The use of Surgisis ® for abdominal wall reconstruction in the separation of omphalopagus conjoined twins

Abstract

Abdominal wall reconstruction in omphalopagus twins poses a difficult reconstructive challenge, as separation often results in a large abdominal wall defect. A number of options are available for closure, including tissue flaps, expanders and patches made of foreign material. Surgisis is a new biodegradable small intestine scaffolding substrate that permits tissue in-growth and results in a permanent durable scar. We describe its use in abdominal wall reconstruction after separation of a set of conjoined twins. A set of omphalopagus conjoined twins shared liver and abdominal wall. After separation at 6 months of age, Twin A's abdomen could be closed primarily, but Twin B could not. A 4-ply Surgisis mesh was used in the upper abdominal closure, and a skin flap was created, to completely cover the patch. Both twins survived the operation. A small portion of the skin flap over the Surgisis broke down, healing by secondary intention. In follow up of over 18 months post procedure, there have been no wound infections and the abdominal wall is intact with no evidence of a hernia. Surgisis can be successfully used for the reconstruction of complex abdominal wall defects in the pediatric patient, including reconstruction after separation of conjoined twins.

Analgesic Effect of Bupivacaine Eluting Porcine Small Intestinal Submucosa (SIS) in Ferrets Undergoing Acute Abdominal Hernia Defect Surgery

“…This material supports rapid host tissue ingrowth and fosters cellular differentiation, resulting in remodeled tissue that closely resembles the original host tissue [1,[10][11][12]. Similar results have been found for other SIS applications including vascular grafts [13,14], dural replacement, urinary bladder augmentation and urethral reconstruction [15], dermal wounds [16,17], soft tissue augmentation [18], and other uses [19][20][21][22][23][24]. This differentiation may, in part, be related to growth factors found in the SIS [2,25].…”

Evaluation of Surgisis for patch repair of abdominal wall defects in children

“…Gabriel and Gollin [8] reported the use of Surgisis combined with a negative pressure dressing for 3 cases of complicated gastroschisis. A case report of Surgisis in the reconstruction of a complicated abdominal wall defect postseparation of omphalopagus twins described no hernia apparent at 18-month follow-up [9]. Surgisis has also been used as a patch during repair of congenital diaphragmatic hernia, with similar short-and long-term outcomes compared with muscle flap closure [3] as well as similar rates of recurrent herniation and small bowel obstruction when compared with Gore-tex patch [10].…”

Early results on the use of biomaterials as adjuvant to abdominal wall closure following cytoreduction and hyperthermic intraperitoneal chemotherapy

“…Specific guidelines for specific biomaterial mesh selection for a given case remain to be defined; however in general it is accepted that for complex and contaminated cases, biomaterial mesh offers a viable substitute to the patient's own tissue. In particular the use of biomaterial mesh has been described to be clinically meaningful when the host native abdominal fascia is insufficient for closure without tension, ie (loss of abdominal domain), when there is a lack of viable tissue and a components separation is not technically feasible, or the field is contaminated or potentially contaminated and permanent synthetic mesh is relatively contraindicated [15]. Biomaterial meshes are known to be resistant to infection[16] and overcome the limitations of synthetic mesh for use in contaminated or potentially contaminated wounds, provide a tissue remodeling matrix, for host tissues and fibroblasts [17].…”