Long-term follow-up of full-thickness skin grafting in giant incisional hernia repair: a randomised controlled trial

Holmdahl, Viktor; Stark, Birgit; Clay, Leonard; Gunnarsson, Ulf; Strigård, Karin

doi:10.1007/s10029-021-02544-z

Cited by 9 publications

(4 citation statements)

References 25 publications

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“…Recently, with the emergence of new biomaterials and processing technologies, surgical mesh categories can be divided into permanent synthetic, resorbable synthetic, biologic, and hybrid meshes, the latter of which contain both biologic and synthetic components [2]. Although synthetic meshes are constructed from strong and affordable materials, their use is commonly associated with inflammation, scar formation, migration, and potentially erosion and pain [2][3][4]. Furthermore, synthetic meshes are not recommended in contaminated or infected fields due to the risk of complications resulting from infection [3,5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of mechanical properties and host tissue response to OviTex™ and Strattice™ surgical meshes

Lombardi

Stec

Edwards

et al. 2023

Hernia

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Purpose This study compared the in vitro/benchtop and in vivo mechanical properties and host biologic response to ovine rumen-derived/polymer mesh hybrid OviTex™ with porcine-derived acellular dermal matrix Strattice™ Firm. Methods OviTex 2S Resorbable (OviTex 2S-R) and Strattice morphology were examined in vitro using histology and scanning electron microscopy; mechanical properties were assessed via tensile test; in vivo host biologic response and explant mechanics were evaluated in a rodent subcutaneous model. Separately, OviTex 1S Permanent (OviTex 1S-P) and Strattice were evaluated in a primate abdominal wall repair model. Results OviTex 2S-R demonstrated layer separation, whereas Strattice retained its structural integrity and demonstrated higher maximum load than OviTex 2S-R out-of-package (124.8 ± 11.1 N/cm vs 37.9 ± 5.5 N/cm, p < 0.001), 24 h (55.7 ± 7.4 N/cm vs 5.6 ± 3.8 N/cm, p < 0.001), 48 h (45.3 ± 14.8 N/cm vs 2.8 ± 2.6 N/cm, p = 0.003), and 72 h (29.2 ± 10.5 N/cm vs 3.2 ± 3.1 N/cm, p = 0.006) following collagenase digestion. In rodents, inflammatory cell infiltration was observed between OviTex 2S-R layers, while Strattice induced a minimal inflammatory response. Strattice retained higher maximum load at 3 (46.3 ± 27.4 N/cm vs 9.5 ± 3.2 N/cm, p = 0.041) and 6 weeks (28.6 ± 14.1 N/cm vs 7.0 ± 3.0 N/cm, p = 0.029). In primates, OviTex 1S-P exhibited loss of composite mesh integrity whereas Strattice integrated into host tissue with minimal inflammation and retained higher maximum load at 1 month than OviTex 1S-P (66.8 ± 43.4 N/cm vs 9.6 ± 4.4 N/cm; p = 0.151). Conclusions Strattice retained greater mechanical strength as shown by lower susceptibility to collagenase degradation than OviTex 2S-R in vitro, as well as higher maximum load and improved host biologic response than OviTex 2S-R in rodents and OviTex 1S-P in primates.

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Section: Introductionmentioning

confidence: 99%

Comparison of mechanical properties and host tissue response to OviTex™ and Strattice™ surgical meshes

Lombardi

Stec

Edwards

et al. 2023

Hernia

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“…Both require repair by functional replacement of the missing tissue. In the cases of abdominal wall weakness, full stability can be achieved by using synthetic meshes ( 1 – 3 ) or autologous grafts ( 4 , 5 ). The goals of reconstruction of the full-thickness abdominal wall include reestablishment of the functional integrity of the abdominal wall with adequate soft-tissue coverage ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Large Full-Thickness Abdominal Wall Defects Using a Free Functional Latissimus Dorsi Muscle

Ninković

Öfner

et al. 2022

Front. Surg.

