Porcine Dermal Graft Research Articles

(140) Penile Length and Girth Restoration in Mb Peyronie: Less Invasive Approach for Complex Composite Graft Corporplasty and Implantation of Inflatable Penile Prosthesis

Abstract Introduction Peyronie's disease (PD) is a fibrotic disorder of the tunica albuginea. It is both a physically and psychologically devastating disorder that causes penile deformity, curvature, narrowing and shortening, which eventually compromise sexual function. Objective The presented technique is a less invasive approach that gives few complications, has a natural cosmetic outcome with preserved preputium, and high patient satisfaction. Methods In the period between December 2017 and May 2022, 65pts aged 33y to 78y underwent complex corporoplasty with inflatable penile prosthesis implantation. Mean penile curvature was 70 o (60 o -95 o ). Average penile shortening was 3.2cm (1 - 5.5cm), and girth narrowing 2.5cm (0 - 4cm). The surgical approach was thru penos-crotal incision, followed by direct dissection of NVB from tunica albuginea, penile eversion, composite corporoplasty (for transversal grafting 0.5mm thick porcine dermal graft, and for longitudinal graft composite semi-resorbable soft mash), and 3-piece inflatable penile prosthesis implantation. Postoperative vacuum drainage and compressive dressing were left in place for one week. Results Follow-up was 2-58 months (mean 21). Penile shape (corrected curvature, length and girth) was restored in all patients. In the first 4 weeks postoperatively 12pts had mild scrotal oedema; 8pts developed mild scrotal haematoma; 7pts developed penile skin oedema; 5pts had a transitory loss of sensitivity. All patients 5 weeks postoperatively started with sexual intercourse. All patients 12 weeks after surgery reported satisfactory aesthetical and functional results with no visible scaring related to surgery. Five pts (12-23 months after surgery) had prosthesis malfunction that needed reimplantation of the prosthesis. Conclusions Penile eversion thru peno-scrotal incision with preserving the prepuce for complex reconstructive surgery of PD is safe and gives the natural aesthetic appearance and good functional result with low complication rate. The high satisfaction rate for the patients is the most important aspect of this surgical method. Disclosure No

Rotator Cuff Repair With Patch Augmentation: What Do We Know?

Repair of massive rotator cuff tears remains a challenging process with mixed success. There is a growing interest in the use of patches to augment the repair construct and the potential to enhance the strength, healing, and associated clinical outcomes. Such patches may be synthetic, xenograft, or autograft/allograft, and a variety of techniques have been tried to biologically enhance their integration and performance. The materials used are rapidly advancing, as is our understanding of their effects on rotator cuff tissue. This article aims to evaluate what we currently know about patch augmentation through a comprehensive review of the available literature. We explore the results of existing clinical trials for each graft type, new manufacturing methods, novel techniques for biological enhancement, and the histological and biomechanical impact of patch augmentation. There are promising results in short-term studies, which suggest that patch augmentation has great potential to improve the success rate. In particular, this appears to be true for human dermal allograft, while porcine dermal grafts and some synthetic grafts have also had promising results. However, there remains a need for high-quality, prospective clinical trials directly comparing each type of graft and the effect that they have on the clinical and radiological outcomes of rotator cuff repair.

Histologic Analysis of Porcine Dermal Graft Augmentation in Treatment of Rotator Cuff Tears

