Experimental Evaluation of Four Biologic Prostheses for Ventral Hernia Repair

Abstract

Permacol provided a strong and durable repair for up to six months. Peri-Guard was equally strong but prone to infection and to skin ulceration. With time, Veritas and Alloderm lost tensile strength associated with marked thinning and with hernia-like bulging in the case of Alloderm.

Giant Omphalocele: What's the Way to Go?

“…Unfortunately these absorbable non-biological meshes remain intact for only three weeks, which may be an insufficient time to create the adequate tissue strength from cellular remodelling [52]. Furthermore, also synthetic-absorbable prosthetic materials for hernia repair have been associated with complications including early surgical site infection, skin erosion, seroma formation, and later, bowel obstruction or fistula formation [53]. Synthetic meshes are particularly susceptible to bacterial contamination and chronic infection, because bacteria adhere avidly to the synthetic polymers and lay down a biofilm, which protects them from host immunological defences and from antibiotics, contributing to bacterial survival [53].…”

“…Furthermore, also synthetic-absorbable prosthetic materials for hernia repair have been associated with complications including early surgical site infection, skin erosion, seroma formation, and later, bowel obstruction or fistula formation [53]. Synthetic meshes are particularly susceptible to bacterial contamination and chronic infection, because bacteria adhere avidly to the synthetic polymers and lay down a biofilm, which protects them from host immunological defences and from antibiotics, contributing to bacterial survival [53]. Infection frequently requires removal of synthetic prosthesis [53,54].…”

“…Synthetic meshes are particularly susceptible to bacterial contamination and chronic infection, because bacteria adhere avidly to the synthetic polymers and lay down a biofilm, which protects them from host immunological defences and from antibiotics, contributing to bacterial survival [53]. Infection frequently requires removal of synthetic prosthesis [53,54].…”

“…The use of ADM in paediatric surgery is attractive, not only because of the lower rate of complications, but because of the absorbable nature of the patch as well as the incorporation of host tissues into the patch which will grow with the child [56]. Downsides include higher cost, and in theory, potential disease transmission [53]. Collagen-rich tissues (skin, pericardium, intestinal submucosa) are harvested and treated to remove cellular elements, leaving the collagen and elastin scaffold intact.…”

“…Collagen-rich tissues (skin, pericardium, intestinal submucosa) are harvested and treated to remove cellular elements, leaving the collagen and elastin scaffold intact. An additional chemical manipulation for some prostheses involves collagen cross-linking which has the effect to retard the degradation of the collagen by blocking collagenasebinding sites, so that the prosthesis remains structurally intact for a longer period of time compared with non-cross-linked materials, but could also prevent sufficient ingrowth of host tissue and, consequently, adequate tissue remodelling [53,57]. Bacterial collagenases are responsible for the breakdown and resorption of implanted collagen materials.…”