Synthetic, biological and composite scaffolds for abdominal wall reconstruction

Abstract

The reconstruction of abdominal wall defects remains a huge surgical challenge. Tension-free repair is proven to be superior to suture repair in abdominal wall reconstruction. Scaffolds are essential for tension-free repair. They are used to bridge a defect or reinforce the abdominal wall. A huge variety of scaffolds are now commercially available. Most of the synthetic scaffolds are composed of polypropylene. They provide strong tissue reinforcement, but cause a foreign body reaction, which can result in serious complications. Absorbable synthetic scaffolds, such as Dexon™ (polyglycolic acid) and Vicryl™ (polyglactin 910), are not suitable for abdominal wall reconstruction as they usually require subsequent surgeries to repair recurrent hernias. Composite scaffolds combine the strength of nonabsorbable synthetic scaffolds with the antiadhesive properties of the absorbable scaffold, but require long-term follow-up. Biological scaffolds, such as Permacol™, Surgisis(®) and Alloderm(®), are derived from acellular mammalian tissues. Non-cross-linked biological scaffolds show excellent biocompatibility and degrade slowly over time. However, remnant DNA has been found in several products and the degradation leads to recurrence. Randomized controlled trials with long-term follow-up studies are lacking for all of the available scaffolds, particularly those derived from animal tissue. This article provides an overview of the different types of scaffolds available, and presents the key clinical studies of the commercially available synthetic, composite and biological scaffolds for abdominal wall reconstruction.

An engineered muscle flap for reconstruction of large soft tissue defects

“…Although a wide variety of biological (21)(22)(23) and synthetic (1,24,25) matrices have been evaluated for their efficacy in tissue repair, their use is limited because of the lack of a blood supply, leading to their necrosis, infection, or possible rejection. In parallel, contemporary surgical techniques exploiting local, regional, or free flaps present disadvantages, such as donor site morbidity, procedure duration, the often scant availability of tissues in the area of the defects, and a requirement for higher surgical skill.…”

“…Proper flap vascularization is essential for its successful integration within the host (24,25,27). Various approaches have been used to create vascularized engineered tissue to improve oxygen supply and diffusion in thick tissues.…”

Reconstruction of Abdominal Wall Musculofascial Defects with Small Intestinal Submucosa Scaffolds Seeded with Tenocytes in Rats

“…[22][23][24][25] Various studies have been performed to prove the feasibility of SIS as a tissue engineering scaffold in animal models of rats, dogs, and pigs, and even human patients. [25][26][27][28] Different types of seed cells have been used for repairing abdominal wall defects, including skeletal muscle, skin fibroblasts, and bone marrow stem cells. 21,25,29 However, there have been no published reports on the use of tenocytes to engineer aponeurosis for potential applications in abdominal wall reconstruction.…”

Preparation of a nano- and micro-fibrous decellularized scaffold seeded with autologous mesenchymal stem cells for inguinal hernia repair

“…13 These materials are easy for cell ingrowth, less susceptible to infection, and less likely to cause foreign body response. 12 However, naturally derived materials tend to degrade and the mechanical strength and tensile strength decrease over time after implantation, [14][15][16] which causes concern in clinical applications as tensile properties are necessities for grafts. Thus, it is important to understand not only the biological response to degradable biomaterials but also the mechanical properties of the implanted tissues over time.…”

“…[16][17][18] The attenuation of graft strength over time is definitely a limitation of the acellular matrices that needs to be overcome. 15 Earlier it was found that scaffolds seeded with cells exhibited stronger mechanical properties than the acellular matrices. In this study, we developed a tissue-engineered mesh (TEM) by seeding autologous mesenchymal stem cells (MSCs) into an organized nanofibrous ECM, which directs the growth, distribution, and function of MSCs for inguinal hernia repair in a rabbit model.…”