A biomechanical analysis of solvent-dehydrated and freeze-dried human fascia lata allografts. A preliminary report

Superior capsule reconstruction using 8mm-thick fresh-frozen fascia lata graft for irreparable supraspinatus and infraspinatus tendon tears: A cadaveric biomechanical study

BACKGROUND

Superior capsule reconstruction (SCR) was developed to restore superior glenohumeral stability and function to shoulder joints with irreparable rotator cuff tears. Previous biomechanical studies have investigated the effects of SCR using dermal graft or freeze-dried fascia lata allograft. The objective of the current study was to investigate the effect of SCR using fresh-frozen fascia lata graft, which closely resembles the fresh fascia lata autograft used clinically, on shoulder biomechanics in irreparable rotator cuff tendon tear.

METHODS

Eight fresh-frozen cadaveric shoulders were tested by using a custom testing device. Subacromial peak contact pressure (pressure sensor), superior glenohumeral translation (three-dimensional digitizing system), and glenohumeral range of motion (goniometer) were compared under three conditions: (1) intact shoulder; (2) simulated irreparable rotator cuff (supraspinatus and infraspinatus) tear; and (3) SCR using fresh-frozen fascia lata graft. SCR was performed according to the technique for SCR using fascia lata autograft. The average graft thickness was 8.6 mm at the medial edge and 8.9 mm at the lateral edge.

RESULTS

Compared with the intact condition, creation of the irreparable rotator cuff tear increased superior translation and subacromial peak contact pressure at 0° (P < 0.01) and 30° (P < 0.001) of glenohumeral abduction. SCR using fresh-frozen fascia lata graft decreased superior translation and subacromial peak contact pressure to the intact level (P < 0.01 for both). SCR using fresh-frozen fascia lata graft did not decrease internal (P = 0.15 to 0.99), external (P = 0.90 to 0.99), or total (P = 0.35 to 0.98) rotation at 0°, 30°, or 60° of glenohumeral abduction, compared with the irreparable supraspinatus and infraspinatus tendon tear condition.

CONCLUSION

For irreparable supraspinatus and infraspinatus tendon tear, SCR using 8 mm-thick fresh-frozen fascia lata graft restored superior glenohumeral stability to the intact level without any restriction of glenohumeral range of motion after surgery.

Comparison of five preservation methods for fascia allograft

IMPORTANCE

Research on tissue preservation, including cortical bone, skin, nerves, and vessels in glycerol and cortical bone in honey, has shown positive results. On the other hand, relatively few studies have been performed on fascia preservation, and comparisons between different fascia preservation methods remain scarce.

OBJECTIVE

This in vitro study compared the biomechanical properties of five different methods of preserving fascia lata.

METHODS

The control group underwent biomechanical testing immediately after decellularization, while the other five groups were stored in glycerol, honey, deep freezer, lyophilizer, and liquid nitrogen for 30 days. The ultimate load, elongation at failure, and stiffness for each group were determined from a load-elongation curve.

RESULTS

A comparison of the ultimate load showed that the control group had the highest value, followed by the glycerol group. The glycerol group was the only group that did not show a significant difference from the control group, while all the other groups showed a significantly lower ultimate load. A comparison of elongation at failure revealed the glycerol group to have the highest value at failure among all groups and was significantly higher than the deep freeze, honey, and cryopreservation groups.

CONCLUSIONS AND RELEVANCE

Glycerol can be used as an effective method for preserving fascia allografts because the resulting allografts show a similar ultimate load to the control group and the highest mean elongation at failure.

Periosteum and fascia lata: Are they so different?

Introduction: The human fascia lata (HFL) is used widely in reconstructive surgery in indications other than fracture repair. The goal of this study was to compare microscopic, molecular, and mechanical properties of HFL and periosteum (HP) from a bone tissue engineering perspective.

