In the past 10 years, hernia repair has evolved from primarily using suture closure to using mesh repair. Synthetic mesh implants were the initial gold standard, but the rate of complications such as infection, adhesions, and erosion was higher with synthetics than has been observed with newer biologic implants. As efforts to develop the ideal implant continue, the advantages of biologics for hernia and other soft-tissue repair become increasingly apparent. Animal-sourced biologics have the potential advantage over human dermis of being more amenable to standardization, and porcine dermal collagen architecture closely resembles that of human dermis. Cross-linking the collagen adds strength and durability to the implant that facilitates healing of surgical wounds, just as endogenous collagen, which is cross-linked, has innate durability that enhances natural wound healing. This review defines and assesses durability of the acellular collagen (biologic) implant options available for hernia repair. The factors that affect wound healing—and hernia repair—are summarized. Additionally, the particular features that enhance durability are described, and durability-related clinical outcomes discussed in the literature are cited to aid clinicians in making informed surgical choices.
BellowsCFAlderAHeltonWS. Abdominal wall reconstruction using biologic tissue grafts: present status and future opportunities. Expert Rev Med Devices. 2006;3:657-675.
2.
ShaikhFMGiriSKDurraniSWaldronDGracePA. Experience with porcine acellular dermal collagen implant in one-stage tension-free reconstruction of acute and chronic abdominal wall defects. World J Surg. 2007;31: 1966-1972.
3.
HammondTMHuangAFryeJProsserKWilliamsNS. Parastomal hernia prevention using a novel collagen implant: a prospective randomized pilot study. Br J Surg. 2006;93(suppl 1):39.
4.
GaertnerWBBonsackMEDelaneyJP. Experimental evaluation of four biologic prostheses for ventral hernia repair. J Gastrointest Surg. 2007;11:1275-1285.
5.
RosenMJ. Biologic mesh for abdominal wall reconstruction: a critical appraisal. Am Surg. 2010;76:1-6.
6.
DiegelmannRFEvansMC. Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci. 2004;9:283-289.
OxlundHChristensenHSeyer-HansenMAndreassenTT. Collagen deposition and mechanical strength of colon anastomoses and skin incisional wounds of rats. J Surg Res. 1996;66: 25-30.
9.
BaileyAJ. Changes in bone collagen with age and disease. J Musculoskel Neuron Interact. 2002;2:529-531.
10.
VerzijlNDeGrootJThorpeSR. Effect of collagen turnover on the accumulation of advanced glycation end products. J Biol Chem. 2000;275:39027-39031.
SørensenLTHemmingsenUKallevaveF. Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg. 2005;241:654-658.
13.
ArnoldMBarbulA. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 suppl):42S-58S.
14.
BartschRHWeissGKästenbauerT. Crucial aspects of smoking in wound healing after breast reduction surgery. J Plast Reconstr Aesthet Surg. 2007;60:1045-1049.
15.
HammondTMChin-AleongJNavsariaHWilliamsNS. Human in vivo cellular response to a cross-linked acellular collagen implant. Br J Surg. 2008;95:438-446.
16.
ArmourADFishJSWoodhouseKAEngPSempleJL. A comparison of human and porcine acellularized dermis: interactions with human fibroblasts in vitro. Plast Reconstr Surg. 2006;117:845-856.
17.
SclafaniAPRomoTIIIJaconoAAMcCormichSACockerRParkerA. Evaluation of acellular dermal graft (AlloDerm) sheet for soft tissue augmentation: a 1-year follow-up of clinical observations and histological findings. Arch Facial Plast Surg. 2001;3:101-103.
18.
FabianTCCroceMAPritchardFE. Planned ventral hernia: staged management for acute abdominal wall defects. Ann Surg. 1994;219:643-650.
19.
PetriglianoFAMcAllisterDRWuBM. Tissue engineering for anterior cruciate ligament reconstruction: a review of current strategies. Arthroscopy. 2006;22:441-451.
20.
BegleyJSKobashiKC. The use of graft materials in anterior compartment pelvic reconstruction. Curr Urol Rep. 2004;5:397-402.
21.
HilesMRecord RitchieRDAltizerAM. Are biologic grafts effective for hernia repair? A systematic review of the literature. Surg Innov. 2009;16:26-37.
22.
VuralEMcLaughlinNHogueWRSuvaLJ. Comparison of biomechanical properties of alloderm and enduragen as static facial sling biomaterials. Laryngoscope. 2006;116: 394-396.
23.
PentlowASmartNJRichardsSKInwardCDMorganJDT. The use of porcine dermal collagen implants in assisting abdominal wall closure of pediatric renal transplant recipients with donor size discrepancy. Pediatr Transplant. 2008;12:20-23.
24.
MeyerWSchwarzRNeurandK. The skin of domestic mammals as a model for the human skin, with special reference to the domestic pig. Curr Probl Dermatol. 1978;7:39-52.
25.
CatenaFAnsaloniLGazzottiF. Use of porcine dermal collagen graft (Permacol) for hernia repair in contaminated fields. Hernia. 2007;11:57-60.
26.
LiangHCChangYHsuCKLeeMHSungHW. Effects of crosslinking degree of an acellular biologic tissue on its tissue regeneration pattern. Biomaterials. 2004;25:3541-3552.
