Abdominal wall reconstruction with large polypropylene mesh: is bigger better?

Assessment of decellularization strategy and biocompatibility testing of full-thickness abdominal wall to produce a tissue-engineered graft

BACKGROUND

Restoration of the abdominal wall defects due to herniation or other complications represents a challenging task of the reconstructive surgery. Synthetic grafts or crosslinked animal-derived grafts, are utilized, followed by significant adverse reactions.

OBJECTIVE

This study aimed to evaluate primarily the production of a decellularized abdominal wall scaffold and secondly its biocompatibility upon transplantation in an animal model.

METHODS

Full-thickness abdominal wall samples were harvested from Wistar Rats and then decellularized utilizing a three-cycle process. To evaluate the decellularization efficacy, histological, biochemical and biomechanical analyses were performed. The biocompatibility assessment involved the implantation of the produced scaffolds to Sprague Dawley rats. The grafts remained for a total period of 4 weeks, followed by immunohistochemistry for the detection of CD11b+, CD4+ and CD8+ cells.

RESULTS

Histological, biochemical and biomechanical results, indicated the production of compatible acellular full-thickness abdominal wall samples. After 4 weeks of implantation, a minor presence of immunity cells was observed.

CONCLUSION

The data of this study indicated the successful production of a full-thickness abdominal wall scaffold. Biologically derived full-thickness abdominal wall scaffolds may have greater potential in restoration of the abdominal wall defects, bringing them one step closer to their clinical utility.

Efficient Decellularization of the Full-Thickness Rat-Derived Abdominal Wall to Produce Acellular Biologic Scaffolds for Tissue Reconstruction: Promising Evidence Acquired from In Vitro Results

BACKGROUND

Functional restoration of abdominal wall defects represents one of the fundamental challenges of reconstructive surgery. Synthetic grafts or crosslinked animal-derived biological grafts are characterized by significant adverse reactions, which are mostly observed after their implantation. The aim of this study was to evaluate the efficacy of the decellularization protocol to produce a completely acellular full-thickness abdominal wall scaffold.

METHODS

Full-thickness abdominal wall samples were harvested from Wistar rats and submitted to a three-cycle decellularization process. Histological, biochemical, and DNA quantification analyses were applied to evaluate the effect of the decellularization protocol. Mechanical testing and immunogenicity assessment were also performed.

RESULTS

Histological, biochemical, and DNA analysis results showed efficient decellularization of the abdominal wall samples after the third cycle. Decellularized abdominal wall scaffolds were characterized by good biochemical and mechanical properties.

CONCLUSION

The data presented herein confirm the effective production of a rat-derived full-thickness abdominal wall scaffold. Expanding this approach will allow the exploitation of the capacity of the proposed decellularization protocol in producing acellular abdominal wall scaffolds from larger animal models or human cadaveric donors. In this way, the utility of biological scaffolds with preserved in vivo remodeling properties may be one step closer to its application in clinical studies.

Repair of lumbar incisional hernia using polypropylene mesh strip sutures - A case report

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Lumbar incisional hernias are rare type of hernias constituting about 1.5% of all ventral hernias.

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Diagnosis is mainly through symptoms corelated with the CT scan findings.

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Repair of these lateral hernias is challenging due to its proximity to the 12 rib and iliac bone.

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Use of mesh strip sutures is a newer concept and may be an effective way to repair lumbar incisional hernias.

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Mesh sutures have demonstrated better resistance to suture pull-through when compared to conventional polypropylene sutures.

Introduction

Lumbar hernias are considered rare and they constitute less than 1.5% of all abdominal wall hernias.

Case report

Here we present a case of a 72-year-old female with a left flank swelling since 2-years diagnosed as a lumbar incisional hernia. This lumbar incisional hernia1 was repaired successfully using polypropylene mesh strip sutures.2

Discussion

Many surgical techniques have been described for repair of LIH. Suture repair, mesh repair and myofascial flaps have been described for lumbar hernias. Repairing a lumbar hernia can be surgically challenging because of its proximity to bony structures, which can limit proper dissection and mesh overlap. We performed defect closure with PMSS. Patient has no recurrence after 2 years of follow up.

Conclusion

In our case of left lumbar incisional hernia, defect closure with PMSS was an effective operation. This technique may also be effective in potentially contaminated settings due to reduced implant load. Further studies are required to understand its biomechanics and long-term outcomes.