Material and Methods: Cadaveric HP and HFL (N = 4 each) microscopic morphology was characterized using histology and immunohistochemistry (IHC), and the extracellular matrix (ECM) ultrastructure assessed by means of scanning electron microscopy (SEM). DNA, collagen, elastin, glycosaminoglycans, major histocompatibility complex Type 1, and bone morphogenetic protein (BMP) contents were quantified. HP (N = 6) and HFL (N = 11) were submitted to stretch tests.

Results: Histology and IHC highlighted similarities (Type I collagen fibers and two-layer organization) but also differences (fiber thickness and compaction and cell type) between both tissues, as confirmed using SEM. The collagen content was statistically higher in HFL than HP (735 vs. 160.2 μg/mg dry weight, respectively, p &lt; 0.0001). On the contrary, DNA content was lower in HFL than HP (404.75 vs. 1,102.2 μg/mg dry weight, respectively, p = 0.0032), as was the immunogenic potential (p = 0.0033). BMP-2 and BMP-7 contents did not differ between both tissues (p = 0.132 and p = 0.699, respectively). HFL supported a significantly higher tension stress than HP.

Conclusion: HP and HFL display morphological differences, despite their similar molecular ECM components. The stronger stretching resistance of HFL can specifically be explained by its higher collagen content. However, HFL contains many fewer cells and is less immunogenic than HP, as latter is rich in periosteal stem cells. In conclusion, HFL is likely suitable to replace HP architecture to confer a guide for bone consolidation, with an absence of osteogenicity. This study could pave the way to a bio-engineered periosteum built from HFL.

Reconstruction of urethral defects using a fascia lata autograft in a dog

A castrated male Shih-Tzu dog was presented for evaluation of urine leakage after urethrotomy. A fistula with urine leakage was identified in the perineal region. On retrograde urethrography, the contrast extravasated from the penile urethra into the subcutaneous tissue of the perineum. Urine leakage with urethrocutaneous fistula was diagnosed. During surgery, the disrupted urethra wall and two urethral defects were identified. A fascia lata autograft was used, rather than primary repair of the urethra. Two pieces of fascia lata were harvested and sutured to the urethral defects. The fistula was treated with debridement and drainage. No evidence of urine leakage and dysuria was noted 6 months postoperatively. Thus, this case report describes successful urethral reconstruction using a fascia lata autograft.

[Bone banks : The state-of-the-art]

Bone banks are responsible for the collection, production, testing, packaging, storage and delivery of osseous grafts. In compliance with legal and quality requirements, it is their main task to ensure the biological properties and the microbiological safety of the transplants as well. German legal requirements for bone banking are explained and current standards with respect to donor selection, laboratory tests and tissue processing, as well as labeling are discussed. Production and preparation procedures should include a validated microbiological inactivation method that largely preserves the biological properties of the tissue.

Solvent-dehydrated dermal allograft (AXIS™) augmented cystocele repair: longitudinal results

INTRODUCTION AND HYPOTHESIS

Surgical repair options for pelvic organ prolapse (POP) include native tissue, allograft, xenograft, and synthetic grafts. Solvent-dehydrated dermal allograft (SDDG) has an improved safety profile. We evaluated the long-term safety and efficacy of SDDG use for cystocele repair.

METHODS

A total of 184 patients completed a minimum follow-up of 12 months. Incontinence Impact Questionnaire (IIQ), Urogenital Distress Inventory (UDI), and Visual Analogue Scale (VAS) were used pre and post operatively. Recurrent cystocele grade ≥ II and/or repeat cystocele repair were considered objective failure.