27.
de Castro BrásLEProffittJLBloorSSibbonsPD. Effect of crosslinking on the performance of a collagen-derived biomaterial as an implant for soft tissue repair: a rodent model. J Biomed Mater Res B Appl Biomater. 2010;95:239-249.
28.
DiazJJJrGuyJBerkesMBGuiliamondeguiOMillerRS. Acellular dermal allograft for ventral hernia repair in the compromised surgical field. Am Surg. 2006;72:1181-1187.
29.
ButlerCELangsteinHNKronowitzSJ. Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications. Plast Reconstr Surg, 2005;116:1263-1275.
30.
WilliamsNSGiordanoPDvorkinLSHuangAHetzerFHScottSM. External pelvic rectal suspension (the express procedure) for full-thickness rectal prolapse: evolution of a new technique. Dis Colon Rectum. 2005;48:307-316.
31.
SailesFCWallsJGueligD. Synthetic and biological mesh in component separation: a 10-year single institution review. Ann Plast Surg. 2010;64:696-698.
32.
LoganathanAAinslieWGWedgwoodKR. Initial evaluation of Permacol bioprosthesis for the repair of complex incisional and parastomal hernias. Surgeon. 2010;8:202-205.
ChavarriagaLFLinELoskenA. Management of complex abdominal wall defects using acellular porcine dermal collagen. Am Surg. 2010;76:96-100.
35.
DufraneDMouradMvan SteenbergheMGoebbelsRMGianelloP. Regeneration of abdominal wall musculofascial defects by a human acellular collagen matrix. Biomaterials. 2008;29:2237-2248.
36.
MacleodTMWilliamsGSandersRGreenCJ. Histological evaluation of Permacol as a subcutaneous implant over a 20-week period in the rat model. Br J Plast Surg. 2005;58:518-532.
37.
ZhengFLinYVerbekenE. Host response after reconstruction of abdominal wall defects with porcine dermal collagen in a rat model. Am J Obstet Gynecol. 2004;191: 1961-1970.
38.
AltmanDMellgrenABlomgrenB. Clinical and histological safety assessment of rectocele repair using collagen mesh. Acta Obstet Gynecol Scand. 2004;83:995-1000.
39.
CheungDBrownLSampathR. Localized inferior orbital fibrosis associated with porcine dermal collagen xenograft orbital floor implant. Ophthal Plast Reconstr Surg. 2004; 20:257-259.
40.
WottonFTAkohJA. Rejection of Permacol mesh used in abdominal wall repair: a case report. World J Gastroenterol. 2009;15:4331-4333.
41.
AveryCHayterJPOrmistonIW. Re: “Localized inferior orbital fibrosis associated with porcine dermal collagen xenograft orbital floor implant.”Ophthal Plast Reconstr Surg. 2005;21:249.
42.
SmartNJ. No evidence of Permacol rejection presented by Wotton and Akoh. World J Gastroenterol. 2010;16:657-658.
43.
ZhengFXuLVerbiestLVerbekenEDe RidderDDeprestJ. Cytokine production following experimental implantation of xenogenic dermal collagen and polypropylene grafts in mice. Neurourol Urodyn. 2007;26:280-289.
44.
GandhiSKubbaLMAbramovY. Histopathologic changes of porcine dermis xenografts for transvaginal suburethral slings. Am J Obstet Gynecol. 2005;192:1643-1648.
45.
GobinASButlerCEMathurAB. Repair and regeneration of the abdominal wall musculofascial defect using silk fibroin-chitosan blend. Tissue Eng. 2006;12:3383-3394.
46.
JungeKKlingeUPreicherAGiboniPNiewieraMSchumpelikV. Elasticity of the anterior abdominal wall and impact for reparation of incisional hernias using mesh implants. Hernia. 2001;5:113-118.
47.
BadylakSKokiniKTulliusBWhitsonB. Strength over time of a resorbable bioscaffold for body wall repair in a dog model. J Surg Res. 2001;99:282-287.
48.
KonstantinovicMLLagaePZhengFVerbekenEKDe RidderDDeprestJA. Comparison of host response to polypropylene and non-cross-linked porcine small intestine serosal-derived collagen implants in a rat model. BJOG. 2005;112:1554-1560.
49.
MulierKENguyenAHDelaneyJPMarquezS. Comparison of Permacol and Strattice for the repair of abdominal wall defects. Hernia. 2011;15:315-319.
50.
StanwixMGNamAJHui-ChouHG. Abdominal ventral hernia repair with current biological prostheses. An experimental large animal model. Ann Plast Surg. 2010;66:403-409.
51.
MaherCBaesslerKGlazenerCMAAdamsEJHagenS. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn. 2008; 27:3-12.
52.
RossJW. Porcine dermal hammock for repair of anterior and posterior vaginal wall prolapse: 5-year outcome. J Minim Invasive Gynecol. 2008;15:459-465.
53.
WardRMSungVWClemonsJLMyersDL. Vaginal paravaginal repair with an AlloDerm graft: long-term outcomes. Am J Obstet Gynecol. 2007;197: 670e1-670e5.
54.
NoviJMMulvihillBHKAryaLA. Vaginal paravaginal repair using human cadaver or porcine dermal implant: a survival analysis. Ohio Res Clin Rev. 2006;15: 16-20.
55.
RidgwayDMMahmoodFMooreL. A blinded randomised controlled trial comparing porcine dermal collagen with polypropylene for primary inguinal hernia repair. J Am Coll Surg. 2007;205(3 suppl):S69.
