Repair Of Abdominal Wall Defects Research Articles

Graphene Oxide Functionalized Double-Layered Patch with Anti-Adhesion Ability for Abdominal Wall Defects.

BackgroundEffective repair of full-thickness abdominal wall defects requires a patch with sufficient mechanical strength and anti-adhesion characteristics to avoid the formation of hernias and intra-abdominal complications such as intestinal obstruction and fistula. However, patches made from polymers or bio-derived materials may not meet these requirements and lack the bionic characteristics of the abdominal wall.Materials and MethodsIn this study, we report a consecutive electrospun method for preparing a double-layer structured nanofiber membrane (GO-PCL/CS-PCL) using polycaprolactone (PCL), graphene oxide (GO) and chitosan (CS). To expand the bio-functions (angiogenesis/reducing reactive oxygen species) of the patch (GO-PCL/NAC-CS-PCL), N-acetylcysteine (NAC) was loaded for the repair of full-thickness abdominal wall defects (2×1.5cm) in rat model.ResultsThe double-layered patch (GO-PCL/NAC-CS-PCL) showed excellent mechanical strength and biocompatibility. After 2 months, rats treated with the patch exhibited the desired repair effect with no hernia formation, less adhesion (adhesion score: 1.50±0.50, P<0.001) and more collagen deposition (percentage of collagen deposition: 34.94%±3.31%, P<0.001).ConclusionThe double-layered nanomembranes presented in this study have good anti-hernia and anti-adhesion effects, as well as improve the microenvironment in vivo. It, therefore, holds good prospects for the repair of abdominal wall defects and provides a promising key as a postoperative anti-adhesion agent.

Functionalized Strategies and Mechanisms of the Emerging Mesh for Abdominal Wall Repair and Regeneration.

Meshes have been the overwhelmingly popular choice for the repair of abdominal wall defects to retrieve the bodily integrity of musculofascial layer. Broadly, they are classified into synthetic, biological and composite mesh based on their mechanical and biocompatible features. With the development of anatomical repair techniques and the increasing requirements of constructive remodeling, however, none of these options satisfactorily manages the conditional repair. In both preclinical and clinical studies, materials/agents equipped with distinct functions have been characterized and applied to improve mesh-aided repair, with the importance of mesh functionalization being highlighted. However, limited information exists on systemic comparisons of the underlying mechanisms with respect to functionalized strategies, which are fundamental throughout repair and regeneration. Herein, we address this topic and summarize the current literature by subdividing common functions of the mesh into biomechanics-matched, macrophage-mediated, integration-enhanced, anti-infective and antiadhesive characteristics for a comprehensive overview. In particular, we elaborate their effects separately with respect to host response and integration and discuss their respective advances, challenges and future directions toward a clinical alternative. From the vastly different approaches, we provide insight into the mechanisms involved and offer suggestions for personalized modifications of these emerging meshes.

Near infrared spectroscopy and abdominal compartmental syndrome in neonates

ABSTRACT Background and Aims Abdominal compartmental syndrome considered the most common cause of postoperative mortality in neonates scheduled for surgical repair of congenital abdominal wall defect. This study aimed primarily to observe the renal and cerebral rSO2 variation during and after surgical reduction, while secondarily to analyze correlations with other perfusion markers of intra-abdominal hypertension. Patients and methods A randomized, prospective, cohort study was piloted in a tertiary care pediatric surgery center from February 2017 to march 2021 where 20 neonates scheduled surgical repair of congenital abdominal wall defects. Near-infrared spectroscopy (NIRS) measurements of regional tissue oxygenation (rSO2) fluctuations performed using the two-channel mode, channel 1 for cerebral monitoring (C rSO2) and channel 2 for renal monitoring (R rSO2), and calculating differences intraoperative as well as postoperative. Results Intra-operative C and R ΔrSO2 had a significant positive correlation with an intraoperative post-ductal SPO2 and MABP changes, while a significant negative correlation was noted with serum lactate level and capillary refill time. Postoperative C ΔrSO2 showed a negative correlation with postoperative serum lactate level, whereas postoperative R ΔrSO2 had a positive correlation with postoperative post-ductal SPO2 changes, and negative correlations with postoperative capillary refill time changes. Pathological intraoperative ΔrSO2 had a statistically significant relation with intraoperative post-ductal SPO2, MABP, capillary refill time, serum lactate level, postoperative serum creatinine level, and postoperative vasoactive-ventilation-renal (VVR) score. Conclusion : NIRS is an efficient non-invasive monitor of cerebral and tissue perfusion, evaluating tissue microcirculation, and considered an early warning for detecting abdominal compartment syndrome (ACS) in neonates.

