The role of biologic mesh in abdominal wall reconstruction: a systematic review of the current literature

Giant Omphalocele: What's the Way to Go?

“…showed that mean reported recurrence rates for the devices Alloderm, Permacol, and Surgisis were 21%, 11%, and 8%, respectively, and similarly the mean rates of surgical site occurrence, as hematoma, seroma, wound infection, dehiscence, or need for graft removal for each device were respectively 31%, 25%, and 40%. Despite most of the published series, as well as the highest cumulative number of patients treated with biologic mesh products for complex abdominal hernia repair, refers to AlloDerm, this review objectively supports the current trend that the use of these devices has moved away from allograft toward xenograft because of the larger and thicker available sizes and the favourable viscoelastic properties in these products [64] and the beneficial role of xenograft in reducing recurrence rates and surgical site complications in open abdominal hernia repair. These results are concordant with findings from high quality animal studies [53,61,62,65,66], but, given the lack randomized controlled trials studies, they need to be better confirmed.…”

“…According to this data AlloDerm has the highest recurrence rates (up to 100%) while Surgisis performs reasonably in clean or cleancontaminated fields (recurrence rate up to 39% in infected fields) and Permacol has the lowest failure rate (0-15%) and the longest time to failure, particularly in contaminated fields. In the same period data from another systematic review on 29 published series conducted by Beale et al [64]. showed that mean reported recurrence rates for the devices Alloderm, Permacol, and Surgisis were 21%, 11%, and 8%, respectively, and similarly the mean rates of surgical site occurrence, as hematoma, seroma, wound infection, dehiscence, or need for graft removal for each device were respectively 31%, 25%, and 40%.…”

“…Timing for definitive repair should be guided by the patient's general conditions and by the naturally occurring relative reduction in size of the hernia compared to the growing abdominal cavity: whenever the abdominal capacity results big enough to attempt to allocate the herniated viscera, with or without complete escharification of the sac, the sac can be excised, hernia content reduced and abdomen closed by layered closure apposing the fascia with or without the use of a prosthetic patch. If a patch is required the suggested mesh to use is Permacol, the biologic mesh which confers the strongest and more durable repair with the lowest failure rate, performing well even in contaminated fields, while maintaining an adequate host tissue in-growth, collagen deposition, and neovascularisation [51,53,61,62,[64][65][66]. In case of big fascial defect, the wall components separation technique [15,47,48] can be used in order to reduce the size of the required prosthetic patch.…”

Clinical Outcomes of Biologic Mesh

“…Approximately half of the wound complications are Clinical Outcomes of Biologic Mesh infections, but biologic meshes are also associated with seromas, hematomas, fistulas, skin necrosis, and mesh disintegration, independent of source, processing, or degree of cross-linking. 6,7 Many of the published articles on biologic mesh for hernia repair comment that synthetic mesh is contraindicated in contaminated conditions and go on to highlight how biologic mesh can address this difficult situation. The complication rates with the use of biologic mesh are, however, comparable to those of synthetic mesh, bringing into question the fundamental indication for the biologic class of prosthetic.…”

Surgical mesh for ventral incisional hernia repairs:Understanding mesh design

“…The most commonly used biological meshes include Alloderm (LifeCell, USA) (allogenic dermis collagen), Permacol (Medtronic, USA) (cross-linked porcine dermis collagen), Strattice (LifeCell, USA) (non-cross-linked porcine dermis collagen), and Surgisis (Cook Biodesign, USA) (porcine intestine collagen). Alloderm is more expensive (36) and, in general, human dermal meshes have a higher recurrence rate than xenogenics (37). The porcine dermis collagens have a slightly better side effect profile than Alloderm and Surgisis, demonstrated by lower rates of seroma formation, lower total surgical morbidity (38), lower failure rates, and longer (134) time to failure in contaminated or infected fields (39).…”