RESULTS

Preoperatively, 17 patients (10%) had grade IV cystocele, 87 (47%) grade III, 70 (38%) grade II, and 10 (5%) grade I. All patients underwent SDDG cystocele repair with/without vaginal sling and/or POP repair and/or hysterectomy. Mean hospital stay was 0.58 days (range 0-4), mean estimated blood loss (EBL) was 111 mL, and mean length of Foley catheterization was 1.85 days (range 0-28). Postoperatively, 113 patients (64%) had no recurrent cystocele, 34 (19%) had grade I, 19 (11%) grade II, and 10 (6%) grade III cystocele. None had grade IV cystocele. Nineteen patients (10.3%) underwent repeat cystocele repair. Thirty-eight patients (21.6%) had postoperative recurrence (recurrent cystocele grade ≥ II and/or repeat cystocele repair). Dermal allograft related adverse events included 1 (0.5%) allograft vaginal exposure, dyspareunia 1 (0.5%), and transient hydronephrosis in 1 (0.5%). There were no vascular, vesical, visceral or neurological injuries.

CONCLUSIONS

These results indicate that SDDG augmented cystocele repair is a safe procedure, with low morbidity, and it's success is comparable to other techniques.

The use of a biostatic fascia lata thigh allograft as a scaffold for autologous human culture of fibroblasts--An in vitro study

The method for covering gingival recession defects and augmenting keratinized gingiva involves the use of autogenuous connective tissue grafts obtained from palatal mucosa in combination with various techniques of flap repositioning or tunnel techniques. In the case of multiple gingival recession defects the amount of connective tissue available for grafting is insufficient. Therefore, the use of substitutes is necessary. The most widely used material in recent years has been the acellular dermal matrix allograft. The disadvantage of its application lies in the absence of cells and blood vessels, which increases incorporation time. Primary cultured human autologic fibroblasts are commonly used to optimize the healing process. The aim of this study was to examine the in vitro biocompatibility of human fascia lata allograft as a new scaffold for primary cultured human autologic fibroblasts. For that, a fibroblast culture obtained from a fragment of gingival tissue taken from the hard palate mucosa of a subject was used. After 14 days the colony cells were inoculated on a fragment of human fascia lata allograft. After a further 7 days of incubation the material was frozen, cut and prepared for histochemical examination. After two weeks of incubation, and 7 days after inoculation on a fragment of fascia lata allograft numerous accumulations of the cultured fibroblast were found that had a typical structure and produced collagen fibres. A human fascia lata allograft can be used as a scaffold for primary cultured human autologic fibroblasts. Further studies should confirm the clinical efficacy of this solution.

Regional variability, processing methods, and biophysical properties of human fascia lata extracellular matrix

This study aims to assess the regional variability, processing methods, mechanical, biochemical, and cellular properties of human fascia lata as a scaffold for soft tissue repair and tissue engineering applications. Ten pairs of fascia lata (donor age 18-55) were used. One fascia patch from each pair was used to assess the geometric and biomechanical variability of fresh fascia. The other from each pair was subjected to 1 of 2 allograft processing methods: antibiotic soak alone or acellularization plus antibiotic soak. Stiffness, modulus, hydroxyproline, chondroitin/dermatan sulfate glycosaminoglycan (CSDS GAG), and DNA content were quantified in fascia from fresh and treated groups. The effect of location was not significant for thickness or stiffness within a 6 x 12 cm2 region of the iliotibial tract of fresh human fascia lata. Processing did not significantly change the stiffness, modulus, or CSDS GAG content of fascia ECM. However, hydroxyproline (collagen) content is significantly reduced in acellularized fascia, probably reflecting a removal of soluble collagen during the treatment (p < 0.02). Processing reduced the DNA content of fresh fascia approximately 10-fold (p < 0.001). The mechanical, chemical and ultrastructural similarities between fascia lata and tendon may make fresh or processed fascia an attractive ECM scaffold for soft tissue, particularly tendon, repair.

Cadaveric fascia lata versus intravaginal slingplasty for the pubovaginal sling: surgical outcome, overall success and patient satisfaction rates

BACKGROUND

A wide variety of surgical procedures has been used to treat female stress urinary incontinence (SUI). The purpose of this study was to compare cadaveric fascia lata (CFL) sling with intravaginal slingplasty (IVS) in the surgical treatment of SUI.

