI: 10.1016/j.jviscsurg.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P Ortega-Deballon
- General and Digestive Surgery Department, CHU Dijon Bourgogne, Inserm UMR 1231, UFR Sciences de Santé, University of Bourgogne, Dijon, France.
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Charleux-Muller D, Romain B, Boisson C, Velten M, Brigand C, Lejeune C. Cost-effectiveness analysis of resorbable biosynthetic mesh in contaminated ventral hernia repair. J Visc Surg 2021; 159:279-285. [PMID: 34116953 DOI: 10.1016/j.jviscsurg.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to compare, in terms of cost and serious complications, the use of biosynthetic resorbable parietal mesh with biologic mesh in patients undergoing contaminated ventral hernia repair (modified Ventral Hernia Working Group grade 3). Poly-4-hydroxy-butyrate (P4HB) biosynthetic mesh has rarely been the subject of comparative studies in the context of contamination. Data are required to confirm the effects of a transition from biological mesh to biosynthetic resorbable mesh. PATIENTS AND METHODS A cost-effectiveness analysis was conducted. It was based on a decision analysis model built with clinical and economic data issued from a before-after study that included 94 patients hospitalized for ventral hernia repair at the University Hospital of Strasbourg (France) from June 2011 to February 2018. The effectiveness endpoint was the number of patients presenting with a serious specific complication or a general complication at 6 months. Data for surgical hospitalization stays, home hospitalizations and ambulatory care costs were included. RESULTS We found fewer serious complications with biosynthetic mesh: 21% versus 33% with biologic mesh. A cost savings of US $5146 was determined. Deterministic sensitivity analyses and a probabilistic analysis confirmed our findings and the robustness of the model. CONCLUSION P4HB biosynthetic resorbable mesh appeared to be the most effective and the least costly option. Additional data will be needed to confirm the superiority of biosynthetic mesh in terms of the recurrence risk reduction over a longer period.
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Affiliation(s)
- D Charleux-Muller
- Department of Digestive Surgery, University Hospital of Strasbourg, 1 avenue Molière, 67200 Strasbourg, France.
| | - B Romain
- Department of Digestive Surgery, University Hospital of Strasbourg, 1 avenue Molière, 67200 Strasbourg, France
| | - C Boisson
- Clinical Epidemiology Unit, Clinical Investigation Center, INSERM, CIC1432, Dijon University Hospital
| | - M Velten
- Department of Public Health, INSERM, UMR-S1113, University Hospital of Strasbourg, 1 place de l'hôpital, 67100 Strasbourg, France
| | - C Brigand
- Department of Digestive Surgery, University Hospital of Strasbourg, 1 avenue Molière, 67200 Strasbourg, France
| | - C Lejeune
- Clinical Epidemiology Unit, Clinical Investigation Center, INSERM, CIC1432, Dijon University Hospital; INSERM, LNC UMR1231, University Bourgogne Franche-Comté, Dijon, France
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Serrano-Aroca Á, Pous-Serrano S. Prosthetic meshes for hernia repair: State of art, classification, biomaterials, antimicrobial approaches, and fabrication methods. J Biomed Mater Res A 2021; 109:2695-2719. [PMID: 34021705 DOI: 10.1002/jbm.a.37238] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/23/2022]
Abstract
Worldwide, hernia repair represents one of the most frequent surgical procedures encompassing a global market valued at several billion dollars. This type of surgery usually requires the implantation of a mesh that needs the appropriate chemical, physical and biological properties for the type of repair. This review thus presents a description of the types of hernias, current hernia repair methods, and the state of the art of prosthetic meshes for hernia repair providing the most important meshes used in clinical practice by surgeons working in this area classified according to their biological or chemical nature, morphology and whether bioabsorbable or not. We emphasise the importance of surgical site infection in herniatology, how to deal with this microbial problem, and we go further into the future research lines on the production of advanced antimicrobial meshes to improve hernia repair and prevent microbial infections, including multidrug-resistant strains. A great deal of progress has been made in this biomedical field in the last decade. However, we are still far from an ideal antimicrobial mesh that can also provide excellent integration to the abdominal wall, mechanical performance, low visceral adhesion and minimal inflammatory or foreign body reactions, among many other problems.