Background: Biologic augmentation via extracellular matrix (ECM) scaffolds has been utilized to address rotator cuff tears with poor-quality tissue. Purpose: To evaluate the cellular changes in graft explants taken from patients treated with porcine dermal grafts for rotator cuff tears. Study Design: Case series; Level of evidence, 4 Methods: Four graft biopsy specimens were obtained from patients treated with porcine dermal grafts in an interposition technique for rotator cuff tears and compared with a nonimplanted graft and a normal rotator cuff specimen. Biopsy of the graft site was performed at 18 days, 3 months, 7 months, and 10.5 months after implantation. Hematoxylin and eosin staining was used to evaluate for cellular and vascular changes. Picrosirius red (PSR) stain with 90° polarized light was performed to evaluate collagen fibril size and orientation. All biopsy specimens were analyzed by a pathologist. Results: There was evidence of progressive remodeling of the porcine dermal grafts. The most mature grafts demonstrated vessel infiltration and extensive remodeling without evidence of inflammation, foreign body reaction, or tissue rejection. PSR demonstrated increased organization of collagen domains, resembling normal tendon by 10.5 months postoperatively. Conclusion: This series suggests that ECM grafts may serve as an effective scaffold for host cell infiltration, collagen reorganization, and vascularization as a result of histologic changes demonstrated with retrieval of specimens from patients with rotator cuff tears that were augmented with porcine dermal grafts.

Prevention of Frey's Syndrome with the Use of Porcine Dermal Collagen Graft: Retrospective Analysis of 76 "Formal" Parotidectomies for Benign Pathologies.

Frey's syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. We conducted a 20-year retrospective study including the patients who had undergone "formal" (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey's syndrome was found after the use of dermal collagen interpositional barrier (P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor's test was positive at an incidence of 59.09% in Group A and 21.87% in Group B (P = .004, 95% CI). Severe Frey's syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B (P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey's syndrome in the compared groups. Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey's syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.

Long‐term outcomes after plaque incision and grafting for Peyronie’s disease: comparison of porcine dermal and bovine pericardium grafts

Plaque incision and grafting (PEG) is one of the mainstays in surgical therapy for severe penile curvature in Peyronie's disease (PD). Different kinds of grafts are available for covering albugineal defects during PEG, both allografts and xenografts. However, to date, none of these proved superior to others. To compare two different types of xenograft, porcine dermal matrix and bovine pericardium matrix in PEG for PD. From 2010 to 2019, 63 patients with PD underwent PEG, using porcine dermal (n=25; Group 1) and bovine pericardium (n=38; Group 2) grafts. Long-term outcomes were evaluated through multi-disciplinary questionnaires administration by phone interview. The following items were considered: correction of penile bending, quality of erection, intercourse ability, penile shortening, and sensitiveness. Overall satisfaction and impact of surgery on sexual activity and quality of life were also investigated. Plaque median (IQR) size was 29 (22-33) mm and was smaller in Group 1 (27.5 vs. 31mm; P=.03). Complete follow-up data were available for 53 patients (84%). Considering post-operative outcomes, no differences were found when considering ED rates, penile shortening, sensitiveness, complications, and penile straightening (all P>.1). Patients in Group 2 were more likely to have palpable penile nodules at follow-up (20.6 vs. 0%; P=.03). However, patient's post-operative sexual life satisfaction was consistent between the two groups, with just 1 (5.3) and 8 (23.5) patients in Group 1 and 2 respectively referring a worsening in sexual life satisfaction (P=0.2). At follow-up, 84.9% of patients that would still undergo surgery for PD, with no statistical difference between the two groups (P=.4). Corporoplasty with PEG is an effective treatment for men with PD. Porcine dermal and bovine pericardium xenografts seem to have similar long-term outcomes.

Comparison between two different techniques for peri-implant soft tissue augmentation: Porcine dermal matrix graft versus tenting screw.

The thickness of the soft tissues around dental implants is crucial for both the preservation of the marginal bone and esthetic profile. Many authors have showed the thickened soft tissues favor a better peri-implant bone stability; however, different thickening techniques can be used for this aim. Forty-seven patients were enrolled in this study, each one had one implant included in this analysis. According to the thickening procedure, patients were assigned into group A (porcine dermal matrix, n=24) or B (healing abutment used as tenting screw to sustain the soft tissues, n=23), soft tissue thickness was measured after flap elevation in a standardized way. Sixmonths after implant placement, implants were uncovered and soft tissue thickness measured again. At second stage, 6months after implant placement, the mean vertical thickness was 3.01 ± 0.58mm in group A and 2.25 ± 0.53mm in group B. The difference between the two groups at 6months was significant (P<0.001). The mean vertical gain in group A was 1.33 ± 0.71mm, whereas it was 0.43 ± 0.55mm in group B. This difference was also statistically significant (P<0.001). The use of a healing abutment for "tenting effect" has limited efficacy to obtain a significant increase in soft tissue thickness. The use of a porcine dermal matrix at time of implant placement is effective to thicken peri-implant tissues.

