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Jing J, Li L, Wu Y, Zheng L, Zhang L, Li H, Wang H. Application of Biologic Graft in Nasal Septal Perforation Repair. Ear Nose Throat J 2024:1455613241233748. [PMID: 38404028 DOI: 10.1177/01455613241233748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
Objective: To explore the clinical outcome when biomaterials are used to repair nasal septal perforations. Methods: A total of 12 patients were treated. The nasal septum was dissected via endoscopic approach. A 4 cm × 7 cm biologic graft (Biodesign® Tissue Graft) was folded to form a double layer, was placed over the perforation, and was affixed into place using suture. Results: Follow-up ranged from 2 to 8 months after the operation. One patient was not completely healed and presented with a remaining defect of about 2 mm × 8 mm in the upper part of the nasal septum. The remaining 11 patients healed completely. Conclusion: Using a biologic graft to repair nasal septal perforations is an easy operation as it prevents the need to take autologous tissue from the patient, allows for a repair to be performed without creating septal flaps, and has good histocompatibility. It is a safe and effective method that can be used clinically.
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Affiliation(s)
- Jianjun Jing
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi, China
| | - Liang Li
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi, China
| | - Yongxiang Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi, China
| | - Liang Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi, China
| | - Longfang Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi, China
| | - Haihong Li
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi, China
| | - Hui Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi, China
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Lipetskaia L, Gonzalez RR, Wu JM, Northington GM, Henley BR, Lane F, Brucker BM, Jarnagin B, Rosenblatt PL. 36-Month Prospective Study of Transvaginal Bovine Graft versus Native Tissue Repair for the Treatment of Pelvic Organ Prolapse. Urology 2022; 167:234-240. [PMID: 35716871 DOI: 10.1016/j.urology.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE(S) To compare the safety and effectiveness of dermal bovine transvaginal graft, Xenform, to native tissue in the surgical treatment of anterior and/or apical pelvic organ prolapse. This study was designed in conjunction with FDA requirements. METHODS This was a prospective, non-randomized, parallel cohort, multi-center trial. The primary objective was to demonstrate non-inferiority between transvaginal graft and native tissue repair at 36 months compared to baseline. Treatment success was based on a composite of objective and subjective measures. The co-primary outcome was the rate of serious device- or procedure-related adverse events. A total of 228 patients at 25 sites were included in the study arm and 485 patients underwent native tissue repair. Propensity score stratification was applied to achieve balance between treatment groups. Study outcomes were compared in per protocol and intent-to-treat analysis. RESULTS The primary outcome, treatment success at 36 months, was 83.6% (191/228) for transvaginal graft and 80.5% (390/485) native tissue repair (0.2%, 90%CI [-5.6%, 5.9%]), demonstrating non-inferiority at a preset margin of -12%. The overall rate of severe adverse events was 5.3% (12/228) in transvaginal graft vs 2.7% (13/485) in native tissue repair groups. The study group demonstrated non-inferiority in serious adverse events at the preset margin of 11.6% (2.0%, 90%CI [-0.8%, 4.7%]). There were no reports of graft erosion, and graft exposure rates were low (0.9% [2/228]). CONCLUSIONS Transvaginal repair of anterior and/or apical prolapse with a biological graft is non-inferior to traditional native tissue repair in effectiveness and safety at 36 months.
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Affiliation(s)
- Lioudmila Lipetskaia
- Program Director, Female Pelvic Medicine & Reconstructive Surgery Fellowship, Department of Obstetrics and Gynecology, Cooper University Health Care, Assistant Professor Cooper Medical School of Rowan University, 3 Cooper Plaza Suite #220, Camden, NJ 08103.
