Xenograft use in reconstructive pelvic surgery: a review of the literature

Abstract

Xenografts, bovine or porcine acellular collagen bioprostheses derived from dermis, pericardium, or small-intestine submucosa, were introduced to overcome synthetic mesh-related complications. Although there are eight commercially available xenografts, there is a paucity of empiric information to justify their use instead of the use of synthetic grafts. In addition, limited data are available about which graft characteristics are important and whether graft-reinforced repairs reduce recurrences and improve outcomes. To address these knowledge gaps, we conducted a Medline search of published reports on xenografts in animal and human trials. Histologic host response to implanted xenograft material depends primarily on chemical cross-linking and porosity, and it is limited to four responses: resorption, incorporation, encapsulation, and mixed. No clinical data unequivocally demonstrate an improved benefit to graft-reinforced repair.

The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up

“…In addition, the pores in the Perigee/Intexen® graft may minimize the risk for hematoma formation, a possible cause for the high graft-related complication rate reported in these studies (5,23). The relative safety of biological compared with synthetic grafts has been reported by others (10,24,25).…”

Integration of nondegradable polystyrene and degradable gelatin in a core–sheath nanofibrous patch for pelvic reconstruction

“…25 However, existing synthetic and natural materials for POP treatment in clinics cannot fully meet these requirements, as shown by 1) the high dyspareunia, infection, and erosion or extrusion rate resulting from the synthesis scaffolds and 2) the rapid degradation of natural scaffolds. [9][10][11][12][13][14][15][16] To overcome these problems, we constructed a composite nanofibrous membrane by electrospinning nanofibers with a PS core embedded in a gelatin sheath as a potential POP. Electrospinning provides a facile approach to fabricate nanofibrous scaffolds similar to natural extracellular matrix, in that they have large surface volume ratio for three-dimensional cell ingrowth and controlled release of bioactive molecules.…”

“…They are also not recommended for high-strain environments in pelvic reconstruction as they usually fail to offer sufficient mechanical support. 13,[15][16][17] For example, although porcine SIS can improve quality-of-life outcomes by attenuating prolapse severity for 6 months, there was no significant difference in improving role limitations, physical limitations, and emotions, compared to traditional anterior repair, after 2 years. 14,18 Hybrid materials are undoubtedly the ideal choice to meet the demands for POP reconstruction because strength and durability of the synthetic component can be combined with the biocompatibility of the biologic materials.…”

“…13 They can also reduce the complications of erosion and fistula formation. 14,15 However, most natural polymers are not durable because of their high degradation rate.…”

Collagen Graft Interposition in Vesicovaginal Fistula Treatment

“…It was difficult to distinguish between collagen already present in the matrix and that laid down by host fibroblasts. This fact has not been unequivocally determined in humans [5] .…”