A comparative analysis of ventral hernia repair with a porcine hepatic-derived matrix and porcine dermal matrix

PURPOSE: Complex abdominal wall hernia repairs present unique challenges for patients and surgeons, often requiring mesh placement. Biologic materials may be utilized in repairs with high risk for postoperative complications. Porcine dermal meshes (PDM) are among the most commonly utilized biologic grafts. Porcine hepatic biologic mesh (PHM) was developed due to its unique characteristics. This study investigates outcomes following acute ventral hernia repair with a porcine-derived hepatic biologic mesh (Miromesh®) and porcine dermis (Strattice™) in a porcine animal model. MATERIALS AND METHODS: Twenty Yucatan pigs underwent hernia creation followed by immediate retrorectus ventral hernia repair and were survived for 1 (n = 4), 2 (n = 6), 6 (n = 5), or 12 (n = 5) months. Animals underwent excision of the anterior abdominal wall and immediate repair with both PDM and PHM positioned in the retrorectus space with 3 cm between grafts. Animals were survived and evaluated for tensiometric strength, histology, and protein analyses. RESULTS: Twenty animals underwent successful hernia creation and repair. Tensiometric strength was similar between repair groups at 1 (63.8 vs. 67.0 N, NS) and 2 months (80.0 vs. 76.1 N, NS), whereas at 6 (72.2 vs. 44.9 N, P= 0.01) and 12 months (66.7 vs. 46.3, P= 0.004), repair strength was greater in PHM. Histological evaluation demonstrated greater inflammation and fibrosis at 12 months in the PHM repairs. Collagen 1 deposition was greater in PHM at 1 (P = 0.1) and 2 (P = 0.015) months. There was no difference in collagen 3 deposition between groups. CONCLUSIONS: Ventral hernia repair with a porcine hepatic mesh results in greater repair strength than repair with porcine dermal grafts.

Suprapubic Granuloma after Retropubic Sling

Background:Stress urinary incontinence is a debilitating condition which occurs in 10-20% of females. Surgical management of stress urinary incontinence is increasingly common. Suburethral slings are most efficacious in treatment of stress urinary incontinence. Graft materials in these procedures can be synthetic or biologic. Common reported complications include bladder perforation, hematoma, vaginal extrusion of implant, de novo urgency symptoms, urinary tract infections and voiding dysfunction. Case:A 43-year-old para 5 woman presented to our department with complaint of a left suprapubic growing mass. Her medical history was significant for stage III cervical cancer treated with chemoradiation three years prior. Her past surgical history included a retropubic porcine dermis Pelvilace sling (Bard Medical, Covington GA) placement and cystoscopy 10 months prior to presentation. The clinical presentation was highly suggestive of local reaction to porcine dermis suburethral sling, however the diagnosis of recurrence of cervical cancer could not be excluded. The patient underwent definitive management with incision and drainage of a large pocket of pus, suprapubic exploration and resection of an indurated mass. The pathology report revealed poorly formed granuloma and no evidence of cancerous cells. The patient had an uncomplicated postoperative course and remains continent and asymptomatic 24 months post operatively. Conclusion:We present a rare case of granuloma formation secondary to reaction to porcine dermis graft that presented as a suprapubic mass.