| | - Ricardo R Gonzalez
- Program Director, Urology Fellowship in Female Pelvic Medicine & Reconstructive Surgery, Weill Cornell College of Medicine, Houston Methodist Hospital Academic Institute, 6560 Fannin Street, Suite 2100, Houston, TX 77030
| | - Jennifer M Wu
- Interim Vice Dean for Academic Affairs, Professor, Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, 4030 Bondurant Hall, Campus Box 7000, Chapel Hill, NC 27599
| | - Gina M Northington
- Associate Professor and Director, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322
| | - Barbara R Henley
- Section Chief & Associate Professor, Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Medical College of Georgia at Augusta University, 1120 15th Street, BB 7514, Augusta, GA 30912
| | - Felicia Lane
- Division Director and Urogynecology Fellowship Director, Department of Obstetrics and Gynecology, University of California, Irvine, 333 City Blvd W Suite 1400, Orange, CA 92868
| | - Benjamin M Brucker
- Director, Division of Female Pelvic Medicine & Reconstructive Surgery and Neurourology, Program Director, FPMRS Fellowship, Departments of Urology and Obstetrics & Gynecology, New York University, Langone Health, 550 First Avenue, New York, NY 10016
| | - Barry Jarnagin
- Medical Director, Center for Pelvic Health, 100 Covey Drive, Suite 205, Franklin, TN 37067
| | - Peter L Rosenblatt
- Director of Urogynecology, Boston Urogynecology Associates / Mount Auburn Hospital, Assistant Professor of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School, 725 Concord Avenue, Suite 3500, Cambridge, MA 02138
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Robinson J, Sulzer JK, Motz B, Baker EH, Martinie JB, Vrochides D, Iannitti DA. Long-Term Clinical Outcomes of an Antibiotic-Coated Non-Cross-linked Porcine Acellular Dermal Graft for Abdominal Wall Reconstruction for High-Risk and Contaminated Wounds. Am Surg 2021; 88:1988-1995. [PMID: 34053226 DOI: 10.1177/00031348211023392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abdominal wall reconstruction in high-risk and contaminated cases remains a challenging surgical dilemma. We report long-term clinical outcomes for a rifampin-/minocycline-coated acellular dermal graft (XenMatrix™ AB) in complex abdominal wall reconstruction for patients with a prior open abdomen or contaminated wounds. METHODS Patients undergoing abdominal wall reconstruction at our institution at high risk for surgical site occurrence and reconstructed with XenMatrix™ AB with intent-to-treat between 2014 and 2017 were included. Demographics, operative characteristics, and outcomes were collected. The primary outcome was hernia recurrence. The secondary outcomes included length of stay, surgical site occurrence, readmission, morbidity, and mortality. RESULTS Twenty-two patients underwent abdominal wall reconstruction using XenMatrix™ AB during the study period. Two patients died while inpatient from progression of their comorbid diseases and were excluded. Sixty percent of patients had an open abdomen at the time of repair. All patients were from modified Ventral Hernia Working Group class 2 or 3. There were a total of four 30-day infectious complications including superficial cellulitis/fat necrosis (15%) and one intraperitoneal abscess (5%). No patients required reoperation or graft excision. Median clinical follow-up was 38.2 months with a mean of 35.2 +/- 18.5 months. Two asymptomatic recurrences and one symptomatic recurrence were noted during this period with one planning for elective repair of an eventration. Follow-up was extended by phone interview which identified no additional recurrences at a median of 45.5 and mean of 50.5 +/-12.7 months. CONCLUSION We present long-term outcomes for patients with high-risk and contaminated wounds who underwent abdominal wall reconstruction reinforced with XenMatrix™ AB to achieve early, permanent abdominal closure. Acceptable outcomes were noted.
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Affiliation(s)
- Jordan Robinson
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, 22442Atrium Health-Carolinas Medical Center, Charlotte, NC, USA
| | - Jesse K Sulzer
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, 22442Atrium Health-Carolinas Medical Center, Charlotte, NC, USA
| | - Benjamin Motz
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, 22442Atrium Health-Carolinas Medical Center, Charlotte, NC, USA
| | - Erin H Baker
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, 22442Atrium Health-Carolinas Medical Center, Charlotte, NC, USA
| | - John B Martinie
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, 22442Atrium Health-Carolinas Medical Center, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, 22442Atrium Health-Carolinas Medical Center, Charlotte, NC, USA
| | - David A Iannitti
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, 22442Atrium Health-Carolinas Medical Center, Charlotte, NC, USA
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Antoniou SA, Pointner R, Granderath FA, Köckerling F. The Use of Biological Meshes in Diaphragmatic Defects - An Evidence-Based Review of the Literature. Front Surg 2015; 2:56. [PMID: 26539439 PMCID: PMC4612643 DOI: 10.3389/fsurg.2015.00056] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/08/2015] [Indexed: 01/30/2023] Open
Abstract
The widespread use of meshes for hiatal hernia repair has emerged in the era of laparoscopic surgery, although sporadic cases of mesh augmentation of traumatic diaphragmatic rupture have been reported. The indications for biologic meshes in diaphragmatic repair are ill defined. This systematic review aims to investigate the available evidence on the role of biologic meshes in diaphragmatic rupture and hiatal hernia repair. Limited data from sporadic case reports and case series have demonstrated that repair of traumatic diaphragmatic rupture with biologic mesh is safe technique in both the acute or chronic setting. High level evidence demonstrates short-term benefits of biologic mesh augmentation in hiatal hernia repair over primary repair, although adequate long-term data are not currently available. Long-term follow-up data suggest no benefit of hiatal hernia repair using porcine small intestine submucosa over suture repair. The effectiveness of different biologic mesh materials on hernia recurrence requires further investigation.
