Autologous tissue repair of large abdominal wall defects

Reilingh, T. S. de Vries; Bodegom, M.E.; Goor, H. van; Hartman, Ed H.M.; Wilt, Gert Jan van der; Bleichrodt, R. P.

doi:10.1002/bjs.5817

Cited by 102 publications

(74 citation statements)

References 51 publications

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“…The aforementioned study demonstrated the lowest recurrence rate in a group undergoing CST hernia repair with soft polypropylene mesh. In the current study, the overall recurrence rate for primary component separation was 20.6%, consistent with other reports [6][7][8][9][10][11]. We were unable to demonstrate a significant difference in hernia recurrence rates between CST alone, CST with biologic mesh or CST with synthetic mesh with a mean follow up of 16 months.…”

Section: Discussionsupporting

confidence: 89%

“…The technique allows for autologous tissue transfer, approximation of the rectus abdominis muscle complex, and closure of the linea alba following bilateral release of the external oblique aponeurosis and posterior rectus sheath. Recurrence rates with this technique have been reported as low as 18% [7]. While the CST was described without the additional utilization of bioprosthetic meshes, meshes are frequently used an adjunctive reinforcement to a ventral hernia repair.…”

Section: Introductionmentioning

confidence: 99%

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Abdominal Wall Reconstruction Utilizing the Component Separation Technique: Does Reinforcing Mesh Reduce Recurrences?

Roth¹

2013

Surgery Curr Res

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Purpose: The component separation technique was initially described as an autologous tissue transfer without biomaterials. This study evaluates the results of component separation hernia with and without reinforcing mesh. Methods Results:The recurrence rate was 20.6% and wound complications occurred in 46%. Body mass index was associated with postoperative wound complications (non-obese 31.3%, overweight 31.8%, obesity/morbid obesity 51%, superobese 69%) but did not impact hernia recurrence rates (non-obese 7%; overweight 12.5%; obesity/morbid obesity 28.8%, super obese, 23.2%; p=0.207). Gender, diabetes, hypertension, pulmonary disease, and smoking status did not impact recurrence rate or wound complications. Prior hernia repairs did not impact recurrence rates (none, 17%; 1, 26.7%, 2+, 23.1%; p=0.589). 58 underwent repair without mesh, 55 with biologic mesh, and 13 with synthetic mesh. There were no differences in recurrences between groups. Conclusion:Obesity significantly increases wound complications following CST hernia repair. Recurrence rates following primary and recurrent hernia repairs are similar. The adjunct of reinforcing mesh does not affect recurrence rates following CST.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Abdominal Wall Reconstruction Utilizing the Component Separation Technique: Does Reinforcing Mesh Reduce Recurrences?

Roth¹

2013

Surgery Curr Res

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“…In Vivo Graft Integration. In order to assess the effects of in vitro incubation periods on tissue integration prospects in vivo, a full thickness segment of the abdominal wall of nude mice, was replaced with muscle grafts of varying degrees of maturity (3,16). All grafts were retrieved and imaged two weeks postimplantation.…”

Section: Resultsmentioning

confidence: 99%

“…angiogenesis | tissue engineering | vascular biology | regenerative medicine F laps serve as important elements in reconstructive surgery, however, the availability of quality autologous muscle flaps, donor site morbidity, length of procedures, and cosmetic concerns present significant limiting factors (1)(2)(3)(4)(5)(6). Tissue survival is dependent on oxygen supply, which is limited to a diffusion distance of up to 300 μm from a supplying blood vessel (7,8).…”

Section: Improved Vascular Organization Enhances Functional Integratimentioning

confidence: 99%

Improved vascular organization enhances functional integration of engineered skeletal muscle grafts

Koffler

Kaufman‐Francis²,

Shandalov³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

178

181

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Severe traumatic events such as burns, and cancer therapy, often involve a significant loss of tissue, requiring surgical reconstruction by means of autologous muscle flaps. The scant availability of quality vascularized flaps and donor site morbidity often limit their use. Engineered vascularized grafts provide an alternative for this need. This work describes a first-time analysis, of the degree of in vitro vascularization and tissue organization, required to enhance the pace and efficacy of vascularized muscle graft integration in vivo. While one-day in vitro was sufficient for graft integration, a three-week culturing period, yielding semiorganized vessel structures and muscle fibers, significantly improved grafting efficacy. Implanted vessel networks were gradually replaced by host vessels, coupled with enhanced perfusion and capillary density. Upregulation of key graft angiogenic factors suggest its active role in promoting the angiogenic response. Transition from satellite cells to mature fibers was indicated by increased gene expression, increased capillary to fiber ratio, and similar morphology to normal muscle. We suggest a “relay” approach in which extended in vitro incubation, enabling the formation of a more structured vascular bed, allows for graft-host angiogenic collaboration that promotes anastomosis and vascular integration. The enhanced angiogenic response supports enhanced muscle regeneration, maturation, and integration.

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“…Fascia lata graft to repair large abdominal wall defects is resistant and supports intra-abdominal pressures, properly integrating the receiving area (15,16) . Integrated grafts keep the collagen fibers architecture and orientation, and they are easily embedded into the fibrocolagenous tissue without causing foreign body reaction (17) .…”

Section: Introductionmentioning

confidence: 99%

Análise da rejeição do transplante de aponeurose em coelhos

David

Gouvêa

Batista

et al. 2012

Einstein (São Paulo)

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Objective: To study the feasibility of heterologous aponeurosis to close the abdominal wall of rabbits emphasizing the rejection process. Methods: This project was approved by the Animals Care Committee of the Faculdade de Ciências Médicas da Santa Casa de São Paulo, and it was carried out at the Experimental Surgery and Technical Unit. Four red female rabbits exchanged abdominal wall aponeurosis with other four white male animals. Two rabbits just had it removed and replaced to be the control group for the healing process. Animals were evaluated once a day, and after 7 days they were sacrificed. Immunohistochemical analysis with CD20 and CD79 was done. Results: The animals did not have cellulitis, abscess, hematoma, wound dehiscence or herniation. The graft site showed intense hyperemia. The histological analysis showed an inflammatory process with maturing myofibroblasts and collagen ranging from incipient to moderate. The number of vessels was reduced and the inflammatory cells were most plasma cells and macrophages. There were no morphological signs of acute rejection with aggressive vascular endothelial damage. The adjacent muscle showed signs of degeneration with inflammatory centralization of nuclei and cytoplasmic condensation. The immunohistochemical analysis (CD20 and CD79) showed that the inflammatory process was not mediated by lymphocytes. Mann-Whitney nonparametric test showed that the hypothesis of equality (p>0.05) should not be discarded. Conclusion: There were no postoperative complications (fistulas, dehiscence etc.) and the histological analysis showed nonspecific inflammatory process. The immunohistochemical analysis showed that the inflammatory process was not due to a possible rejection.Keywords: Graft rejection; Antigens, CD20; Transplantation; Abdominal wall/surgery; Rabbits Analysis of transplant rejection in rabbits aponeurosisAnálise da rejeição do transplante de aponeurose em coelhos

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Autologous tissue repair of large abdominal wall defects

Cited by 102 publications

References 51 publications

Abdominal Wall Reconstruction Utilizing the Component Separation Technique: Does Reinforcing Mesh Reduce Recurrences?

Abdominal Wall Reconstruction Utilizing the Component Separation Technique: Does Reinforcing Mesh Reduce Recurrences?

Improved vascular organization enhances functional integration of engineered skeletal muscle grafts

Análise da rejeição do transplante de aponeurose em coelhos

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