Association between buried penis and Peyronie’s disease: one stage surgical correction using porcine dermal collagen graft (Permacol™)

Association between buried penis and Peyronie’s disease: one stage surgical correction using porcine dermal collagen graft (Permacol™)

Complex abdominal wall repair using a combination of porcine dermal matrix and omentum flap in patient with digestive tract fistula: report of a case and review of the literature

Purpose: The purpose of this article is to propose an effective approach for giant abdominal wall defects repair in a contaminated field, using a combination of porcine dermal collagen graft (Permacol) and omental interpositional flap. Case: We report a case of a 41-year-old woman submitted to emergency laparotomy, splenectomy and hepatic haemostasis for massive hemoperitoneum. She developed enteric fistula, cutaneous, muscolar and fascial necrosis leading to evisceration. At the fourth intervention we finally reconstructed abdominal wall defect using a combination of Parmacol and omental flap. Conclusion: The reconstruction of large, full-thickness, eventually contaminated abdominal wall defects is often a challenging undertaking. Similar difficulties are usually encountered with early abdominal wall closure after damage-control surgery and/or open-abdomen management. In these situations the use of synthetic mesh is contrindicated; adsorbable mesh can be used as temporary solution and some techniques of autologous tissue repair have been suggested. Therefore no ideal operative repair technique or prosthetic material for reconstruction of the fascial defect is currently available in the literature. Recently, the development of biologic meshes has shown successful rates in the management of these parietal wall defects. Also in this patient, porcine dermal collagen mesh combined with omental flap allowed us to reconstruct large abdominal wall defect.

Biocompatible porcine dermis graft to treat severe cystocele: impact on quality of life and sexuality.

To study the quality of life (QoL) and sexual function changes of women affected by severe cystocele treated using biocompatible porcine dermis graft. 20 women (ranging in age from 47 to 71 years, mean age 58.7) with third- and fourth-degree cystocele (according to Baden and Walker classification) were enrolled. The Short Form-36 questionnaire to assess QoL was administrated at baseline and 12 months after surgical treatment. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to measure the changes of sexual behavior was used at baseline and 12 months after surgical treatment. Each woman underwent translabial color Doppler ultrasonography to measure the clitoral blood flow before and 12 months after surgical treatment. Women reported QoL improvement (P < 0.001). By PISQ-12, improvement of the behavioral emotive factor score, the physical factor score, the partner-related factor score and of the total score during the 12-month follow-up with respect to baseline experience was observed (P < 0.001). Color Doppler measurement showed that the mean pulsatility index, peak systolic velocity, resistance index and end-diastolic velocity of clitoral arteries did not significantly change (P = NS). Biocompatible porcine dermis graft to treat severe cystocele considerably improves QoL and sexual function, and does not influence clitoral blood flow. Our data could add new information about sexual behavior after prolapse treatment using this kind of graft, particularly about the impact on clitoral blood flow changes.

Complex rectovaginal fistula repair with non-cross-linked porcine graft augmentation

Our aim was to demonstrate a unique approach to repairing a complex rectovaginal fistula using a non-cross-linked porcine dermal graft.

Effect of Platelet-Rich Plasma and Porcine Dermal Collagen Graft Augmentation for Rotator Cuff Healing in a Rabbit Model