METHODS

One hundred and thirty-nine women with SUI were randomly assigned to either CFL sling (n = 67) or IVS (n = 72). Concomitant urinary urge incontinence was present in 49 patients (73%) in the CFL sling and 44 patients (61%) in the IVS group. Daily mean pad usage was 4.1 +/- 3.5 in the CFL sling and 2.9 +/- 1.7 in the IVS group. The objective cure rate was evaluated by the pad test, and patient satisfaction rate was assessed by a subjective questionnaire.

RESULTS

The surgical results of both procedures with a follow-up 12 months were documented. The overall success rate was 79% in the CFL sling and 70.8% in the IVS (p = 0.261). In contrast patient satisfaction rates were 82 and 87.5%, respectively (p = 0.210). Comparison of the CFL sling with IVS showed persistent urinary urge incontinence in 67 and 25% (p = 0.0001) and de novo urinary urge incontinence in 22 and 6.9%, respectively (p = 0.009). The groups did not differ significantly with respect to intraoperative and postoperative complications.

CONCLUSIONS

There is no statistical difference in the overall success, satisfaction and complication rates in either group. In our series, both procedures were found to be effective, durable and significantly improved quality of life in patients with SUI but long-term results are awaited.

Comparison of solvent-dehydrated allograft dermis and autograft rectus fascia for pubovaginal sling: questionnaire-based analysis

OBJECTIVES

To evaluate the efficacy of pubovaginal sling using human cadaveric dermis processed by solvent dehydration and compare results to those of another group in which autograft rectus fascia was used.

MATERIAL AND METHODS

The efficacy of autologous rectus fascia (group 1, n=25) or solvent-dehydrated cadaveric dermis (group 2, n=24) for pubovaginal sling were compared in women with stress urinary incontinence (SUI). Surgical outcome, patient satisfaction and quality of life was assessed by the urogenital distress inventory (UDI-6) and the incontinence impact questionnaire (IIQ-7).

RESULTS

Mean follow-up for patients in group 1 and group 2 were 18 and 13 months, respectively. Our questionnaire-based assessment revealed that SUI was either cured or improved in a total of 21 (84%) patients in group 1 and 19 (79%) patients in group 2. No statistically significant difference was found for the overall success (P<0.05) and no major complications were encountered in both groups.

CONCLUSIONS

Use of allograft dermis as an alternative to autologous rectus fascia for pubovaginal sling had comparable improvement in patient satisfaction and quality of life at intermediate term.

Healing of bone defects by an osteopromotion technique using solvent-dehydrated cortical bone plate: a clinical and radiological study

Osseous defects of the jaws following trauma, cysts, infection or congenital deformity may show poor osteogenesis and the affected area may never be completely filled with bone. It is widely accepted in guided tissue regeneration that physically halting soft connective tissue proliferation into bone allows bone regeneration. This concept is called the "osteopromotion principle." The purpose of the present study was to evaluate the effect of solvent-dehydrated cortical bone plates as a barrier to allow bone regeneration by assessing the osteopromotion principle. 30 patients (18 male, 12 female) with cystic lesions of the jaws were assigned to two different groups. The patients in Group A were treated by enucleation. In Group B, were treated by removal of the lesion and placing a solvent-dehydrated cortical bone plate on top of the cyst cavity to avoid ingrowth of connective tissue. Both groups were evaluated radiographically using spiral-computed tomography (CT) before surgery and 12 months postoperatively. In group B, all cystic cavities showed complete bone healing in 12 months. At the same period, invasion of the soft connective tissue were observed in the patients treated only by enuclation. This study demonstrates that solvent-dehydrated cortical bone plates can be used as a barrier in treatment of cyst cavities and they hinder ingrowth of connective tissues and promote successful bone healing.

