Evaluation of human acellular dermis versus porcine acellular dermis in an in vivo model for incisional hernia repair

Abstract

Incisional hernias commonly occur following abdominal wall surgery. Human acellular dermal matrices (HADM) are widely used in abdominal wall defect repair. Xenograft acellular dermal matrices, particularly those made from porcine tissues (PADM), have recently experienced increased usage. The purpose of this study was to compare the effectiveness of HADM and PADM in the repair of incisional abdominal wall hernias in a rabbit model. A review from earlier work of differences between human allograft acellular dermal matrices (HADM) and porcine xenograft acellular dermal matrices (PADM) demonstrated significant differences (P < 0.05) in mechanical properties: Tensile strength 15.7 MPa vs. 7.7 MPa for HADM and PADM, respectively. Cellular (fibroblast) infiltration was significantly greater for HADM vs. PADM (Armour). The HADM exhibited a more natural, less degraded collagen by electrophoresis as compared to PADM. The rabbit model surgically established an incisional hernia, which was repaired with one of the two acellular dermal matrices 3 weeks after the creation of the abdominal hernia. The animals were euthanized at 4 and 20 weeks and the wounds evaluated. Tissue ingrowth into the implant was significantly faster for the HADM as compared to PADM, 54 vs. 16% at 4 weeks, and 58 vs. 20% for HADM and PADM, respectively at 20 weeks. The original, induced hernia defect (6 cm2) was healed to a greater extent for HADM vs. PADM: 2.7 cm2 unremodeled area for PADM vs. 1.0 cm² for HADM at 20 weeks. The inherent uniformity of tissue ingrowth and remodeling over time was very different for the HADM relative to the PADM. No differences were observed at the 4-week end point. However, the 20-week data exhibited a statistically different level of variability in the remodeling rate with the mean standard deviation of 0.96 for HADM as contrasted to a mean standard deviation of 2.69 for PADM. This was significant with P < 0.05 using a one tail F test for the inherent variability of the standard deviation. No significant differences between the PADM and HADM for adhesion, inflammation, fibrous tissue or neovascularization were noted.

Remodeling of Noncrosslinked Acellular Dermal Matrices in a Rabbit Model of Ventral Hernia Repair

“…Consistent with our results, others have described the similar behavior of CollaMend and Strattice [23] along with no negative effects on the tensile strength of the repair zone when used for abdominal wall reconstruction [39,40]. In clinical practice, Strattice has been used as an effective adjunct in abdominal wall reconstruction, acting as reinforcement during component separation in a wide variety of indications and showing low patient complication rates [41].…”

Repair of Abdominal Wall Defects with Biodegradable Laminar Prostheses: Polymeric or Biological?

“…Consistent with our results, the Butler group [15] has tested Collamend® and St and affirms that these prostheses exhibit rapid tissue and vascular infiltration, indicating the clinical advantages of an abdominal reconstruction that does not compromise the resistance to the implant’s traction area. However, compared with bioprostheses of human origin, Collamend® and St exhibit greater cellular and vascular infiltration [16] and provide stronger support [17].…”

Hernioplasty with polypropylene implant after an abdominal trauma of a pregnant cat

“…Although many studies have shown that the use of polypropylene mesh can lead to the development of an excessive fibrosis, visceral adhesions, formation of enterocutaneous fistulas, deformation and migration of the prosthesis, nowadays this material is the most used both in veterinary and human medicine (BELLOWS; ALDER; HELTON, 2006;LAMPERT et al, 2009;NGO et al, 2011). This is due to a greater availability of polypropylene mesh, is one of the most well studied techniques and most commonly used to solve the problem (SHOUKRY, 1997).…”