Biologic Materials for Pelvic Floor Reconstruction

Gomelsky, Alex; Dmochowski, Roger R.

doi:10.1007/s11884-012-0139-6

Cited by 5 publications

(5 citation statements)

References 87 publications

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“…Based on the Gomelsky et al paper, any graft significantly reduces objective prolapse recurrence rates compared to no graft. Gomelsky et al concluded that there is a lack of data supporting the use of biologics in pelvic prolapse repair and that more randomized controlled trials must be conducted to determine which graft is superior-synthetic vs. biologic [1].…”

Section: Discussionmentioning

confidence: 99%

“…The treatments for POP include the following: Pelvic floor therapy, pessaries, and surgical treatment. The estimated number of women that have a lifetime risk of undergoing an operation for a POP is 11% [1]. In April 2019, the FDA took surgical mesh for transvaginal use off the market due to safety and effectiveness concerns (mesh erosion).…”

Section: Introductionmentioning

confidence: 99%

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Biologic Graft Augmentation of Anterior Mesh Erosion Complicated by Poor Wound Healing Secondary to Heavy Tobacco Use

Williams

McBrayer

Leggio

2021

Uro

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(1) Background: Pelvic organ prolapse (POP) is common among post-menopausal women affecting more than 25% in their lifetime—with 11% having a lifetime risk of undergoing an operation for a POP. In April 2019, the Food and Drug Administration (FDA) took surgical mesh for transvaginal use off the market due to safety and effectiveness concerns. This leaves colporrhaphy or colporrhaphy with bio-graft options for a POP surgical repair. (2) Case: In this report, we look at a case with anterior mesh erosion complicated by poor wound healing secondary to heavy tobacco use and how it was successfully removed and augmented with a Coloplast axis allograft dermis biological graft secured with an Anchorsure sacrospinous ligament/arcus tendineus fascia pelvis fixation device and prolene suture. (3) Results: After failing two prior surgeries to rectify the mesh erosion, a final procedure was performed using a biologic dermal graft and a double-layer closure to aid in protecting and increasing the integrity of the tissue. (4) Conclusions: Collectively, the patient and her surgeries highlight the difficult nature of complete mesh removal and how tobacco use can significantly affect the proper healing of surgical sites. The number of surgeries necessary to address the patient’s chief complaint and the resolution of her symptoms with the biologic graft supports the challenges one faces with mesh removal and poor wound healing secondary to tobacco use. This case illustrates that complicated transvaginal mesh erosion should initially be augmented with a biologic dermal graft secured via sacrospinous ligament/arcus tendineus fascia pelvis fixation and double-layer closure and not only if visible mesh removal alone fails.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biologic Graft Augmentation of Anterior Mesh Erosion Complicated by Poor Wound Healing Secondary to Heavy Tobacco Use

Williams

McBrayer

Leggio

2021

Uro

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“…Decellularized scaffolds from various organs and animals have shown signs of providing support through remodeling, while minimizing the inflammatory host response that leads to complications [1]. Previous limited clinical studies have not been able to show consistent advantages of xenograft use [6][7][8] but there is evidence of significant diversity among the different types of xenografts, precluding their treatment as a homogenous group [9].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of pelvic organ prolapse surgery with porcine small intestinal submucosa graft implantation

Alexandridis

Teleman

Rudnicki

2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: The ideal implant material for the surgical repair of pelvic organ prolapse in women is yet to be found. This retrospective study aims to evaluate a porcine small intestinal submucosa (SIS) graft (Surgisis TM ). Study design: We reviewed the medical records of women that were operated upon for pelvic organ prolapse using implantation of SIS graft and we examined the short-term complications and recurrence rates.Results: A total of 155 surgical procedures were reviewed. SIS graft was placed in the anterior, posterior and middle compartments in 93 (60%), 71 (45.8%) and 13 (8.4%) cases, respectively. At three-month follow-up, 22.6% of anterior graft repairs displayed anatomical recurrence (POP-Q stage ! 2), compared to 4.8% of posterior and none of the middle compartment graft repairs. During the three postoperative months, 56% of the women were recorded with complications, mostly urinary retention (19%) and pain (12%). The incidence of grade III complications was 5.3%. Persistent complications at three months were observed in 28% of all cases. Logistic regression analysis showed that previous prolapse surgery at the same compartment was a significant predictor for recurrence of prolapse after SIS graft application, whereas lower age, smoking and longer duration of surgery were significant predictors for the development of complications. Younger women had higher risk of developing pain postoperatively. Conclusion: Pain and urinary tract symptoms hold a central position in the complications profile of SIS graft-augmented prolapse surgery. The relatively high recurrence rates do not suggest a clear benefit from SIS graft use.

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“…15,16 Consequently, cross-linked matrices have been associated with comparable or increased complication rates relative to that for the polypropylene mesh in prolapse surgeries. 17,18 In this study, we used a 2-ply MatriStem in our composite graft to counteract the degenerative changes induced by Gynemesh PS (referred to as Gynemesh going forward) with minimal impact on its mechanical properties. To evaluate the potential of using MatriStem alone in prolapse repair, we chose a 6-layered product (MatriStem pelvic floor matrix) with mechanical properties in the range of those of polypropylene mesh 19 and slowed degradation rate for replacement by host tissue.…”

Section: Introductionmentioning

confidence: 99%

Extracellular Matrix Regenerative Graft Attenuates the Negative Impact of Polypropylene Prolapse Mesh on Vagina in Rhesus Macaque

Liang

Knight

Barone

et al. 2017

Obstet Gynecol Surv

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BACKGROUND-The use of wide pore lightweight polypropylene mesh to improve anatomical outcomes in the surgical repair of prolapse has been hampered by mesh complications. One of the prototype prolapse meshes has been found to negatively impact the vagina by inducing a decrease in smooth muscle volume and contractility and the degradation of key structural proteins (collagen and elastin), resulting in vaginal degeneration. Recently, bioscaffolds derived from extracellular matrix have been used to mediate tissue regeneration and have been widely adopted in tissue engineering applications.

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Biologic Materials for Pelvic Floor Reconstruction

Cited by 5 publications

References 87 publications

Biologic Graft Augmentation of Anterior Mesh Erosion Complicated by Poor Wound Healing Secondary to Heavy Tobacco Use

Biologic Graft Augmentation of Anterior Mesh Erosion Complicated by Poor Wound Healing Secondary to Heavy Tobacco Use

Efficacy and safety of pelvic organ prolapse surgery with porcine small intestinal submucosa graft implantation

Extracellular Matrix Regenerative Graft Attenuates the Negative Impact of Polypropylene Prolapse Mesh on Vagina in Rhesus Macaque

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