Article
Ventral hernia repair using allogenic acellular dermal matrix in a swine model.
University of Maryland Division of Plastic Surgery, University of Maryland Medical Center, 22 S. Greene St., Baltimore, MD 21201, USA.
Hernia (impact factor:
1.84).
12/2004;
8(4):336-42.
DOI:10.1007/s10029-004-0241-6
pp.336-42
Source: PubMed
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Citations (0)
- Cited In (8)
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Article: The effect of AlloDerm envelopes on periprosthetic capsule formation with and without radiation.
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ABSTRACT: The pathobiology of radiation-induced periprosthetic capsular formation and factors that may ameliorate its development have not been fully elucidated. The authors hypothesized that AlloDerm would diminish radiation-induced capsular formation. Two 5-ml implants were placed submuscularly in the backs of 41 rats. The right implant was wrapped with AlloDerm and the left remained bare. After 48 hours, 20 animals underwent irradiation to each implant, and 21 animals underwent no further treatment and served as controls. After 3 and 12 weeks, the capsules were harvested and submitted for tensile strength and histologic examination. Intraprosthetic pressures were measured in each implant at the time of surgery and when the animals were killed. The intraprosthetic pressure decrease was uniform among all groups at 3 and 12 weeks. Between 3 and 12 weeks, capsular tensile strength increased in nonirradiated bare implants. There was considerable invasion of nonirradiated AlloDerm by inflammatory infiltrates at 3 weeks, and AlloDerm thickness decreased over time. Cellular invasion of AlloDerm was decreased with irradiation at both time points. Capsular tensile strength and thickness of the irradiated bare and AlloDerm capsules did not change between 3 and 12 weeks. Radiation increased inflammation of bare capsules at 12 weeks, but it was significantly reduced in irradiated AlloDerm capsules. The majority of irradiated bare capsules developed pseudoepithelium, whereas AlloDerm protected capsules from this transformation. AlloDerm decreases radiation-related inflammation and delays or diminishes pseudoepithelium formation and thus may slow progression of capsular formation, fibrosis, and contraction.Plastic and reconstructive surgery 04/2009; 123(3):807-16. · 2.74 Impact Factor -
Article: Soft polypropylene mesh, but not cadaveric dermis, significantly improves outcomes in midline hernia repairs using the components separation technique.
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ABSTRACT: The search continues for the "ideal" repair of the midline ventral hernia, and the components separation technique has a low, but still concerning, hernia recurrence rate. The authors hypothesize that adding prosthetic or bioprosthetic meshes to the midline closure during components separation would reduce recurrence rates with minimal added morbidity. Over a 3-year period, patients had a components separation procedure where either acellular cadaveric dermis (n = 26) or soft polypropylene mesh (n = 28) was used as an intraperitoneal underlay for reinforcement of the midline repair, but not as a "bridging material." In 36 operations, the mesh or cadaveric dermis was placed at the time of the components separation, and in the remaining cases (n = 18), the underlay was used to treat a recurrence after components separation. Cadaveric dermis was associated with a 46 percent "true" recurrence rate that required reoperation (mean follow-up, 17.3 months), whereas soft polypropylene mesh had a significantly lower recurrence rate of 11 percent (p = 0.0057) during a follow-up period of 16 months. Because of a higher incidence of concomitant bowel surgery and contamination in the cadaveric dermis group, additional subset analysis of uncontaminated cases was performed, demonstrating a 61 percent recurrence rate for cadaveric dermis compared with 12 percent for soft polypropylene (p = 0.0017). No significant differences in major and minor complications were seen between groups. Soft polypropylene mesh, but not acellular dermis, demonstrates acceptably low complication and hernia recurrence rates when used as a reinforcement of the midline ventral hernia closure in conjunction with components separation.Plastic and reconstructive surgery 10/2009; 124(3):836-47. · 2.74 Impact Factor -
Article: The component separation index: a standardized biometric identity in abdominal wall reconstruction.
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ABSTRACT: Objective: Reconstruction of traumatic ventral hernias often requires additional techniques to the abdominal wall component separation, such as the use of interpositional reconstruction with an acellular dermal matrix or other mesh to bridge the defect. Methods: We have developed a new value termed the "Component Separation Index" to evaluate ventral hernia defects. Choosing a fixed point on a preoperative axial computed tomographic scan (aorta) and the medial leading edges of the rectus abdominus muscles, we determined the angle of diastasis of the hernia. This angle is divided by 360° giving a relative value of the transverse defect size as compared to the estimated circular body habitus for that specific patient. A retrospective review of 36 cases of ventral hernia repairs was performed. The Component Separation Index was calculated from the preoperative computed tomographic scans obtained before repair. Group 1 (n = 18) required component separation for closure. Group 2 (n = 18) required component separation and placement of interpositional mesh to span the hernia defect. Results: The Component Separation Index values were then compared using the student t test for each group. The mean Component Separation Index for group 1 was 0.11 with standard deviation of 0.06. The mean Component Separation Index for group 2 was 0.21 with standard deviation of 0.04 (P < .0001). As this value approaches 0.21, the likelihood of an interpositional repair in addition to component separation becomes much greater. Conclusions: While there is no substitute for clinical acumen when evaluating these defects, objective measurements can provide a valuable additional tool for the surgeon facing these challenging cases.Eplasty 01/2012; 12:e17.
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Keywords
22 Yucatan miniature pigs
3 months
9 months
ADM additionally
DE USA
Fluorescein testing
interpositional graft
LifeCell Corporation
minimal adhesions
NJ USA
pig skin
polytetrafluoroethylene mesh
primary fascial
separate 3-cm fascial incision
tensiometry testing
two 6x4-cm pieces
vascular ingrowth
ventral hernias
W.L. Gore & Associates
xenogenic response
