Porcine acellular dermal matrix (PADM) vascularises after exposure in open necrotic wounds seen after complex hernia repair

Abstract

Biological alternatives to synthetic meshes are increasingly utilised in complex abdominal wall reconstruction. There is a lack of evidence demonstrating that non-cross-linked porcine acellular dermal matrix vascularizes and integrates with human tissue in suboptimal wound conditions. We aimed to evaluate these properties in Strattice™ (Life Cell Inc., Branchburg, NJ) following ventral hernia repair. A retrospective review of patients with high-risk ventral hernia repair utilising Strattice™ as an onlay after open component separation was conducted. Patients with postoperative wound exploration and exposure of the onlay were included in this review. One patient underwent punch biopsy for histological analysis. Eleven patients with wound complications necessitating postoperative debridement and exposure of Strattice™ onlay were identified. The onlay was partially debrided in two cases, and one case required complete excision. Vascularisation was clinically evident in 10 of 11 cases (91%) as demonstrated by the presence of granulation tissue and/or the ability to support a skin graft. Histological analysis of one onlay 3 months postoperatively showed neovascularisation and collagen remodelling with minimal inflammatory response. Strattice™ demonstrated resistance to rejection, ability to undergo vascularisation and incorporation into host tissues in sub-optimal wound conditions following ventral hernia repair.

Incarcerated and eventrated abdominal wall hernia reconstruction with autologous double-layer dermal graft in the field of purulent peritonitis—A case report

“…The rationale of the external graft perforation is its faster integration and remodellation. During the integration of the ADM neovascularisation and collagenous remodelling were proved even under suboptimal (infected, necrotic) conditions [19]. Presumably, the same process is likely to happen in the case of the autologous vital dermal grafts too.…”

Comparison of porcine and human acellular dermal matrix outcomes in wound healing: a deep dive into the evidence

“…It has become clear that more research is required in this area. Though there is evidence of effective vascularization following xenograft application in hernia repairs [ 12 ].…”

“…It has become clear that more research is required in this area. Though there is evidence of effective vascularization following xenograft application in hernia repairs [12]. It has been noted however that allografts have a weaker tensile strength than porcine ADM in hernia repair [2,25,26].…”

Advances on the modification and biomedical applications of acellular dermal matrices

“…It remains a significant challenge for surgeons to repair or reconstruct such forms of soft tissue defects. Due to its unique structure and excellent biological properties, such as the ability to support vascular ingrowth and incorporate native tissues, ADM is nowadays commonly used to repair tissue defects in cases when the available autogenous musculofascial tissue is not adequate for tension-free closure [89]. This approach has significantly improved the success rates of such operations and has reduced the incidence of wound complications [90,91].…”