The use of dermal automesh for incidental hernia repair in abdominoplasty: Clinical, biochemical, and radiological results

Autologous full-thickness skin in the repair of complex ventral hernias: an innovative step into the future of complex hernia repair?

The repair of complex ventral hernias, such as giant incisional or parastomal hernia, is associated with a high risk for complications and recurrence. Some serious complications are related to implantation of synthetic mesh as reinforcement material. Autologous full-thickness skin graft (FTSG) as reinforcement material in the repair of these complex hernias may offer a safe alternative. This is a review of the history of FTSG use in hernia surgery and the experiences of our research group regarding its application over the last decade. The results of FTSG used in the repair of giant ventral hernias are promising, and this method may already be recommended in selected cases. We have also conducted a translational chain of preclinical studies, based on a murine model, to gain a greater understanding of the behaviour of FTSG implanted in various positions in the abdominal wall. The use of intraperitoneal FTSG as reinforcement material in parastomal hernia repair is currently being evaluated in a randomised, controlled, multicentre study.

Corset Autodermis External Obliqueplasty Reinforcement of Rectus Diastasis and Umbilical Hernia Repairs during Abdominoplasty

SUMMARY

Abdominoplasty is among the most commonly performed aesthetic operations and is frequently combined with rectus abdominis musculoaponeurotic plication of rectus diastasis and repair of umbilical and ventral hernias. The authors present a spare parts technique to assist in reinforcement of both rectus diastasis plication and hernia repair during abdominoplasty operations using an autodermis onlay reinforcement graft. The graft is harvested from the excess abdominal pannus normally discarded during abdominoplasty and is inset on tension between the bilateral semilunar lines and plicated along a concave "corset" contour. This reduces distracting forces on the hernia and diastasis repairs and further augments abdominal contour. This technique has been performed for 8 years on 82 low-surgical-risk patients, without any noted increase in complications. The corset autodermis external obliqueplasty is a spare parts technique that may reduce recurrence of rectus diastasis and abdominal hernias repaired at the time of abdominoplasty and is an alternative strategy to mesh placement in this risk-averse aesthetic surgery population.

Autologous Dermal Mesh in Severe Postpregnancy Recti Muscles Diastasis

INTRODUCTION

The severe postpregnancy diastasis of recti muscles causes a biomechanical alteration of the statics of the trunk and an unaesthetic bulging of the abdominal wall. This is always combined with cutaneous and subcutaneous excess, which is different on a case-by-case basis. There is not a consensus on the best way to treat it. The anterior sheath plication is the mostly used surgical technique, and many surgeons believe that the use of mesh is necessary in the cases of severe diastasis. The authors here report the outcomes of the use of dermal automesh in the retromuscular layer.

MATERIALS AND METHODS

Between January 2015 and December 2019, a retrospective study on 101 patients was conducted. All patients underwent the repairment of the diastasis recti with transversalis sheath plication and dermal automesh reinforcement in the sublay fashion. In addition, all the patients had an abdominal wall ultrasound before the operation and an ultrasound after 1 month, 3 months, 6 months, 1 year and every year afterward. The median follow-up was 32.5 months RESULTS: No major complications, such as infections, extrusions, respiratory diseases or thrombosis, were reported. The follow-up abdominal wall ultrasound reported the absence of muscle recti diastasis in all patients. All patients were completely satisfied with the final result.

CONCLUSION

In postpregnancy women, the severe recti muscles diastasis dermal automesh repair is safe and effective. The dermal graft is easy to handle, has demonstrated comparable tensile strength to alloplastic mesh and is available in abdominoplasty or miniabdominoplasty from the excised skin.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abdominal skin tensile strength in aesthetic and massive weight loss patients and its role in ventral hernia repair

Background

Clarifying the biomechanics of abdominal skin could lead to different uses for this tissue such as the ventral repair of hernias in patients with excess skin and incisional hernias. The objective of this study was to compare the maximum tensile strength of abdominal skin to commercial meshes and to verify whether or not it varies between aesthetic patients and massive weight-loss patients.

Methods

Experimental cross-sectional study. Skin samples sized 32 × 20 mm were taken from 15 abdominoplasties and 10 panniculectomies. The skin specimens were analyzed in vertical and horizontal tensile strength tests. Results were compared between the two groups including their traction directions. Commercial meshes were also tested. The results were analyzed using the Generalized Estimating Equation.

Results

The maximum tensile strength supported vertically by abdominal dermis was 403.5 ± 27.4 N in the abdominoplasty group and 425.9 ± 33.9 N in the panniculectomy group. Horizontally, the values were 596.5 ± 32.2 N and 612.5 ± 43.9 N respectively. The strengths between traction directions were significantly different (p < 0.001). There were no differences between the groups with regard to the maximum tensile strength (p = 0.472). Tested commercial meshes had the following values: polypropylene 104.6 N, low-weight polypropylene 54.4 N, polytetrafluorethylene (PTFE) 82.2 N, and hydrated porcine small-intestinal submucosa 60.0 N.

Conclusion

In our study, the tensile strength of the tested human abdominal dermis samples, both aesthetic and post-bariatric, was superior to the commercial meshes. Therefore, in selected cases, abdominal dermis could be an alternative tool in abdominal reconstruction during panniculectomies with concomitant hernia repair.

Electronic supplementary material

The online version of this article (10.1186/s12893-019-0523-7) contains supplementary material, which is available to authorized users.