A smart scaffold composed of three-dimensional printing and electrospinning techniques and its application in rat abdominal wall defects

BackgroundBiological composite scaffolds are increasingly being used in abdominal wall reconstruction but still have certain shortcomings. The present study describes here a novel three-dimensional (3D) scaffold fabricated by combining 3D printing (3DP) and electrospinning (ESP).MethodsBiological composite scaffolds are composed of integrated 3DP interconnected macrofiber and random ESP microfiber networks. The 3DP scaffold retains intact 3D architecture and mechanical properties, while the ESP network serves as a cell entrapment system at the extracellular matrix (ECM) scale. Biological composite scaffolds are implanted in a defective rat abdominal wall to detect if it could induce early vascularization and reconstruction of the tissue defect.ResultsSEM analysis reveals a pore diameter of 424.47 ± 58.49 μm and a porosity of 70.46 ± 2.48% for biological composite scaffolds. In the in vitro test of cell proliferation, biological composite scaffolds do not affect rat dermal fibroblast proliferation in a time- and dose-dependent manner. The animal experiments show tissue remodeling and early angiogenesis as compared to 3DP scaffolds.ConclusionsOur experiment prepares a biological scaffold with both a macro- and microscale structure by ESP and 3DP technology. Thus, the integration of 3DP and ESP techniques provides a new set of smart scaffolds for abdominal wall defect and hernia repair.

Mesenchymal stem cell tailored bioengineered scaffolds derived from bubaline diaphragm and aortic matrices for reconstruction of abdominal wall defects.

Bioengineered scaffolds derived from the decellularized extracellular matrix (ECM) obtained from discarded animal organs and tissues are attractive candidates for regenerative medicine applications. Tailoring these scaffolds with stem cells enhances their regeneration potential making them a suitable platform for regenerating damaged tissues. Thus, the study was designed to investigate the potential of mesenchymal stem cells tailored acellular bubaline diaphragm and aortic ECM for the repair of full-thickness abdominal wall defects in a rabbit model. Tissues obtained from bubaline diaphragm and aorta were decellularized and bioengineered by seeding with rabbit bone marrow derived mesenchymal stem cells (r-BMSC). Full-thickness abdominal wall defects of 3 cm × 4 cm size were created in a rabbit model and repaired using five different prostheses, namely, polypropylene sheet, nonseeded diaphragm ECM, nonseeded aorta ECM, r-BMSC bioengineered diaphragm ECM, and r-BMSC bioengineered aorta ECM. Results from the study revealed that biological scaffolds are superior in comparison to synthetic polymer mesh for regeneration in terms of collagen deposition, maturation, neovascularization, and lack of any significant (P > 0.05) adhesions with the abdominal viscera. Seeding with r-BMSC significantly increased (P < 0.05) the collagen deposition and biomechanical strength of the scaffolds. The bioengineered r-BMSC seeded acellular bubaline diaphragm showed even superior biomechanical strength as compared to synthetic polymer mesh. Tailoring of the scaffolds with the r-BMSC also resulted in significant reduction (P < 0.01) in antibody and cell mediated immune reactions to the xenogeneic scaffolds in rabbit model.