The Pathomechanics of Plantar Fasciitis

Plantar fasciitis is a musculoskeletal disorder primarily affecting the fascial enthesis. Although poorly understood, the development of plantar fasciitis is thought to have a mechanical origin. In particular, pes planus foot types and lower-limb biomechanics that result in a lowered medial longitudinal arch are thought to create excessive tensile strain within the fascia, producing microscopic tears and chronic inflammation. However, contrary to clinical doctrine, histological evidence does not support this concept, with inflammation rarely observed in chronic plantar fasciitis. Similarly, scientific support for the role of arch mechanics in the development of plantar fasciitis is equivocal, despite an abundance of anecdotal evidence indicating a causal link between arch function and heel pain. This may, in part, reflect the difficulty in measuring arch mechanics in vivo. However, it may also indicate that tensile failure is not a predominant feature in the pathomechanics of plantar fasciitis. Alternative mechanisms including 'stress-shielding', vascular and metabolic disturbances, the formation of free radicals, hyperthermia and genetic factors have also been linked to degenerative change in connective tissues. Further research is needed to ascertain the importance of such factors in the development of plantar fasciitis.

Solvent-dehydrated cadaveric dermis: a new allograft for pubovaginal sling surgery

AIM

The aim of this study was to evaluate the efficacy of solvent-dehydrated cadaveric dermis in pubovaginal sling surgery for the first time in the literature.

METHODS

Twenty-five women with stress urinary incontinence underwent pubovaginal sling surgery using 2 x 12 cm allograft dermis. Preoperatively, all patients were evaluated by a detailed urogynecologic evaluation, voiding diary, pelvic examination and urodynamic investigation. Outcome was assessed by the Urogenital Distress Inventory short form and standardized follow-up questionnaires.

RESULTS

Twenty (80%) patients were cured of stress incontinence symptoms. Seventeen wore no pad and three reported occasional stress urinary incontinence and used no or one pad at a mean follow up of 12 months. Five (20%) patients in our series experienced the same amount of leakage as before the surgery. Seventy-six percent of the patients indicated that urinary incontinence was no longer negatively affecting their daily life and were satisfied with the procedure.

CONCLUSIONS

Questionnaire-based assessment of outcome suggests that solvent-dehydrated cadaveric dermis is effective in the treatment of stress urinary incontinence. However, larger and comparative prospective studies with long-term results and randomized comparison of tissue preparation techniques are warranted.

Effect of freeze-drying and gamma irradiation on biomechanical properties of bovine pericardium

Freeze-drying and gamma irradiation are the techniques widely use in tissue banking for preservation and sterilization of tissue grafts respectively. However, the effect of these techniques on biomechanical properties of bovine pericardium is poorly known. A total of 300 strips of bovine pericardium each measured 4 cm x 1 cm were used in this study to evaluate the effect of freeze-drying on biomechanical properties of fresh bovine pericardium and the effect of gamma irradiation on biomechanical properties of freeze-dried bovine pericardium. The strips were divided into three equal groups, which consist of 100 strips each group. The three groups were fresh bovine pericardium, freeze-dried bovine pericardium and irradiated freeze-dried bovine pericardium. The biomechanical properties of the pericardial strips were measured by a computer controlled instron tensiometer while the strips thickness was measured by Mitutoyo thickness gauge. The results of the study revealed that freeze-drying has no significant (p > 0.05) effect on the tensile strength, Young's modulus (stiffness) and elongation rate of fresh bovine pericardium. Irradiation with 25 kGy gamma rays caused significant decreased in the tensile strength, Young's modulus and elongation rate of the freeze-dried pericardium. However, gamma irradiation has no significant effect on the thickness of freeze-dried bovine pericardium, while freeze-drying caused significant decreased in the thickness of the fresh bovine pericardium. The outcome of this study demonstrated that freeze-drying has no significant effect on the biomechanical properties of fresh bovine pericardium, and gamma irradiation caused significant effect on the biomechanical properties of freeze-dried bovine pericardium.

Clinical comparison of the Tutoplast allograft and autologous patellar tendon (bone-patellar tendon-bone) for the reconstruction of the anterior cruciate ligament: 2- and 6-year results

BACKGROUND

The use of an allograft as a suitable transplant is still open to debate, in terms of donor morbidity, implantation reaction, and long-term results, as well as the risk of disease transmission.