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Affiliation(s)
- Ángel Serrano-Aroca
- Biomaterials and Bioengineering Lab, Centro de Investigación Traslacional San Alberto Magno, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Salvador Pous-Serrano
- Surgical Unit of Abdominal Wall, Department of General and Digestive Surgery, La Fe University Hospital, Valencia, Spain
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Grossi S, Grimaldi A, Congiu T, Parnigoni A, Campanelli G, Campomenosi P. Human Primary Dermal Fibroblasts Interacting with 3-Dimensional Matrices for Surgical Application Show Specific Growth and Gene Expression Programs. Int J Mol Sci 2021; 22:ijms22020526. [PMID: 33430241 PMCID: PMC7825678 DOI: 10.3390/ijms22020526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 01/06/2023] Open
Abstract
Several types of 3-dimensional (3D) biological matrices are employed for clinical and surgical applications, but few indications are available to guide surgeons in the choice among these materials. Here we compare the in vitro growth of human primary fibroblasts on different biological matrices commonly used for clinical and surgical applications and the activation of specific molecular pathways over 30 days of growth. Morphological analyses by Scanning Electron Microscopy and proliferation curves showed that fibroblasts have different ability to attach and proliferate on the different biological matrices. They activated similar gene expression programs, reducing the expression of collagen genes and myofibroblast differentiation markers compared to fibroblasts grown in 2D. However, differences among 3D matrices were observed in the expression of specific metalloproteinases and interleukin-6. Indeed, cell proliferation and expression of matrix degrading enzymes occur in the initial steps of interaction between fibroblast and the investigated meshes, whereas collagen and interleukin-6 expression appear to start later. The data reported here highlight features of fibroblasts grown on different 3D biological matrices and warrant further studies to understand how these findings may be used to help the clinicians choose the correct material for specific applications.
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Affiliation(s)
- Sarah Grossi
- Department of Biotechnology and Life Sciences, University of Insubria, DBSV, Via J.H. Dunant 3, 21100 Varese, Italy; (S.G.); (A.G.); (A.P.)
| | - Annalisa Grimaldi
- Department of Biotechnology and Life Sciences, University of Insubria, DBSV, Via J.H. Dunant 3, 21100 Varese, Italy; (S.G.); (A.G.); (A.P.)
| | - Terenzio Congiu
- Department of Surgical Sciences, University of Cagliari, 09100 Cagliari, Italy;
| | - Arianna Parnigoni
- Department of Biotechnology and Life Sciences, University of Insubria, DBSV, Via J.H. Dunant 3, 21100 Varese, Italy; (S.G.); (A.G.); (A.P.)
| | - Giampiero Campanelli
- Milano Hernia Center, Department of Surgical Science, Istituto Clinico Sant’Ambrogio, Via Luigi Giuseppe Faravelli 16, 20149 Milan, Italy;
- Department of Medicine and Surgery, University of Insubria, DMC, Via Guicciardini 9, 21100 Varese, Italy
| | - Paola Campomenosi
- Department of Biotechnology and Life Sciences, University of Insubria, DBSV, Via J.H. Dunant 3, 21100 Varese, Italy; (S.G.); (A.G.); (A.P.)
- Correspondence: ; Tel.: +39-0332-421322
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7
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Fundamentals of Extracellular Matrix Biomaterial Assimilation: Effect of Suture Type on Attachment Strength and Cell Repopulation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2635. [PMID: 32537327 PMCID: PMC7253251 DOI: 10.1097/gox.0000000000002635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/04/2019] [Indexed: 01/10/2023]
Abstract
The clinical results with extracellular matrix biomaterials are confounded by expectations of material response based on years of experience with permanent or degradable synthetic polymers. However, the remodeling or assimilation of extracellular matrix biomaterials is dictated by cell-mediated processes rather than fibrous encapsulation or hydrolytic degradation. Previously, we found that tissue adherence and revascularization were dictated by proximity with de-epithelialized host tissue. We now investigate the effects of polymer and fixation type on attachment strength and rate of cell repopulation in an intra-abdominal implant model.