Background: The rate of healing failure after surgical repair of chronic rotator cuff tears is considerably high. Purpose: To verify the effect of platelet-rich plasma (PRP) with and without porcine dermal collagen graft augmentation on tendon-to-bone healing, using the rabbit supraspinatus tendon. Study Design: Controlled laboratory study. Methods: A total of 80 rabbits were randomly allocated into 4 groups (20 rabbits per group: 12 for histological and 8 for mechanical testing): repair (R), repair + patch augmentation (RPa), repair + PRP (RPr), and repair + patch + PRP (RPaPr). The right shoulder was used for experimental interventions, and the left served as a control. Six weeks after the detachment of the supraspinatus, the torn tendon was repaired in a transosseous manner, simulating double-row repair in all groups. Platelet-rich plasma was prepared and applied onto the repair site in the RPr and RPaPr groups, and the patch was used to augment the repair in the RPa and RPaPr groups. The mechanical tensile strength test was performed at 8 weeks after repair and the histological evaluation at 4 and 8 weeks. Results: At 4 weeks, the collagen fibers were poorly organized, and fiber continuity was not established in all groups. However, vascularity and cellularity were higher with granulation tissue formation in the PRP-treated groups (RPr and RPaPr) than the nontreated groups (R and RPa). At 8 weeks, tendon-to-bone integration was much improved with more collagen fibers, and longitudinally oriented collagen fibers were visible in all groups. The PRP-treated groups showed better collagen fiber continuity and orientation than the nontreated groups; however, no distinctive difference was found between the patch-augmented groups (RPa and RPaPr) and nonaugmented groups (R and RPr). The mean load-to-failure results were 61.57 ± 29.99 N, 76.84 ± 16.08 N, 105.35 ± 33.82 N, and 117.93 ± 12.60 N for the R, RPa, RPr, and RPaPr groups, respectively, and they were significantly different between the R and RPr (P = .018), R and RPaPr (P = .002), and RPa and RPaPr (P = .029) groups. Conclusion: This animal study showed the enhancement of tendon-to-bone healing after local administration of autologous PRP assessed by histological and biomechanical testing in a rabbit model of chronic rotator cuff tears. However, there was little additive effect of the patch graft. Clinical Relevance: The use of PRP might be a biological supplement to increase the rotator cuff healing rate, which still remains low even after successful cuff repair, but this result should be interpreted with caution regarding clinical applications.

Comparative outcomes of two porcine dermal biologic grafts in infected fields

Bradley, Joel F.; Williams, Kristopher B. MD; Wormer, Blair A. MD; Walters, Amanda L. MS; Lincourt, Amy E. PhD, MBA; Heniford, Todd B. MD, FACS Author Information

The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up

We evaluated the anatomical success and complications of Perigee® with porcine dermis Graft in the repair of anterior vaginal wall prolapse (AVWP) MATERIALS AND METHODS: After Institutional Review Board (IRB) approval, the charts of all patients who underwent AVWP repair using the Perigee/InteXen® kit from July 2005 to July 2009 were reviewed. Patients who had less than 6-month follow-up were excluded. Preoperative data including patient age, previous AVWP repairs, hysterectomy status, preoperative dyspareunia and pertinent physical findings were collected and recorded. Postoperative success was defined as anatomical stage 0 or I using the Pelvic Organ Prolapse Quantification (POP-Q) scoring system. Graft related complications were also recorded. Out of 89 patients, 69 completed at least 6-month follow-up. Median follow-up was 13 (6-48) months. Seventeen patients (25%) had previous AVWP repair and 32 (46%) had previous hysterectomy. Preoperatively, AVWP stage II was found in 9 (13%), stage III in 27 (39%) and stage IV in 33 (48%) patients. Anatomic success was found in 48 (69%) patients, with 23 (33%) having stage 0 and 25 (36%) stage I AVWP. Intraoperative complications included incidental cystotomy in one patient and bladder perforation in one. Postoperative complications included vaginal exposure and dyspareunia in one case, wound dehiscence in one and tenderness over the graft arm with dyspareunia in one. The use of porcine dermis in AVWP repair is safe with minimal graft related complications; however, anatomical success is lower than that reported with the use of synthetic grafts.

V56 Corpora cavernosa reconstruction with porcine dermal matrix graft and inflatable penile prosthesis implant in a case of massive, post-infective penile fibrosis

V56 Corpora cavernosa reconstruction with porcine dermal matrix graft and inflatable penile prosthesis implant in a case of massive, post-infective penile fibrosis

Original Technique for Penile Girth Augmentation Through Porcine Dermal Acellular Grafts: Results in a 69‐Patient Series