HYPOTHESIS

The clinical results 2 and 6 years after implantation of a bone-patellar tendon-bone allograft (Tutoplast) and bone-patellar tendon-bone autograft show no significant difference in relation to stability, function, and rate of rupture.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHOD

Between 1995 and 1998, 268 patients with anterior cruciate ligament ruptures were surgically treated: 132 patients received a bone-patellar tendon-bone allograft implantation and 136 patients a bone-patellar tendon-bone autograft. The results were evaluated using the International Knee Documentation Committee, Noyes, and Lysholm scores.

RESULTS

There were 201 patients assessable after 2 years and 186 patients after 6 years. Ruptures of the implants in the allograft group occurred in 20 patients (20.6%) within 2 years and in 38 patients (44.7%) after 6 years. In the autograft group, transplants ruptured in 5 patients (4.8%) after 2 years and in 6 patients (5.9%) after 6 years.

CONCLUSION

Based on the data, it would appear that the regular use of bone-patellar tendon-bone allografts, particularly for physically active patients, is unsuitable.

A Randomized Controlled Trial Comparing Fascia Lata and Synthetic Mesh for Sacral Colpopexy

OBJECTIVE

To compare the objective anatomic outcomes after sacral colpopexy performed with cadaveric fascia lata and polypropylene mesh.

METHODS

Patients undergoing a sacral colpopexy were randomized to receive either fascia lata or polypropylene mesh in a double-blinded fashion. Data were collected at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The main outcome measures were pelvic organ prolapse quantification (POP-Q) system stage and individual POP-Q points over time. Objective anatomic failure was defined as POP-Q stage 2 or more at any point during the follow-up period. Proportions of patients with objective anatomic failure at 1 year in each group were compared using the chi(2) test. Mean POP-Q points and stage at 1 year were compared by using the independent samples t test.

RESULTS

One hundred patients were randomized to receive either fascia (n = 46) or mesh (n = 54). Of the 89 patients returning for 1-year follow-up, 91% (41/45) of the mesh group and 68% (30/44) of the fascia group were classified as objectively cured (P = .007). We found significant differences between the mesh and fascia groups with respect to the 1-year postoperative comparisons of points Aa, C, and POP-Q stage. There were no differences between the 2 groups with respect to points TVL (total vaginal length), GH (genital hiatus), PB (perineal body), Ap or Bp (2 points along the posterior vaginal wall).

CONCLUSIONS

Polypropylene mesh was superior to fascia lata in terms of POP-Q points, POP-Q stage, and objective anatomic failure rates.

LEVEL OF EVIDENCE

I.

Comparison of long-term outcomes of autologous fascia lata slings with Suspend Tutoplast fascia lata allograft slings for stress incontinence

OBJECTIVE

This study was undertaken to compare the objective and subjective long-term surgical outcomes in patients receiving Tutoplast fascia lata allograft slings with those receiving autograft slings for the treatment of stress urinary incontinence (SUI).

STUDY DESIGN

We reviewed all patients (n = 71) undergoing suburethral sling with either autologous fascia lata (n = 39) or Tutoplast fascia lata (n = 32) for urodynamic stress incontinence (USI) from October 1, 1998, to August 1, 2001.

RESULTS

Of the original 71 patients, 47 were evaluated by objective and/or subjective means at a minimum of 2 years after surgery. Subjective quality of life measures, subjective continence, maximum urethral closure pressure, and bladder neck mobility were not different between the 2 groups. USI was demonstrated in 41.7% of allograft patients compared with no autograft patients (P = .007).

CONCLUSION

Although patient reported cure of SUI is high for both sling types, USI recurs at a significantly higher rate in Tutoplast slings compared with autologous slings.

Changes in tensile strength of cadaveric human fascia lata after implantation in a rabbit vagina model

PURPOSE

We determined changes in tensile properties after vaginal implantation of human cadaveric fascia lata.