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8
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Recurrent intestinal fistulation after porcine acellular dermal matrix reinforcement in enteric fistula takedown and simultaneous abdominal wall reconstruction. Hernia 2019; 24:537-543. [DOI: 10.1007/s10029-019-02097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
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9
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Health-Related Quality of Life After Ventral Hernia Repair With Biologic and Synthetic Mesh. Ann Plast Surg 2019; 82:S332-S338. [DOI: 10.1097/sap.0000000000001768] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Kaufmann R, Timmermans L, van Loon YT, Vroemen JPAM, Jeekel J, Lange JF. Repair of complex abdominal wall hernias with a cross-linked porcine acellular matrix: cross-sectional results of a Dutch cohort study. Int J Surg 2019; 65:120-127. [PMID: 30946996 DOI: 10.1016/j.ijsu.2019.03.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/24/2019] [Accepted: 03/24/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The use of synthetic mesh in potentially contaminated and contaminated incisional hernias may lead to a higher morbidity and mortality. Biological meshes may provide a solution, but since these meshes are rarely used, little is known about long-term results. The aim of this cohort study was to evaluate the long-term clinical efficacy and patient satisfaction following Permacol™ in complex abdominal wall hernia repair (CAWHR) patients in a cross-sectional fashion. MATERIALS AND METHODS All patients were operated for CAWHR with Permacol™ in the Netherlands between 2009 and 2012. The design was a multicenter cross-sectional cohort study. The STROCSS statement was followed. Patients were interviewed, underwent abdominal examination, and completed quality-of-life questionnaires. ClinicalTrials.gov Identifier NCT02166112. Research Registry Identifier researchregistry4713. RESULTS Seventy-seven patients were seen in the outpatient clinic. Their hernias were classified as potentially contaminated in 25 patients (32.5%) and infected in 52 patients (67.5%). The mean follow-up was 22.2 ± 12.6 months. The most frequent postoperative complication was wound infection (n = 21; 27.3%), meshes had to be removed in five patients (6.5%). By the time of their visit to the outpatient clinic, 22 patients (28.6%) had a recurrence of whom ten (13%) had undergone reoperation. Thirty-nine patients (50.6%) had bulging of the abdominal wall. Quality-of-life questionnaires revealed that patients graded their health status with a mean 6.8 (± 1.8) out of 10 points. CONCLUSION Bulging and recurrence are frequently observed in patients treated with Permacol™ for CAWHR. Considering both recurrence and bulging as undesirable outcomes of treatment, a total of 46 patients (59.7%) had an unfavorable outcome. Infection rates were high, but comparable with similar patient cohorts. Quality-of-life questionnaires revealed that patients were satisfied with their general health, but scored significantly lower on most quality-of-life modalities of the Short Form-36 questionnaire.
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Affiliation(s)
- Ruth Kaufmann
- Department of Surgery, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Lucas Timmermans
- Department of Surgery, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Yu T van Loon
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands; Department of Surgery, Elisabeth TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, the Netherlands.
| | - Joseph P A M Vroemen
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK, Breda, the Netherlands.
| | - Johannes Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands.
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11
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Sahoo S, Ma J, Tastaldi L, Baker AR, Loftis J, Rosen MJ, Derwin KA. Biodegradable hyaluronan hydrogel coatings on acellular dermis grafts-A potential strategy to improve biologic graft durability in hernia repair application. J Biomed Mater Res B Appl Biomater 2019; 107:2664-2672. [PMID: 30860665 DOI: 10.1002/jbm.b.34357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/28/2019] [Accepted: 02/20/2019] [Indexed: 11/07/2022]
Abstract
Biologic grafts used in hernia repair undergo rapid cellular infiltration and remodeling, but their premature degradation often results in hernia recurrence. We hypothesize that a temporary barrier that prevents infiltration of acute inflammatory cells into the graft during the initial 4 weeks of implantation could mitigate graft degradation. The purpose of this study is to design tyramine-substituted hyaluronan (THA) hydrogel coatings with tunable degradation properties, as a means to develop a resorbable barrier for human acellular dermis grafts (HADM). THA plugs prepared at different cross-linking densities, by varying cross-linking agent concentration (0.0001-0.0075% H2 O2 ), demonstrated varying rates of in vitro degradation (25 U/mL hyaluronidase, 48 h). Based on these results, HADM grafts were coated with THA at three cross-linking densities (0.0001%, 0.00075%, and 0.003% H2 O2 ) and THA coating degradation was evaluated in vitro (25 U/mL hyaluronidase, 48 h) and in vivo (rat intraperitoneal implantation, 1-4 weeks). THA coatings degraded in vitro and in vivo with the lowest cross-linking density (0.0001% H2 O2 ), generally showing greater degradation as evidenced by significant decrease in coating cross-sectional area. However, all three coatings remained partially degraded after 4 weeks of in vivo implantation. Alternate strategies to accelerate in vivo degradation of THA coatings are required to allow investigation of the study hypothesis. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2664-2672, 2019.