Although different techniques for augmentation phalloplasty have been reported in the medical literature, this issue is still highly controversial, and none of the proposed procedures has been unanimously approved. The aim of this study is to describe an innovative surgical technique for penile girth augmentation with porcine dermal acellular grafts, through a small transverse incision at the penile base, along the penopubic junction. Between 2000 and 2009, 104 patients were referred to our institution for penile enhancement. After a preoperative psychosexual consultation and a general medical assessment, 69 patients were deemed suitable good candidates for surgery. The average penis circumference was measured at the mid-length of the penis and was 8.1 cm (5.4-10.7 cm) and 10.8 cm (6.5-15.8 cm) during flaccidity and erection, respectively. All patients received penile augmentation with porcine dermal acellular grafts. Results evaluation of an innovative technique for penile girth augmentation through exogenous porcine grafts and small penobubic incision. Postoperative measurements were performed at 6 and 12 months. At the 1-year follow-up, the average penis circumference was 11.3 cm (8.2-13.2 cm, 3.1 cm mean increase) during flaccidity and 13.2 cm (8.8-14.5 cm, 2.4 cm mean increase) during erection. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. Sexual activity was resumed from 1 to 2 months after surgery. The psychosexual impact of the operation was beneficial in the majority of cases. Penile girth enlargement with acellular dermal matrix grafts has several advantages over augmentation with autogenous dermis-fat grafts: the elimination of donor site morbidity and a significantly shorter operation time. With this approach, through a short dorsal incision at the base of the penis, the scar is concealed in a crease covered by pubic hair and thus hardly visible.

Traitement de la rectocèle par une prothèse biologique de derme porcin inter-rectovaginale associé à une sacropexie infracoccygienne

To evaluate an infracoccygeal colpopexy procedure by tension-free synthetic tape for vaginal apical prolapse associated with a posterior mesh procedure using porcine dermal graft for rectocele repair. A retrospective study concerning 35 women. The surgical procedure included rectocele repair with porcine dermal collagen implant (porcine dermal matrix, native) associated with transgluteal infracoccygeal sacropexy using a polypropylene sling. Median follow up was 48 months (42-54). A vaginal hysterectomy was associated in 43% and a cure of cystocele was associated in 63% of cases. No intra-operative complication was noted. The prevalence of dyschesia decreased from 25% (eight patients) preoperatively to 3% (one patient) postoperatively. No cases of de novo dyspareunia was noted. Five (14%) patients had a recurrent prolapse (two cases of rectocele stage 2, one case of grade 3 rectocele associated with a cystocele, a case of uterine prolapse associated with cystocele and one case of recurrent isolated uterine prolapse). Among them, three patients (9%) required a re-intervention for prolapse recurrence. No vaginal mesh exposure was observed. Perineal pain was reported by 12 (33%) patients at one month follow-up, but no patient complained with perineal pain one year follow-up. Infracoccygeal sacropexy associated with rectocele repair using porcine dermal collagen implant was associated with satisfactory results at medium term follow-up.

A transperineal approach to perineal hernia repair using suture anchors and acellular porcine dermal mesh

Perineal hernia following major pelvic surgery is a rare but recognised complication. Various surgical approaches to the repair of a symptomatic perineal hernia have been described. We describe the first reported use of the Mitek suture anchors to secure an acellular porcine dermal graft to the ischia during the transperineal repair of a large perineal hernia.

Transvaginal Repair and Graft Interposition for Rectovaginal Fistula Due to a Neglected Pessary

: There are few reported cases of rectovaginal fistula due to a neglected pessary, with few data to guide management. : An 83-year-old lady presented with an impacted Gellhorn pessary 5 years after insertion. Upon removal of the pessary in the operating room, a 4-cm high rectovaginal fistula was discovered. An immediate transvaginal layered repair was performed with porcine dermal graft interposition and partial obliteration of the posterior vagina. At 8 months' follow-up, the patient remained asymptomatic with normal bowel function. : A large, high rectovaginal fistula due to a neglected pessary can be repaired vaginally with the use of a graft and partial obliteration of the posterior vagina to provide additional layers of closure, without the need for colostomy. The literature is reviewed, focusing on the management of pessary-related rectovaginal fistula and the role of graft augmentation.