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Affiliation(s)
- Stavros A Antoniou
- Center for Minimally Invasive Surgery, Neuwerk Hospital , Mönchengladbach , Germany ; Department of General Surgery, University Hospital of Heraklion , Heraklion , Greece
| | - Rudolph Pointner
- Department of General and Visceral Surgery, Hospital Zell am See , Zell am See , Austria
| | | | - Ferdinand Köckerling
- Department of Surgery, Center for Minimally Invasive Surgery, Vivantes Hospital , Berlin , Germany
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Leigh DR, Kim MS, Kovacevic D, Baker AR, Tan CD, Calabro A, Derwin KA. Human fascia lata ECM scaffold augmented with immobilized hyaluronan: inflammatory response and remodeling in the canine body wall and shoulder implantation sites. J Biomater Sci Polym Ed 2014; 26:1-15. [PMID: 25400204 DOI: 10.1080/09205063.2014.975394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We postulate that immobilization of tyramine-substituted hyaluronan (THA) into an extracellular matrix (ECM) scaffold may be a strategy to promote an anti-inflammatory response to the ECM. Further, we posit that the implantation site could influence the inflammatory response and remodeling of an ECM scaffold. Eight beagles underwent implantation of fascia ECM grafts, treated with either immobilized low molecular weight (57 kDa) THA or water only, in both the shoulder injury and body wall sites. Dogs were euthanized at 12 weeks and fascia grafts harvested en bloc for histology. Grafts implanted at the body wall had significantly higher inflammatory cell infiltrate and vascularity, and significantly lower retardance (collagen density), than grafts at the shoulder, suggestive of a more intense, persistent, and perhaps degradative inflammatory and remodeling response at the body wall than shoulder injury site in the canine model. However, the presence of immobilized low MW THA had no effect on the inflammation response or remodeling of fascia ECM compared to water-treated controls. Importantly, these results suggest that the inflammatory response and remodeling of biomaterial implants depends on the location of implantation and therefore our animal models need to be carefully chosen. Further, the potential anti-inflammatory advantages of hyaluronan (HA) in wound healing do not appear to be realized when presenting it to the host as non-degradable hydrogel even if its capacity for binding HA binding protein is maintained. Further study treating ECM with uncross-linked (free) HA or immobilized low MW THA as a means to deliver free HA or other biomolecules to a surgical repair site is warranted.
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Affiliation(s)
- Diane R Leigh
- a Department of Biomedical Engineering and the Orthopaedic Research Center , Cleveland Clinic , Cleveland , OH , USA
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Abstract
BACKGROUND Biologic grafts are increasingly used instead of synthetic mesh for parastomal hernia repair due to concerns of synthetic mesh-related complications. This systematic review was designed to evaluate the use of these collagen-based scaffolds for the repair of parastomal hernias. METHODS Studies were retrieved after searching the electronic databases MEDLINE, EMBASE and Cochrane CENTRAL. The search terms 'paracolostomy', 'paraileostomy', 'parastomal', 'colostomy', 'ileostomy', 'hernia', 'defect', 'closure', 'repair' and 'reconstruction' were used. Selection of studies and assessment of methodological quality were performed with a modified MINORS index. All reports on repair of parastomal hernias using a collagen-based biologic scaffold to reinforce or bridge the defect were included. Outcomes were recurrence rate, mortality and morbidity. RESULTS Four retrospective studies with a combined enrolment of 57 patients were included. Recurrence occurred in 15.7% (95% confidence interval [CI] 7.8-25.9) of patients and wound-related complications in 26.2% (95% CI 14.7-39.5). No mortality or graft infections were reported. CONCLUSIONS The use of reinforcing or bridging biologic grafts during parastomal hernia repair results in acceptable rates of recurrence and complications. However, given the similar rates of recurrence and complications achieved using synthetic mesh in this scenario, the evidence does not support use of biologic grafts.
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Affiliation(s)
- Nicholas Jonathan Slater
- Department of Surgery, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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