MATERIALS AND METHODS

Baseline tensile properties were determined for freeze-dried, gamma irradiated human cadaveric fascia lata from 3 separate lots. Fascial strips (2 x 0.5 cm.) from 2 lots were implanted between the rectovaginal membrane and vaginal mucosa in New Zealand white rabbits. The strips were excised en bloc 12 weeks after implantation. Tensile property measurements were repeated and compared with pre-implantation values.

RESULTS

Pre-implantation interlot and intralot variability in baseline tensile properties was significant. After implantation there was an approximate 90% decrease in tensile strength from baseline values. There was no gross evidence of graft autolysis.

CONCLUSIONS

The decrease in tensile strength of cadaveric fascial graft was significant after implantation in this model.

Long-term results of the application of solvent-dehydrated bone xenograft and duramater xenograft for the healing of oroantral osseous defects: a pilot experimental study

The aim of this study was to investigate the long-term effects of the use of human cadaveric solvent-dehydrated bone graft and duramater as a barrier membrane for the treatment of oroantral communication. Standard oroantral osseous defects were created in five minipigs. Subjects received cancellous bone graft in the form of block or microchips, duramater or a combination of bone and membrane. Uneventful healing was achieved in all of the subjects, clinically including the control site which did not receive any material. The operated bone segments were evaluated both by radiological and histological examinations after 6 months. Radiological evaluation was carried out using bone density analysis software and histological evaluation made by light microscopy. Radiological and histological results revealed that bone grafting of oroantral osseous defects improved the bone quality. However, application of duramater did not change this activity, both alone or combined with bone grafts. Within the limits of this experimental study, although solvent-dehydrated bone grafts were found superior and could be applied for the healing of osseous oroantral defects, resorbable membranes did not contribute to this process.

Corporoplasty using pericardium allograft (tutoplast) with complex penile prosthesis surgery

Penile prosthesis implantation can be challenging for such presentations as penile fibrosis and prosthesis erosion and conditions in which the corporal body is severely damaged or deficient. The technical complexity of some repairs and the infections associated with synthetic graft materials will sometimes pose limitations to using these materials. We offer a new role for Tutoplast processed pericardial allograft for complex corporoplasty during penile prosthesis surgery.

Nonautologous sling materials

This article provides a comprehensive and updated review of the current nonautologous sling materials available for treatment of stress urinary incontinence. The various materials are described, relevant clinical studies are discussed, and newer materials are outlined. Complications arising from use of different materials also are described.

Histologic analysis of the tibial bone tunnel after anterior cruciate ligament reconstruction using solvent-dried and gamma-irradiated fascia lata allograft

Anterior cruciate ligament (ACL) reconstruction using free tendon graft requires biologic fixation in the bone tunnel. This report describes the intratunnel histology retrieved from a 47-year-old woman who underwent high tibial osteotomy 17 months after ACL reconstruction using a hybrid graft (a solvent-dried and gamma-irradiated fascia lata allograft as a core wrapped with iliotibial autograft). The patient underwent revision because of pain resulting from osteoarthrotic change, and the graft appeared to be taut and healthy on second-look arthroscopy. The sample was taken from the site of the metaphyseal osteotomy site. Histologic examination of the samples was performed with a light microscope (H&E and Masson trichrome stain). Biologic fixation of the graft to the bone was evident from observation of collagen fiber continuities, resembling Sharpey fibers. Integration of the autograft and allograft seemed to have occurred; the junction between the allograft and the autograft could not be determined. However, there was a difference in ligamentization depending on location. In the peripheral region of the graft (the autograft region), the collagen fibers showed a distinct crimped pattern; the fibroblasts were arranged regularly along the major axis of the collagen fiber bundle. In the central part of the graft (the allograft region), remodeling seemed to be delayed. There were acellular, bubbly or myxoid degeneration areas in which the fiber bundles were less oriented and there was increased vascularity.

Use of cadaveric solvent-dehydrated fascia lata for cystocele repair--preliminary results

OBJECTIVES

To present a surgical technique in which cadaveric fascia lata is used for cystocele repair.

