Supplemental cross-linking in tissue-based surgical implants for abdominal wall repair

Porcine dermis implants in soft-tissue reconstruction: current status

Soft-tissue reconstruction for a variety of surgical conditions, such as abdominal wall hernia or pelvic organ prolapse, remains a challenge. There are numerous meshes available that may be simply categorized as either synthetic or biologic. Within biologic meshes, porcine dermal meshes have come to dominate the market. This review examines the current evidence for their use and the limitations of knowledge. Although there is increasing evidence to support their safety, long-term follow-up studies that support their efficacy are lacking. Numerous clinical trials that remain ongoing may help elucidate their precise role in soft-tissue reconstruction.

The role of biologic meshes in abdominal wall reconstruction

There are unacceptably high rates of recurrence following surgery for incision hernia repair using suture repair techniques in isolation. As the reconstruction of abdominal walls has expanded with complex surgery, the materials used as adjuncts to support the repair have changed. In the article we review the current use of biologic meshes in abdominal wall reconstruction and the techniques used.

A scientific evidence for the efficacy of biologic implants for soft tissue reconstruction

The challenges and complications arising from abdominal surgery frequently necessitate soft tissue reconstruction or augmentation. Soft tissue repair generally has been revolutionised by the introduction of synthetic meshes, but their use is contra-indicated in contaminated or infected fields. Biologic materials derived from devitalised allo- or xenogeneic tissues have been proposed as a safer alternative to synthetics and provide an extracellular scaffold necessary for the in-growth of new blood vessels and infiltration of native stromal cells. We review the scientific evidence behind commercially available biologic prostheses in relation to the impact of tissue source, manufacturing processes and supplemental cross-linking on in vitro and in vivo (animal model and clinical) performance. Cross-linked meshes exhibit increased resistance to collagenase activity and degradation whilst still allowing tissue in-growth. Mesh durability may be the most important characteristic in determining optimal clinical outcomes, particularly in the context of the increased collagenase activity seen in contaminated or infected fields. Of all the biologic meshes currently available, HDMI cross-linked acellular porcine dermis has been associated with the best clinical outcomes in contaminated or infected fields.