Abstract
Purpose: Parastomal hernia is a common complication of an enterostoma. Current methods of repair have high recurrence rates and are associated with severe complications. Autologous full-thickness skin as reinforcement may reduce the recurrence and complication rates. This study aims to investigates the tensile strength of full-thickness skin; information that is essential if we are to proceed with clinical trials on humans.Methods: Full-thickness skin samples from 12 donors were tested for tensile strength, as well as the load tolerated by a suture through the skin. Strips of skin were cut out and stretched until breaking point. Sutures were made through skin samples and traction applied until either the tissue or the suture gave way. All done while recording the forces applied using a dynamometer. Identical tests were carried out on commercially available synthetic and biologic graft material for comparison.Results: The full-thickness skin strips had a median tensile strength of 604 N/cm. This tensile strength was significantly higher than that of the compared materials evaluated in this study. In full-thickness skin, the suture, or tissue endured a median force of 67 N before giving way, which was as high as, or higher than similar sutures through the compared materials.Conclusions: The tensile strength of full-thickness skin vastly exceeds the physiological forces affecting the abdominal wall, and sutures through skin endure high loads before giving way. The tensile strength of a full-thickness skin graft and the strength of sutures through this material will not limit its use for reinforcement in parastomal hernia repair.
Highlights
In Sweden more than 3,000 patients are operated with a stoma each year, the majority of which become permanent [1]
Full-thickness skin has remarkable mechanical properties that make it potentially ideal as reinforcement material in parastomal hernia repair, and strength will not be a limitation in initial trials that are planned
This study contributes significantly to the information required before proceeding with clinical trials comparing full-thickness skin with currently available commercial materials as reinforcement in the repair of parastomal hernia
Summary
In Sweden more than 3,000 patients are operated with a stoma (including urostomy) each year, the majority of which become permanent [1]. A parastomal hernia differs from other hernias since the stoma itself is an iatrogenic aperture created in the abdominal wall. As with inguinal and incisional hernia, the use of mesh has become standard in the repair of parastomal hernia. Repair is still associated with high recurrence rates, in some studies up to 46% [8,9,10]. The use of foreign material can lead to serious complications including mesh infection, fistula formation, and erosion of the intestinal wall. These problems have made the safe and reliable repair of parastomal hernia a major surgical challenge that remains to be surmounted
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