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Fernandez LG, Murry J, Matthews MR, Thompson CL, Abdelgawad M, Bjorklund R. Definitive Closure Using an Ovine Reinforced Tissue Matrix in Contaminated Penetrating Abdominal Trauma. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943188. [PMID: 38389297 PMCID: PMC10900261 DOI: 10.12659/ajcr.943188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND Cases involving penetrating abdominal trauma may be complex and often involve damage to multiple organ systems. Synthetic, biologic, and reinforced biologic matrices/reinforced tissue matrices (RBMs/RTMs) are frequently used in hernia repair and other surgical procedures requiring reinforcement, including trauma cases that require abdominal repair. CASE REPORT The first case was a 35-year-old male patient with a stab wound (SW) to the right side of the chest and the abdomen resulting in damage to the diaphragm, epicardium, liver, and duodenum. The second case was a 22-year-old male patient who suffered multiple traumas after an automated trencher accident, including a skull fracture with exposed brain and major lacerations to the shoulder and abdomen causing a large right-flank hernia. In both cases, OviTex® (TELA Bio, Inc., Malvern, PA), a reinforced tissue matrix (RTM), was used to help obtain and maintain abdominal wall closure. We also present an institutional economic analysis using data from the author's institution with average case cost and future projections for procedure volume and product usage volume through 2021. CONCLUSIONS We report favorable outcomes in a series of patients with contaminated (CDC Wound Class III) surgical fields who underwent abdominal wall closure and reinforcement with OviTex RTM. Our work adds to the growing body of literature suggesting that reinforced biologics offer a potential alternative to biological meshes in the setting of a contaminated surgical field. Additionally, in comparison to other commonly available biologic matrices, use of OviTex RTM may be a cost-effective option to achieve abdominal wall closure even in complex cases.
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Affiliation(s)
- Luis G Fernandez
- Department of Surgery, Division of Trauma Surgery/Surgical Critical Care, University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Jason Murry
- Department of Surgery, Division of Trauma Surgery/Surgical Critical Care, University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Marc R Matthews
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Banner University of Arizona/University Medical Center, Tuscon, AZ, USA
| | | | - Mohamed Abdelgawad
- Department of Surgery, Division of Trauma Surgery/Surgical Critical Care, University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Rebekah Bjorklund
- Department of Surgery, Division of Trauma Surgery/Surgical Critical Care, University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
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Kumar S, Singh J, Sundaramurthi S. Recurrence in ventral abdominal wall hernias treated using semiabsorbable hybrid meshes. Updates Surg 2024; 76:325-326. [PMID: 37782402 DOI: 10.1007/s13304-023-01635-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 08/16/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Sanjana Kumar
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jaiveer Singh
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sudharsanan Sundaramurthi
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
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Najm A, Niculescu AG, Gaspar BS, Grumezescu AM, Beuran M. A Review of Abdominal Meshes for Hernia Repair-Current Status and Emerging Solutions. MATERIALS (BASEL, SWITZERLAND) 2023; 16:7124. [PMID: 38005054 PMCID: PMC10672379 DOI: 10.3390/ma16227124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Abdominal hernias are common issues in the clinical setting, burdening millions of patients worldwide. Associated with pain, decreased quality of life, and severe potential complications, abdominal wall hernias should be treated as soon as possible. Whether an open repair or laparoscopic surgical approach is tackled, mesh reinforcement is generally required to ensure a durable hernia repair. Over the years, numerous mesh products have been made available on the market and in clinical settings, yet each of the currently used meshes presents certain limitations that reflect on treatment outcomes. Thus, mesh development is still ongoing, and emerging solutions have reached various testing stages. In this regard, this paper aims to establish an up-to-date framework on abdominal meshes, briefly overviewing currently available solutions for hernia repair and discussing in detail the most recent advances in the field. Particularly, there are presented the developments in lightweight materials, meshes with improved attachment, antimicrobial fabrics, composite and hybrid textiles, and performant mesh designs, followed by a systematic review of recently completed clinical trials.
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Affiliation(s)
- Alfred Najm
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 8 Calea Floresca, Sector 1, 014461 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Bogdan Severus Gaspar
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 8 Calea Floresca, Sector 1, 014461 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania
| | - Mircea Beuran
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 8 Calea Floresca, Sector 1, 014461 Bucharest, Romania
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Najm A, Niculescu AG, Rădulescu M, Gaspar BS, Grumezescu AM, Beuran M. Novel Material Optimization Strategies for Developing Upgraded Abdominal Meshes. Int J Mol Sci 2023; 24:14298. [PMID: 37762601 PMCID: PMC10531784 DOI: 10.3390/ijms241814298] [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] [Received: 08/29/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Over 20 million hernias are operated on globally per year, with most interventions requiring mesh reinforcement. A wide range of such medical devices are currently available on the market, most fabricated from synthetic polymers. Yet, searching for an ideal mesh is an ongoing process, with continuous efforts directed toward developing upgraded implants by modifying existing products or creating innovative systems from scratch. In this regard, this review presents the most frequently employed polymers for mesh fabrication, outlining the market available products and their relevant characteristics, further focusing on the state-of-the-art mesh approaches. Specifically, we mainly discuss recent studies concerning coating application, nanomaterials addition, stem cell seeding, and 3D printing of custom mesh designs.
