Abstract
BackgroundThe use of human acellular dermis (hAD) to close open abdomen in the treatment process of severe peritonitis might be an alternative to standard care. This paper describes an investigation of the effects of fluids simulating an open abdomen environment on the biomechanical properties of Epiflex® a cell-free human dermis transplant.MethodshAD was incubated in Ringers solution, blood, urine, upper gastrointestinal (upper GI) secretion and a peritonitis-like bacterial solution in-vitro for 3 weeks. At day 0, 7, 14 and 21 breaking strength was measured, tensile strength was calculated and standard fluorescence microscopy was performed.ResultshAD incubated in all five of the five fluids showed a decrease in mean breaking strength at day 21 when compared to day 0. However, upper GI secretion was the only incubation fluid that significantly reduced the mechanical strength of Epiflex after 21days of incubation when compared to incubation in Ringer’s solution.ConclusionhAD may be a suitable material for closure of the open abdomen in the absence of upper GI leakage and pancreatic fistulae.
Highlights
The use of human acellular dermis to close open abdomen in the treatment process of severe peritonitis might be an alternative to standard care
The present study focuses on an in-vitro examination of the effect of incubation in Ringer’s solution, urine, blood, a bacteria mixture and upper gastrointestinal secretion on the mechanical strength of human acellular dermis (hAD)
Breaking strength of hAD incubated in upper GI secretion showed the most distinct decrease of 78% over 21 days
Summary
The use of human acellular dermis (hAD) to close open abdomen in the treatment process of severe peritonitis might be an alternative to standard care. This paper describes an investigation of the effects of fluids simulating an open abdomen environment on the biomechanical properties of Epiflex® a cell-free human dermis transplant. Dermis is rich in collagen of various subtypes [10] and its biomechanical strength is principally a function of the density and degree of hydration [11] and crosslinking [12] of the collagen fibers. These factors will influence the extent to which a hAD retains its mechanical strength when incubated in aggressive fluids akin to those present in an infected open abdomen
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