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Affiliation(s)
- Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jinjin Ma
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Luciano Tastaldi
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Andrew R Baker
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jacki Loftis
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael J Rosen
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kathleen A Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
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12
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Young DA, McGilvray KC, Ehrhart N, Gilbert TW. Comparison of in vivo remodeling of urinary bladder matrix and acellular dermal matrix in an ovine model. Regen Med 2018; 13:759-773. [DOI: 10.2217/rme-2018-0091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: Biologically derived surgical graft materials come from a variety of sources with varying mechanical properties. This study aimed to evaluate the host response and mechanical performance of two extracellular matrix devices in a large animal preclinical model. Materials & methods: Bilateral defects were created in the fascia lata of sheep and repaired with either an acellular dermal matrix (ADM) or urinary bladder matrix (UBM). After 1 or 3 months, the repair site was explanted for histological and mechanical analysis. Results & conclusion: Despite pre-implantation mechanical differences, both UBM and ADM demonstrated similar mechanical performance at 3 months. However, UBM was completely remodeled into site-appropriate tissue by 3 months, while ADM showed limited tissue incorporation.
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Affiliation(s)
| | - Kirk C McGilvray
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Nicole Ehrhart
- Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Thomas W Gilbert
- ACell, Inc., Columbia, MD 21046, USA
- McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
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Young DA, Jackson N, Ronaghan CA, Brathwaite CEM, Gilbert TW. Retrorectus repair of incisional ventral hernia with urinary bladder matrix reinforcement in a long-term porcine model. Regen Med 2018; 13:395-408. [DOI: 10.2217/rme-2018-0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aim: Not all biologically derived materials elicit the same host response when used for reinforcement of ventral hernia repairs. This study aimed to evaluate the remodeling characteristics of the abdominal wall following reinforcement with urinary bladder matrix (UBM) in a large animal preclinical model of ventral hernia repair. Materials & methods: Midline defects in 36 Yucatan minipigs were reinforced with UBM-derived surgical devices using a classic Rives–Stoppa–Wantz approach, and compared with primary repair controls. After 3 or 8 months, the abdominal wall was explanted for histological and mechanical analysis. Results & conclusion: All UBM-derived surgical devices were completely resorbed within 8 months and facilitated deposition of vascularized, biomechanically functional connective tissue in the retrorectus plane, with no evidence of hernia formation.
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Affiliation(s)
| | | | | | | | - Thomas W Gilbert
- ACell Inc., Columbia, MD 21046, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
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14
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Abdominal wall reinforcement: biologic vs. degradable synthetic devices. Hernia 2016; 21:305-315. [DOI: 10.1007/s10029-016-1556-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
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15
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Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery 2016; 160:828-838. [DOI: 10.1016/j.surg.2016.04.041] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/05/2016] [Accepted: 04/09/2016] [Indexed: 12/29/2022]
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16
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Abdominal Closure after TRAM Flap Breast Reconstruction with Transversus Abdominis Muscle Release and Mesh. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1014. [PMID: 27757337 PMCID: PMC5055003 DOI: 10.1097/gox.0000000000001014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
Abstract
Breast reconstruction with a pedicled transverse rectus abdominis muscle (TRAM) flap can result in significant abdominal wall donor-site morbidity. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. We present our novel technique of posterior components separation with transversus abdominis muscle release and retromuscular mesh reinforcement for donor-area closure during pedicled TRAM flap breast reconstruction.