Prevention of intestinal adhesion and regeneration of abdominal wall tissue with meshes containing an electrostatically spun acellular dermal matrix (ADM)/silk fibroin (SF) fiber composite polypropylene mesh

The repair of abdominal wall defects often requires the use of polypropylene (PP) as the main material. After a PP mesh is implanted in the body, contact with the intestine can cause adhesions between the intestine and the mesh, leading to serious complications such as intestinal fistula. In this study, we used electrostatic spinning technology to coat one side of PP meshes with an electrostatically spun isolating layer of acellular dermal matrix (ADM)/silk fibroin (SF) hybrid material. These meshes were used to repair abdominal wall defects in model rats and were compared with polycaprolactone (PCL) composite polypropylene meshes and PP meshes. The results showed that the adhesion score and area of ADM/SF-PP meshes were smaller than those of PCL-PP and PP meshes. Immunohistochemical assessment revealed that the ADM/SF meshes could effectively reduce the inflammatory response at the contact surface between the meshes and abdominal organs. The tissues regenerated on the abdominal side were rich in new blood vessels. Furthermore, the ADM/SF meshes could effectively reduce the expression levels of the inflammation-related factors IL-6 and TNF-α. The expression levels of tissue regeneration-related factors, such as VEGF and PAX-7, were also higher after ADM/SF-PP mesh-mediated repair than after PCL-PP mesh and PP mesh repair. Thus, ADM/SF-PP meshes can effectively reduce the inflammatory response at the contact surface between the meshes and abdominal organs and quickly promote regeneration of abdominal surface tissue to prevent and reduce abdominal adhesion and support restoration of the abdominal wall.

Large-Scale Fabrication of Robust Artificial Skins from a Biodegradable Sealant-Loaded Nanofiber Scaffold to Skin Tissue via Microfluidic Blow-Spinning.

Given that many people suffer from large-area skin damage, skin regeneration is a matter of high concern. Here, an available method is developed for the formation of large-area robust skins through three stages: fabrication of a biodegradable sealant-loaded nanofiber scaffold (SNS), skin tissue reconstruction, and skin regeneration. First, a microfluidic blow-spinning strategy is proposed to fabricate a large-scale nanofiber scaffold with an area of 140cm × 40cm, composed of fibrinogen-loaded polycaprolactone/silk fibroin (PCL/SF) ultrafine core-shell nanofibers with mean diameter of 65nm. Then, the SNS forms, where the gelling reaction of fibrin sealant occurs in situ between thrombin and fibrinogen on PCL/SF nanofiber surface, to promote the migration and proliferation of fibroblasts, accelerating skin regeneration. Through an in vivo study, it is shown that the SNS can rapidly repair acute tissue damage such as vascular bleeding and hepatic hemorrhage, and also promote angiogenesis, large-area abdominal wall defect repair, and wound tissue regeneration for medical problems in the world. Besides, it avoids the risk of immune rejection and secondary surgery in clinical applications. This strategy offers a facile route to regenerate large-scale robust skin, which shows great potential in abdominal wall defect repair.

&lt;p&gt;Electrospun Scaffold with Sustained Antibacterial and Tissue-Matched Mechanical Properties for Potential Application as Functional Mesh&lt;/p&gt;

IntroductionVarious materials and approaches have been used to reduce the mesh-induced inflammatory response and modify the mesh with tissue-matched mechanical properties, aiming to improve the repair of abdominal wall defects.Materials and MethodsIn this study, we fabricated a polycaprolactone (PCL)/silk fibroin (SF) mesh integrated with amoxicillin (AMX)-incorporating multiwalled carbon nanotubes (MWCNTs) via electrospinning, grafting and crosslinking, developing a sustainable antibiotic and flexible mesh. AMX was loaded into the hollow tubular MWCNTs by physical adsorption, and a nanofibrous structure was constructed by electrospinning PCL and SF (40:60 w/w). The AMX@MWCNTs were then chemically grafted onto the surfaces of the PCL/SF nanofibers by treating with 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide/N-hydroxysuccinimide (EDC/NHS) solution for simultaneous crosslinking and coating. The incorporation of AMX into the MWCNTs (AMX@MWCNTs) and the integration of the AMX@MWCNTs with the PCL/SF nanofibers were characterized. Then, the functional mesh was fabricated and fully evaluated in terms of antibacterial activity, mechanical properties and host response.ResultsOur results demonstrated that the PCL/SF nanofibrous structure was fabricated successfully by electrospinning. After integrating with AMX@MWCNT by grafting and crosslinking, the functional mesh showed undeformed structure, modified surface hydrophilicity and biocompatible interfaces, abdominal wall-matched mechanical properties, and a sustained-release antibiotic profile in E. coli growth inhibition compared to those of PCL/SF mesh in vitro. In a rat model with subcutaneous implantation, the functional mesh incited less mesh-induced inflammatory and foreign body responses than PCL/SF mesh within 14 days. The histological analysis revealed less infiltration of granulocytes and macrophages during this period, resulting in the loosely packed collagen deposition on the functional mesh and prominent collagen incorporation.DiscussionTherefore, this designed PCL/SF–AMX@MWCNT nanofibrous mesh, functionalized with antibacterial and tissue-matched mechanical properties, provides a promising alternative for the repair of abdominal wall defects.

