Collagen-Based Prostheses for Hernia Repair
Closure of abdominal wall defects is still a major surgical problem. The usual methods have significant disadvantages. If the defect is bridged by prosthetic material, nonabsorbable prostheses have produced the best results. However, the presence of prost
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Introduction
Autologous and Homologous Implants
Closure of abdominal wall defects is still a major surgical problem. The usual methods have significant disadvantages.! If the defect is bridged by prosthetic material, nonabsorbable prostheses have produced the best results. However, the presence of prosthetic material may lead to eventual complications due to foreign body reaction, lack of fixation to the surrounding host tissues, or erosion of the viscera and overlying skin. Moreover, synthetic meshes require skin cover, are prone to infection, and cannot be used in a contaminated environment. 2 Reconstructions with autologous material such as free dermal, fascial, or musculofascial flaps are also unsatisfactory. Transplant harvesting is time consuming and frequently followed by functional deficits at the donor site. The results of such reconstructions are often disappointing because of bulging of denervated muscles and reherniation rates of up to 20%.! Ideally, prosthetic material acts as a scaffold for the ingrowth of fibrocollagenous tissue and supports the abdominal wall or diaphragm until the newly formed host tissue can resist intraabdominal pressure. The use of a collagen prosthetic mesh for hernia repair is based on this concept. Collagen is the m.yor supportive component of connective tissue and constitutes about 30% of the total body protein in mammals. Existing as stress-resisting fibers with a characteristic structural organization, collagen imparts strength to skin, fascia, dura, bone, tendon, ligaments, and the gut wal1. 3 For application as prosthetic devices, collagen is available as a reconstituted product or, in its naturally occurring form, as a fibrous collagen matrix. Reconstituted collagen is manufactured from solubilized collagen, usually from animal skins, reconstituted into filaments, sheets, tapes, sponges, or tubing. 4 The advantage of reconstituted collagen is that it consists of highly purified collagen that can be molded into any shape, but major disadvantages are its low physical strength and its relatively poor resistance to biodegradation. Fibrous collagen is available as fascia, dura mater, and dermis, providing a naturally woven, biological fabric. Because fibrous collagen retains its structural integrity, it maintains its original stress-resisting mechanical properties. Clearly, as a prosthetic device for the repair of hernia, fibrous collagen is the preferable material.
Dermal Implants
R. Bendavid et al. (eds.), Abdominal Wall Hernias © Springer Science+Business Media New York 2001
In 1913, Otto Loewe was the first to report the use of autodermoplasty for hernia repair.5 With good results, he implanted dermal grafts in nine patients with abdominal wall defects. Both Loewe 5 and Rehn 6 advised removal of the epidermal layer and the subcutaneous fat to prevent infection and cyst formation. However, the method was not widely accepted because removal of the epidermal layer was difficult and time consuming. In Russia, the method became popular after Janov7 perfected a method of
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