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Affiliation(s)
- Alfred Najm
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 014461 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Marius Rădulescu
- Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry, Politehnica University of Bucharest, 011061 Bucharest, Romania;
| | - Bogdan Severus Gaspar
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 014461 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania
| | - Mircea Beuran
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 014461 Bucharest, Romania
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Sillcox R, Jackson HT. Mesh Versus No Mesh for Cruroplasty. J Laparoendosc Adv Surg Tech A 2022; 32:1144-1147. [PMID: 35980377 DOI: 10.1089/lap.2022.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This review describes the evolution of hiatal hernia repair for the past several decades: From the use of a primary tissue repair only, the subsequent inclusion of synthetic mesh and its complications, to current day indications for mesh use. We will highlight the recent research in biologic and composite meshes as well as the ongoing limitations in studying their efficacy. Finally, we will describe our institutional indications and surgical technique practices in the utilization of biologic mesh.
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Affiliation(s)
- Rachel Sillcox
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Hope T Jackson
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Timmer AS, Claessen JJM, Brouwer de Koning IM, Haenen SM, Belt EJT, Bastiaansen AJNM, Verdaasdonk EGG, Wolffenbuttel CP, Schreurs WH, Draaisma WA, Boermeester MA. Clinical outcomes of open abdominal wall reconstruction with the use of a polypropylene reinforced tissue matrix: a multicenter retrospective study. Hernia 2022; 26:1241-1250. [PMID: 35441284 PMCID: PMC9525385 DOI: 10.1007/s10029-022-02604-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
Objective To assess mesh behaviour and clinical outcomes of open complex abdominal wall reconstruction (CAWR) with the use of a polypropylene reinforced tissue matrix. Methods A multicenter retrospective study of adult patients who underwent open CAWR with the use of a permanent polypropylene reinforced tissue matrix (OviTex®) between June 2019 and January 2021. Results Fifty-five consecutive patients from four hospitals in the Netherlands were analysed; 46 patients with a ventral hernia and 9 patients with an open abdomen. Most patients with a ventral hernia had one or more complicating comorbidities (91.3%) and one or more complicating hernia characteristics (95.7%). Most procedures were performed in a (clean) contaminated surgical field (69.6% CDC 2–4; 41.3% CDC 3–4). All nine patients with an open abdomen underwent semi-emergent surgery. Twelve out of 46 patients with a ventral hernia (26.1%) and 4 of 9 patients with an open abdomen (44.4%) developed a postoperative surgical site infection that made direct contact with the mesh as confirmed on computed tomography (CT), suspicious of mesh infection. No patient needed mesh explantation for persistent infection of the mesh. During a median follow-up of 13 months, 4 of 46 ventral hernia patients (8.7%) developed a CT confirmed hernia recurrence. Conclusion Polypropylene reinforced tissue matrix can withstand infectious complications and provides acceptable mid-term recurrence rates in this retrospective study on open complex abdominal wall reconstructions. Longer follow-up data from prospective studies are required to determine further risk of hernia recurrence. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-022-02604-y.
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Affiliation(s)
- Allard S Timmer
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Jeroen J M Claessen
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | | | - Suzanne M Haenen
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - Eric J T Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | | | | | - Werner A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Infection and Immunity, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
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Smith MJ, Dempsey SG, Veale RWF, Duston-Fursman CG, Rayner CAF, Javanapong C, Gerneke D, Dowling SG, Bosque BA, Karnik T, Jerram MJ, Nagarajan A, Rajam R, Jowsey A, Cutajar S, Mason I, Stanley RG, Campbell A, Malmstrom J, Miller CH, May BCH. Further structural characterization of ovine forestomach matrix and multi-layered extracellular matrix composites for soft tissue repair. J Biomater Appl 2022; 36:996-1010. [PMID: 34747247 PMCID: PMC8721687 DOI: 10.1177/08853282211045770] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Decellularized extracellular matrix (dECM)-based biomaterials are of great clinical utility in soft tissue repair applications due to their regenerative properties. Multi-layered dECM devices have been developed for clinical indications where additional thickness and biomechanical performance are required. However, traditional approaches to the fabrication of multi-layered dECM devices introduce additional laminating materials or chemical modifications of the dECM that may impair the biological functionality of the material. Using an established dECM biomaterial, ovine forestomach matrix, a novel method for the fabrication of multi-layered dECM constructs has been developed, where layers are bonded via a physical interlocking process without the need for additional bonding materials or detrimental chemical modification of the dECM. The versatility of the interlocking process has been demonstrated by incorporating a layer of hyaluronic acid to create a composite material with additional biological functionality. Interlocked composite devices including hyaluronic acid showed improved in vitro bioactivity and moisture retention properties.
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Affiliation(s)
- Matthew J Smith
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Sandi G Dempsey
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Robert WF Veale
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | | | - Chloe A F Rayner
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Chettha Javanapong
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Dane Gerneke
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Shane G Dowling
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Brandon A Bosque
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Tanvi Karnik
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Michael J Jerram
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Arun Nagarajan
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Ravinder Rajam
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Alister Jowsey
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Samuel Cutajar
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Isaac Mason
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Roderick G Stanley
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Andrew Campbell
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Jenny Malmstrom
- Department of Chemical and Materials Engineering, The University of Auckland, Auckland, New Zealand
| | - Chris H Miller
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
| | - Barnaby C H May
- Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand
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