Quantitative in vivo assessment of the tissue response to dermal sheep collagen in abdominal wall defects

Abstract Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods A prospective clinical trial started in 2016 and designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and a longer operative and anesthesia time. At 30-days, surgical site occurrences were observed in 18 (47.4%) AI vs. 17 (44.7%) CC; surgical site infection occurred in 4 (10.4%) AI vs. 6 (15.8%) CC, and a higher number of procedural interventions were required in the CC group, 15.8% AI vs. 28.9% CC. At 6-months follow-up, no chronic infections or hernia recurrences were observed in both groups. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

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Selective Germline Genome Edited Pig Meninges Grafts for the Abdominal Wall Closure in Damage Control Surgery

10.1101/2020.02.12.946178 ◽

2020 ◽

Author(s):

Lijin Zou ◽

Youlai Zhang ◽

Ying He ◽

Hui Yu ◽

Jun Chen ◽

...

Keyword(s):

Inflammatory Response ◽

Abdominal Wall ◽

Damage Control ◽

Abdominal Wall Reconstruction ◽

Rabbit Model ◽

Damage Control Surgery ◽

Electrolyte Balance ◽

Abdominal Wall Defects ◽

Temporary Abdominal Closure

AbstractReconstruction of abdominal wall defects is still a big challenge in surgery, especially where there is insufficient fascia muscular or excessive tension of the defects in emergency and life-threatening scenarios. Indeed, the concept of damage control surgery has been advanced in the management of both traumatic and nontraumatic surgical settings. The strategy requires abridged surgery and quick back to intensive care units (ICU) for aggressive resuscitation. In the damage control laparotomy, patients are left with open abdomen or provisional closure of the abdomen with a planned return to the operating room for definitive surgery. So far, various techniques have been utilized to achieve early temporary abdominal closure, but there is no clear consensus on the ideal method or material for abdominal wall reconstruction. We recently successfully created the selective germline genome-edited pig (SGGEP) and here we aimed to explore the feasibility of in vivo reconstruction of the abdominal wall in a rabbit model with SGGEP meninges grafts (SGGEP-MGs). Our result showed that the SGGEP-MGs could restore the integrity of the defect very well. After 7 weeks of engraftment, there was no sign of herniation observed, the grafts were re-vascularized, and the defects were well repaired. Histologically, the boundary between the graft and the host was very well integrated and there was no strong inflammatory response. Therefore, this kind of closure could help restore the fluid and electrolyte balance and to dampen systemic inflammatory response in damge control surgery while ADM graft failed to establish re-vascularization as the same as the SGGEP-MG. It is concluded that the meninges of SGGEP could serve as a high-quality alternative for restoring the integrity of the abdominal wall, especially for damage control surgery.

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A clinically relevant in vivo model for the assessment of scaffold efficacy in abdominal wall reconstruction

Journal of Tissue Engineering ◽

10.1177/2041731416686532 ◽

2016 ◽

Vol 8 ◽

pp. 204173141668653 ◽

Cited By ~ 6

Author(s):

Jeffrey CY Chan ◽

Krishna Burugapalli ◽

Yi-Shiang Huang ◽

John L Kelly ◽

Abhay Pandit

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Rabbit Model ◽

In Vivo Model ◽

Abdominal Wall Defects ◽

Tissue Samples ◽

Collagen Formation ◽

Hernia Formation ◽

Surgical Meshes

An animal model that allows for assessment of the degree of stretching or contraction of the implant area and the in vivo degradation properties of biological meshes is required to evaluate their performance in vivo. Adult New Zealand rabbits underwent full thickness subtotal unilateral rectus abdominis muscle excision and were reconstructed with the non-biodegradable Peri-Guard®, Prolene® or biodegradable Surgisis® meshes. Following 8 weeks of recovery, the anterior abdominal wall tissue samples were collected for measurement of the implant dimensions. The Peri-Guard and Prolene meshes showed a slight and obvious shrinkage, respectively, whereas the Surgisis mesh showed stretching, resulting in hernia formation. Surgisis meshes showed in vivo biodegradation and increased collagen formation. This surgical rabbit model for abdominal wall defects is advantageous for evaluating the in vivo behaviour of surgical meshes. Implant area stretching and shrinkage were detected corresponding to mesh properties, and histological analysis and stereological methods supported these findings.