Selection of biological prosthesis for abdominal wall repair on the basis of in vitro biocompatibility determination.

Research on prostheses for repairing abdominal wall defects has progressed through past decades for developing an ideal prosthesis. The study was designed to compare different extracellular matrix (ECM) derived biological prostheses as alternate to conventional synthetic polymeric prostheses for the repair of full thickness abdominal wall defects. Five biological scaffolds derived from bovine diaphragm, bovine aorta, bovine gall bladder, porcine gall bladder, and rabbit skin were prepared and screened for their in vitro biocompatibility. Decellularized ECMs were subjected to various biocompatibility analyses, namely, water absorption potential, matrix degradation analysis, biomechanical testing, and cytocompatibility analysis. Though the rabbit skin displayed maximum biomechanical strength, due to its rapid degradation, it failed to fulfill the criteria of an ideal prosthesis. ECMs derived from bovine diaphragm and aorta were found to be superior than others based upon hydration and matrix degradation analysis, with best scores for bovine diaphragm followed by bovine aorta. The bovine diaphragm and aorta also displayed sufficient biomechanical strength, with diaphragm being the second highest (next to rabbit skin), in biomechanical strength followed by aorta. None of the biological prosthesis revealed any cytotoxicity. Thus, bovine diaphragm and aorta derived ECM fulfill the necessary criteria for their use as biological prosthesis. Because these prostheses are biocompatible, apart from their low cost, ease of availability, and simple preparation, they present a potential alternative to synthetic prosthesis for repair of abdominal wall defects, especially in veterinary patients.

Durable and Effective Antibacterial Cotton Fabric Collaborated with Polypropylene Tissue Mesh for Abdominal Wall Defect Repair.

A feasible, efficient antibacterial and anti-infective mesh for clinical abdominal wall defect repair is significant, but challenging due to the complexity of the postoperative wound environment. Herein, a simple strategy was provided to construct woven cotton fabric modified with gentamicin (Gem) via the enamine bonds. The obtained cotton fabric possessed favorable antibacterial properties against E. coli and S. aureus with the bactericidal rate of over 99.99% and could be combined with a commercial polypropylene (PP) mesh to serve as a two-layer composite mesh for abdominal wall defect repair. The antibacterial cotton layer was systematically characterized by FTIR, XPS, SEM, EDS, and mechanical measurements. The C2C12 cells and human fibroblasts were employed to assess the cytocompatibility of the composite mesh in vitro. Furthermore, the rat abdominal wall defect model was used to evaluate the efficacy of antibacterial and anti-infection properties. It was demonstrated that the two-layer composite mesh possessed favorable biocompatibility and satisfactory anti-infection properties involved in abdominal wall defect repair. Therefore, this synergetic two-layer composite mesh would out-perform surgical PP meshes in preventing infectious complications.

Repair of Ventral Abdominal Wall Hernias

The repair of noninguinal abdominal wall defects is one of the most common procedures general surgeons perform. Despite this, there is little agreement or consensus in the literature as to the ideal approach for this difficult problem. In recent years, population-based studies have provided better data on the true failure rates associated with the various herniorrhaphies. Wound morbidity has also emerged as an important outcome measure, and definitions by the Ventral Hernia Working Group (VHWG) have begun to standardize such benchmarks. Future evidence will come from the large multi-institutional collaborations currently forming. This topic review discusses the classification of ventral hernias, abdominal wall anatomy, and choices of prosthetic materials. Incisional hernia repair is discussed, as are the operative steps and techniques for both an open and a laparoscopic ventral hernia repair. Special circumstances, including loss of abdominal domain and contaminated surgical fields, periumbilical hernia repair, and atypical ventral hernias are also described. This review contains 10 figures, 18 tables, and 71 references. Keywords: Hernia, incisional hernia, mesh, laparotomy, laparoscopy, incarceration, surgical site infection, hernia repair

Application of double circular suturing technique (DCST) in the repair of large abdominal wall defects after resection of abdominal wall tumor.