METHODS

Twenty-one consecutive women (mean age 67 +/- 10 years) with severe cystocele were prospectively enrolled. All patients underwent meticulous clinical and urodynamic preoperative evaluations. Solvent-dehydrated, Tutoplast-processed, cadaveric fascia lata was used for cystocele repair. The fascia was anchored transversally between the bilateral arcus tendineus and the cardinal and uterosacral ligaments. Standard endopelvic plication was performed thereafter as a second layer. Patients with overt or occult sphincteric incontinence underwent concomitant pubovaginal sling (PVS) surgery as well, using the same material. The main outcome measures included recurrent urogenital prolapse, persistent or de novo urinary incontinence (stress or urge), and dyspareunia.

RESULTS

Of the 21 patients, 19 underwent concomitant PVS, 3 concomitant vaginal hysterectomy, and 8 posterior colporrhaphy in addition to their cystocele repair. The mean follow-up was 20.1 +/- 6.7 months (range 12 to 30). No postoperative complications related to the material or technique occurred. None of the patients developed a recurrent cystocele. Two patients (9%), one of whom underwent concomitant posterior colporrhaphy, developed mild recto-enterocele at 4 to 6 months postoperatively. Six patients underwent concomitant PVS for occult sphincteric incontinence. None developed postoperative stress incontinence. Thirteen other patients underwent concomitant PVS for overt sphincteric incontinence. All but two were stress-continent postoperatively. One half of the patients with preoperative urge or mixed incontinence had persistent urge incontinence postoperatively. None of the patients developed postoperative de novo urge incontinence or dyspareunia.

CONCLUSIONS

The use of solvent-dehydrated cadaveric fascia lata for cystocele repair, as well as PVS, is associated with encouraging short and medium-term results. Long-term follow-up is needed to evaluate whether these results are durable.

Outcome in 104 pubovaginal slings using freeze-dried allograft fascia lata from a single tissue bank

We describe our experience with the use of allograft fascia lata for the treatment of stress urinary incontinence. One hundred and four patients underwent allograft fascia lata pubovaginal slings. Preoperatively, all were evaluated by a detailed urogynecologic evaluation, voiding diary, and pelvic examination. The pubovaginal sling was performed using a 2x15-cm freeze-dried nonirradiated cadaveric fascia lata specimen. Outcome measures were assessed by a urogynecologic questionnaire, pad usage, and disease-specific quality-of-life questionnaires. Eighty-eight percent (91 of 104) responded to a mailed urogynecology and disease-specific quality-of-life questionnaire with an average follow-up period of 19. 4 +/- 10.3 months. The mean preoperative daily pad usage was 4.6 +/- 3.0, postoperatively pad usage was 1.1 +/- 1.4 (P < 0.0001). Urge incontinence resolved in 41% (n = 24) of the 59 patients who complained of this preoperatively. Eighty-seven percent of the responders indicated that urinary incontinence was not substantially affecting their daily life. As in our preliminary report, the use of freeze-dried allograft pubovaginal sling continues to provide good results without adverse outcomes. A prospective, randomized comparison of autologous versus allograft slings and a review of preparation techniques used by tissue banks are needed.

Recollagenation of acne scars

BACKGROUND

Depressed acne scars remain a difficult problem to correct with present methods.

OBJECTIVE

A new process to restore the dermal thickness destroyed by acne inflammation, called recollagenation, was developed.

METHODS

After an intradermal pocket was created at each depressed site, an implant of freeze-dried, irradiated, human cadaver fascia lata was inserted through a needle hole to elevate the depressed epidermis. Selected sites were retreated to establish the desired dermal topography.

RESULTS

Initially, local inflammation created an elevated phlegmon at the treatment site, which then progressively leveled over the subsequent 4-10 weeks. Ultimately, a predictable improvement in skin contour occurred in the majority of depressions.

CONCLUSION

Recollagenation is an effective method to repair acne lesions.