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Tissue response to polypropylene meshes used in the repair of abdominal wall defects

Biomaterials ◽

10.1016/s0142-9612(97)00162-2 ◽

1998 ◽

Vol 19 (7-9) ◽

pp. 669-675 ◽

Cited By ~ 68

Author(s):

J.M Bellón ◽

L.A Contreras ◽

J Buján ◽

D Palomares ◽

A Carrera-San Martı́n

Keyword(s):

Abdominal Wall ◽

Tissue Response ◽

Abdominal Wall Defects

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Repair of Abdominal Wall Defects In Vitro and In Vivo Using VEGF Sustained-Release Multi-Walled Carbon Nanotubes (MWNT) Composite Scaffolds

PLoS ONE ◽

10.1371/journal.pone.0064358 ◽

2013 ◽

Vol 8 (5) ◽

pp. e64358 ◽

Cited By ~ 7

Author(s):

Zhicheng Song ◽

Zhi Yang ◽

Jianjun Yang ◽

Zhengni Liu ◽

Zhiyou Peng ◽

...

Keyword(s):

Carbon Nanotubes ◽

Sustained Release ◽

Abdominal Wall ◽

Abdominal Wall Defects ◽

Composite Scaffolds ◽

Multi Walled Carbon Nanotubes ◽

Walled Carbon Nanotubes

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Biomechanical Behaviour and Biocompatibility of Ureidopyrimidinone-Polycarbonate Electrospun and Polypropylene Meshes in a Hernia Repair in Rabbits

Materials ◽

10.3390/ma12071174 ◽

2019 ◽

Vol 12 (7) ◽

pp. 1174 ◽

Cited By ~ 2

Author(s):

Mori da Cunha ◽

Hympanova ◽

Rynkevic ◽

Mes ◽

Bosman ◽

...

Keyword(s):

Inflammatory Response ◽

Abdominal Wall ◽

Muscular Atrophy ◽

Abdominal Wall Defect ◽

Fatty Infiltration ◽

Pelvic Organ ◽

Abdominal Wall Defects ◽

Full Thickness ◽

Recurrence Rates

Although mesh use has significantly improved the outcomes of hernia and pelvic organ prolapse repair, long-term recurrence rates remain unacceptably high. We aim to determine the in vivo degradation and functional outcome of reconstructed abdominal wall defects, using slowly degradable electrospun ureidopyrimidinone moieties incorporated into a polycarbonate backbone (UPy-PC) implant compared to an ultra-lightweight polypropylene (PP) textile mesh with high pore stability. Twenty four New-Zealand rabbits were implanted with UPy-PC or PP to either reinforce a primary fascial defect repair or to cover (referred to as gap bridging) a full-thickness abdominal wall defect. Explants were harvested at 30, 90 and 180 days. The primary outcome measure was uniaxial tensiometry. Secondary outcomes were the recurrence of herniation, morphometry for musculofascial tissue characteristics, inflammatory response and neovascularization. PP explants compromised physiological abdominal wall compliance from 90 days onwards and UPy-PC from 180 days. UPy-PC meshes induced a more vigorous inflammatory response than PP at all time points. We observed progressively more signs of muscle atrophy and intramuscular fatty infiltration in the entire explant area for both mesh types. UPy-PC implants are replaced by a connective tissue stiff enough to prevent abdominal wall herniation in two-thirds of the gap-bridged full-thickness abdominal wall defects. However, in one-third there was sub-clinical herniation. The novel electrospun material did slightly better than the textile PP yet outcomes were still suboptimal. Further research should investigate what drives muscular atrophy, and whether novel polymers would eventually generate a physiological neotissue and can prevent failure and/or avoid collateral damage.

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OV12 THE EARLY OUTCOMES OF ABDOMINAL WALL RECONSTRUCTION WITH POLYVINYLIDENE (PVDF) MESH IN THE INFECTED SETTING: VIDEO PRESENTATION

British Journal of Surgery ◽

10.1093/bjs/znab396.063 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Claudio Birolini ◽

Eduardo Tanaka ◽

Jocielle Miranda ◽

Abel Murakami ◽

Edivaldo Utiyama

Keyword(s):

Abdominal Wall ◽

Abdominal Wall Reconstruction ◽

Synthetic Mesh ◽

Tissue Response ◽

Abdominal Wall Defects ◽

Technical Aspects ◽

Video Presentation ◽

Wound Breakdown ◽

Management Of Complications ◽

Short Video

Abstract The early outcomes of abdominal wall reconstruction with polyvinylidene (PVDF) mesh in the infected setting: video presentation Aim The use of synthetic mesh to repair infected defects of the abdominal wall remains controversial. PVDF mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. The study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. Material and Methods Video presents the technical aspects and some of the outcomes of patients included in a prospective clinical trial designed to evaluate the short and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) Patients were submitted to single-staged repairs, using onlay PVDF mesh reinforcement to treat their defects. Results The technical aspects of the operation, and the management of complications such as wound breakdown, exposed mesh and post-operative seromas are shown in this short video. The early and late outcomes are presented for discussion. Conclusions The use of PVDF mesh in the infected setting presented very favorable results with a low incidence of wound infection.

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