BackgroundThe aim of this study was to investigate the clinical effects of repairing large defects using the double circular suturing technique (DCST) after resection of abdominal wall tumor.MethodsThe clinical data of 62 patients (25 men, 37 women; average age 41.7±22.4 years) who underwent DCST between October 2010 and November 2018 for the repair of large abdominal wall defects with anti-adhesion underlay mesh after resection of abdominal wall tumor were retrospectively analyzed. The maximum diameter of abdominal wall defect after resection of abdominal wall tumor was 10.4±5.6 cm. The course of disease was 1–341 months, and the average was 32.4 months. Operative time, postoperative hospitalization time, perioperative complications, tumor recurrence in situ, incidence of postoperative chronic pain, and hernia were recorded.ResultsAll 62 operations were completed successfully. The operative time was 73.2±31.4 minutes, and the mean postoperative hospitalization time was 9.6 days (range, 2–20 days). In total, 54 patients were followed up postoperatively for a median 6.7 years (range, 0.9–9.0 years). Partial splitting of incisions occurred in 2 patients, fat liquefaction of incisions occurred in 3 patients, and chronic pain occurred in 4 patients. No tumor in situ recurrence, hernia, or other complications were found in any cases in the follow-up. Tumor metastasis occurred in 9 patients with 6 of these patients dying of tumour progression.ConclusionsWith simple operations, short procedure time, few complications, low tumor recurrence rate, and low incidence of postoperative chronic pain, application of DCST in the repair of large abdominal wall defects is effective after resection of abdominal wall tumor.

A retrospective, Italian multicenter study of complex abdominal wall defect repair with a Permacol biological mesh

Complex abdominal wall defects (CAWDs) can be difficult to repair and using a conventional synthetic mesh is often unsuitable. A biological mesh might offer a solution for CAWD repair, but the clinical outcomes are unclear. Here, we evaluated the efficacy of a cross-linked, acellular porcine dermal collagen matrix implant (Permacol) for CAWD repair in a cohort of 60 patients. Here, 58.3% patients presented with a grade 3 hernia (according to the Ventral Hernia Working Group grading system) and a contaminated surgical field. Permacol was implanted as a bridge in 46.7%, as an underlay (intraperitoneal position) in 38.3% and as a sublay (retromuscolar position) in 15% of patients. Fascia closure was achieved in 53.3% of patients. The surgical site occurrence rate was 35% and the defect size significantly influenced the probability of post-operative complications. The long-term (2 year) hernia recurrence rate was 36.2%. This study represents the first large multi-centre Italian case series on Permacol implants in patients with a CAWD. Our data suggest that Permacol is a feasible strategy to repair a CAWD, with acceptable early complications and long-term (2 year) recurrence rates.