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17
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Fayezizadeh M, Majumder A, Belyansky I, Novitsky YW. Outcomes of Retromuscular Porcine Biologic Mesh Repairs Using Transversus Abdominis Release Reconstruction. J Am Coll Surg 2016; 223:461-8. [PMID: 27349683 DOI: 10.1016/j.jamcollsurg.2016.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Optimal mesh reinforcement and operative technique for major abdominal wall reconstructions (AWR) remain debatable. Posterior component separation via transversus abdominis release (TAR) allows for wide sublay mesh reinforcement with durable reconstruction, and has been gaining popularity in recent years. Although biologic mesh has been associated with mixed results, outcomes of AWR with bioprosthetics have not been well elucidated to date. We evaluated our outcomes of TAR reconstructions with retromuscular porcine biologic mesh reinforcement. STUDY DESIGN Consecutive patients undergoing AWR using TAR with biologic mesh sublay reinforcement were identified in our prospective databases and analyzed. We characterized patient demographics and perioperative details. Main outcomes measures included wound complications and hernia recurrence. RESULTS Between 2007 and 2014, seventy-seven patients (mean age 56 years, mean BMI 35 kg/m(2)) underwent AWR using TAR with biologic mesh. Mean hernia size was 306 ± 128 cm(2) with mean width of 14.3 ± 3.3 cm. The vast majority of patients had grade 3 hernias (92%) and more than half had a history of wound infection (55%). There were 22 (28.6%) surgical site infections consisting of 14 deep, 7 superficial, and 1 organ-space surgical site infections. There were no incidences of chronic mesh infection or explantation. In patients with at least 12 months follow-up (mean duration 28.2 months), there were 8 (12.5%) recurrences. CONCLUSIONS Complex hernias repaired with TAR and retromuscular porcine biologic mesh reinforcement are associated with a low rate of serious perioperative wound/mesh complications. Additionally, our approach resulted in a fairly low rate of hernia recurrences in this complex cohort of patients. We believe that the TAR approach and retromuscular mesh placement can be beneficial when biologic mesh reinforcement is chosen during complex and/or contaminated abdominal wall reconstructions.
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Affiliation(s)
- Mojtaba Fayezizadeh
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Arnab Majumder
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Igor Belyansky
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - Yuri W Novitsky
- Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, Cleveland, OH.
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Pascual G, Sotomayor S, Adel F, Pérez-Köhler B, Rodríguez M, Cifuentes A, Bellón JM. Remodeling of Noncrosslinked Acellular Dermal Matrices in a Rabbit Model of Ventral Hernia Repair. Eur Surg Res 2015; 56:32-48. [DOI: 10.1159/000441721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/14/2015] [Indexed: 11/19/2022]
Abstract
Background: Bioprostheses represent a significant advance in the abdominal wall reconstruction since they become degraded until their complete elimination in the recipient organism. This study examines remodeling in the host of three noncrosslinked porcine dermal collagen biomeshes: Strattice™ (St; LifeCell Corp.), XCM Biologic® Tissue Matrix (XCM; Synthes CMF) and Protexa® (Pr; Deco Med S.R.L.). Methods: Partial ventral hernia defects created in New Zealand White rabbits were repaired using the biomeshes that were placed in an inlay, preperitoneal position. At 14 and 90 days after implantation, explants were assessed in terms of their host tissue incorporation by morphological studies, collagen gene/protein expression (quantitative real-time PCR/immunofluorescence), macrophage response (immunohistochemistry) and biomechanical strength. Results: There were no cases of mortality or infection. Among our macroscopic findings, the mesh detachment detected in one third of the Pr implants at 90 days was of note. The host tissue response to all the biomeshes was similar at both time points, with a tendency observed for their encapsulation. There were no appreciable signs of mesh degradation. The extent of host tissue infiltration and collagenization was greater for St and Pr than for XCM. Macrophages were observed in zones of inflammation and tissue infiltration inside the mesh. XCM showed a greater macrophage response at 90 days (p < 0.05). Improved tensile strength was observed for St (p < 0.05) over Pr and unrepaired defects. Conclusions:St showed the best behavior, featuring good collagenization and tensile strength while also inducing a minimal foreign body reaction.
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Guillaume O, Teuschl AH, Gruber-Blum S, Fortelny RH, Redl H, Petter-Puchner A. Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio-Functionality to Meshes. Adv Healthc Mater 2015; 4:1763-89. [PMID: 26111309 DOI: 10.1002/adhm.201500201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Indexed: 12/19/2022]
Abstract
Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.
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Affiliation(s)
- Olivier Guillaume
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Andreas Herbert Teuschl
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- University of Applied Sciences Technikum Wien; Department of Biochemical Engineering; Höchstädtplatz 5 1200 Vienna Austria
| | - Simone Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - René Hartmann Fortelny
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Alexander Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
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Clinically relevant mechanical testing of hernia graft constructs. J Mech Behav Biomed Mater 2015; 41:177-88. [DOI: 10.1016/j.jmbbm.2014.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/15/2014] [Accepted: 10/19/2014] [Indexed: 12/28/2022]
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