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Human versus Non-Cross-Linked Porcine Acellular Dermal Matrix Used for Ventral Hernia Repair: Comparison of In Vivo Fibrovascular Remodeling and Mechanical Repair Strength

Campbell, Kristin Turza M.D.; Burns, Nadja K. M.D.; Rios, Carmen N. B.S.; Mathur, Anshu B. Ph.D.; Butler, Charles E. M.D.

Plastic and Reconstructive Surgery: June 2011 - Volume 127 - Issue 6 - p 2321-2332
doi: 10.1097/PRS.0b013e318213a053
Experimental: Original Articles

Background: Human acellular dermal matrix (HADM) and non-cross-linked porcine acellular dermal matrix (ncl-PADM) are clinically useful for complex ventral hernia repair. Direct comparisons between the two in vivo are lacking, however. This study compared clinically relevant early outcomes with these bioprosthetic materials when used for ventral hernia repair.

Methods: Seventy-two guinea pigs underwent inlay repair of surgically created hernias with HADM (n = 37) or ncl-PADM (n = 35). Repair sites were harvested at 1, 2, or 4 weeks postoperatively. Adhesions were graded and quantified. Mechanical testing and histologic and immunohistologic (factor VIII) analyses of cellular and vascular infiltration were performed.

Results: No infections or recurrent hernias occurred. No difference was observed in mean adhesion surface area or tenacity between groups. Mean cellular infiltration (p < 0.002, weeks 1 and 4; p < 0.006, week 2) and vascular infiltration (p < 0.0003, week 1; p < 0.0001, weeks 2 and 4) were greater in HADM. Ultimate tensile strength at the implant-musculofascia interface increased over time with both materials, but no difference was observed at 4 weeks. The mean ultimate tensile strength of explanted ncl-PADM itself was consistently greater than that of HADM. The elastic modulus (stiffness) did not differ between groups at the interface but was greater in explanted ncl-PADM (p < 0.0001, weeks 1 and 2; p < 0.02, week 4).

Conclusions: Both HADM and ncl-PADM become infiltrated with host cells and blood vessels within 4 weeks and have similar musculofascia-bioprosthetic interface strength. However, HADM has greater cellular and vascular infiltration. Longer-term studies will help determine whether later differences in material strength, stiffness, and remodeling affect hernia and/or bulge incidence.

Houston, Texas

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Received for publication November 2, 2010; accepted December 1, 2010.

Presented in part at the 94th Annual Scientific Meeting of the American College of Surgeons, in San Francisco, California, October 12 through 16, 2008, and at the 53rd Annual Scientific Meeting of the Plastic Surgery Research Council, in Springfield, Illinois, May 28 through 31, 2008.

Disclosure: Dr. Butler serves as a consultant for LifeCell Corporation. None of the authors have anything to disclose in relation to the content of this article.

Charles E. Butler, M.D., Department of Plastic Surgery, Unit 1488, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030,

©2011American Society of Plastic Surgeons