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IntroductionThe large full-thickness abdominal wall defect has to be treated by considering anatomical and functional requirements. The abdominal wall must regain total physiological function, which means that the full thickness abdominal wall defect must be reconstructed anatomically, not only according to the anatomical requirements but also maintaining the functional dynamic voluntary movement. Defects in the abdominal wall alter respiratory mechanics and can impair the diaphragm function. Additionally, muscles of the anterolateral abdominal wall increase the stability of the lumbar region of the vertebral column by tensing the thoracolumbar fascia and by increasing intraabdominal pressure.Materials and MethodsThe timing and method of reconstruction must be chosen depending upon the etiology of the defect. Severe traumatic injuries, abdominal wall infections, necrotizing soft tissue loss, or sepsis needs to undergo staged reconstruction following adequate debridement to control the infectious process, establish the zone of injury, and for proper treatment of intraabdominal pathology, thereby achieving temporary primary closure using split-thickness skin grafting to the viscera. At the time of definitive reconstruction, deep skin graft dermabrasion give us a facial-like layer with adequate strength to stabilize the static abdominal wall. This dermal layer is supported by free functional (innervated) latissimus dorsi muscle (fLDM), giving full anatomical coverage and functional stability. After oncologic resections full-thickness abdominal wall reconstruction was performed immediately with a combination of fLDM flaps and meshes.ResultsA total of 14 patients underwent abdominal wall reconstruction using the fLDM flap. Staged reconstruction was applied in 8 cases. In the remaining six cases, two had no mesh support, three had synthetic mesh, and one had a fascial graft, which were covered with fLDM flap. There were no free flaps failure. One flap revision due to venous anastomosis thrombosis was performed. Donor site seromas occurred in 5 cases and were treated with punction and direct doxycycline injection. Electromyographic testing postoperatively confirmed reinnervation of transplanted LDM.ConclusionUsing fLDM as a definitive solution, we are not only able to repair soft tissue defects, but also reconstruct voluntary contractility and dynamic natural functional abdominal wall. Transplanted LDM offers enough contractile capacity and strength to replace the function of the missing abdominal wall muscles.

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“…It is recommended that mesh be used in the surgical treatment of incisional hernias larger than 2 cm because of the lower recurrence rate [ 8 , 14 , 15 ]. In the primary closure of ventral hernias, the recurrence rate is up to 60%, while this rate is 10-30% for repairs with mesh [ 1 , 3 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Surgical Treatment Results of Large Incisional Hernias

Korkut¹,

Aksungur²,

Altundas³

et al. 2022

Cureus

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Incisional hernias are one of the most common complications after abdominal surgery. Surgical repairs of large incisional hernias have higher complications and recurrence rates compared to smaller incisional hernia repairs. For this reason, it is a more difficult and experience-requiring application for surgeons. In addition, there is no evidence-based consensus in the literature regarding the optimal surgical treatment of large incisional hernias. The aim of this study is to compare the results of the three most common surgical treatment methods used in a tertiary university hospital for the repair of large incisional hernias in terms of patients' characteristics, recurrence, and complication rates of the treatment methods. MethodsBetween 2014 and 2020, 366 patients with incisional hernias with facial defects larger than 10 cm in a tertiary medical faculty hospital located in eastern Turkey were analyzed. Patients were divided into three groups according to the surgical method used: open onlay prolene mesh (OPM) method, laparoscopic intraperitoneal sublay dual mesh (IPSDM) method, and open IPSDM method. Postoperative complications were divided into five groups as follows: wound complications, complications due to surgical procedures, medical complications, recurrences, and mortality. Treatment methods were compared according to the demographic characteristics of the patients and the postoperative complication rates. ResultsOf the patients, 141 were male and 225 were female, and the mean age was 58.0 ± 28 years. Of the patients, 81.9% were operated on with the open OPM, 10.9% with the laparoscopic IPSDM, and 7.1% with the open IPSDM. Wound complications occurred in 26.7% of patients, surgical complications in 3.2%, medical complications in 6.5%, recurrence in 9.2%, and mortality in 0.8% of patients. Total wound complications were significantly higher in the open OPM group (30%) (p = 0.009). Total surgery complications were significantly higher in the laparoscopic IPSDM group (15%) (p = 0.002). There was no significant difference between groups for medical complications (p = 0.540). Although no recurrence was observed in the open IPSDM group, no significant difference was observed between the groups (p = 0.099). There was no difference in mortality rates between the groups (p = 0.450). The overall complication rate was highest in the open OPM group (48.3%) and lowest in the open IPSDM group (27%) (p = 0.092). The operative time was found to be significantly shorter in open IPSDM (p < 0.001). The length of hospital stay was highest in the open OPM group and lowest in the open IPSDM group (p = 0.450). ConclusionsAlthough hernia defect is greater in the open IPSDM compared to other methods, this method is more advantageous in terms of the complication rate associated with the surgical procedure, the overall complication rate, the duration of surgery, and the recurrence rate. Laparoscopic IPSDM is a more advantageous method in terms of the overall wound and medical complications.

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Long-term follow-up of full-thickness skin grafting in giant incisional hernia repair: a randomised controlled trial

Cited by 9 publications

References 25 publications

Comparison of mechanical properties and host tissue response to OviTex™ and Strattice™ surgical meshes

Comparison of mechanical properties and host tissue response to OviTex™ and Strattice™ surgical meshes

Reconstruction of Large Full-Thickness Abdominal Wall Defects Using a Free Functional Latissimus Dorsi Muscle

Comparison of Surgical Treatment Results of Large Incisional Hernias

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