Recognizable neonatal clinical features of aplasia cutis congenita

BackgroundAplasia cutis congenita (ACC), classified in nine groups, is likely to be underreported, since milder isolated lesions in wellbeing newborns could often be undetected, and solitary lesions in the context of polymalformative syndromes could not always be reported. Regardless of form and cause, therapeutic options have in common the aim to restore the deficient mechanical and immunological cutaneous protection and to limit the risk of fluid leakage or rupture of the exposed organs. We aimed to review our institutional prevalence, comorbidities, treatment and outcome of newborns with ACC.MethodsWe conducted a retrospective study including all newborns affected by ACC and admitted at the University Mother-Child Department from October 2010 to October 2019. Anthropometric and clinical characteristics of ACC1 versus a non-isolated ACC group were analyzed.ResultsWe encountered 37 newborns, 16 with ACC1 versus 21 with non-isolated ACC. The incidence rate of 0.1% in ACC1 was higher than expected, while 19% of cases showed intrafamilial autosomal dominant transmission. Higher birth weight centile, though lower than reference population, being adequate for gestational age, normal Apgar score and euglycemia characterizing ACC1 resulted associated to a rapid tissue regeneration. Non-isolated ACC, in relation to concomitant congenital anomalies and higher prematurity rate, showed more surgical and medical complications along with the risk of neonatal death. Specifically, newborns with ACC4 were characterized by the frequent necessity of abdominal wall defect repair, responsible for the occurrence of an abdominal compartment syndrome.ConclusionPrompt carefully assessment of the newborn with ACC in order to exclude concomitant other congenital malformations, provides clues to the underlying pathophysiology, and to the short-term prognosis. Family should be oriented toward identification of other family members affected by similar pathology, while obstetric history should exclude initial multiple pregnancy with death of a co-twin, placental anomalies and drug assumption. Molecular-genetic diagnosis and genetic counseling are integrative in individualized disease approach.

Dermo-Peritoneal Flap: a Novel, Safe and Effective Technique to Manage Abdominal Defects in Complicated Recurrent Incisional Hernia

Recurrences after open surgical or laparoscopic repair of abdominal wall defects are not uncommon. No technique is the “best” solution, and a wide variety of surgical options are being used by surgeons for specific defects or locations with variable results. We describe a new technique “dermo-peritoneal flap,” which can easily be used to manage such difficult incisional hernias. Three patients having difficult recurrent incisional hernia were operated from April 2014 to May 2016 using the “dermo-peritoneal flap” technique. Detailed pre-operative assessment was done by structured questionnaire and ultrasonography (USG) scan to rule out co-existing intra-abdominal pathology and subacute/blind loop obstruction. Also, the approximate size and location of defect were estimated clinically and confirmed by pre-operative USG scan. A vertical ellipse in midline was marked, and the area was de-epithelialized. Bilateral abdominal flaps were elevated, leaving the de-epithelized dermo-fat patch over sac. After reaching the defect, blunt separation of the sac was done from edges of the defect. The sac was reduced into the abdominal cavity without opening. Edges of dermal tissue were sutured to edges of the defect. Onlay prolene mesh-plasty was done, and abdomen was closed with suction drains. Patients were aged 48, 52, and 57 years, and all patients were women. The patients had undergone 6, 5, and 6 surgeries, and duration of hernia was 6, 6.5, and 4.5 years respectively. Two of the patients had undergone resection anastomosis of gangrenous bowel previously. All patients have shown no signs of recurrence. Mild discharge from the suture line was seen in two patients, which resolved spontaneously on dressings. One of them has developed a midline scar similar to natural umbilicus. The concept of de-epithelialization of thinned-out skin over sac makes surgery easier and safe and also provides tough and vascular tissue which plugs the defect. It can also be used universally with any technique of repair for any location and size of defect. This is a case series of 3 lady patients, all of whom had ventral/incisional hernias operated earlier by this new technique of isolated de-epithelialized overlying skin used as a flap strengthened with overlay mesh.

Laparoscopic fundoplication for a case of esophageal hiatal hernia after gastroschisis repair

BackgroundEsophageal hiatal hernia and gastroesophageal reflux have been recognized as inevitable complications after the definitive gastroschisis operation. Patients with refractory gastroesophageal reflux require anti-reflux surgery; however, the surgical adhesions may complicate subsequent surgical therapy, especially in the cases treated by staged repair.Case presentationA male infant who showed a severe gastroesophageal reflux due to hiatal hernia after staged abdominal fascial closure of gastroschisis. In spite of continuous conservative management, frequent vomiting and hematemesis had become progressively worse at the age of 8 months. Laparoscopic Nissen fundoplication was attempted and completed with no adverse events.ConclusionsLaparoscopic fundoplication may be applied, as a first-line approach, for the treatment of gastroesophageal reflux in this difficult group of patients, after the repair of congenital abdominal wall defect.

Clinical application of acellular matrix derived from the bubaline diaphragm and caprine rumen for the repair of abdominal wall defects in animals

The abdominal wall hernias resulting due to trauma or other clinical conditions are common in animals. Large hernias required the use of synthetic mesh, which is costly and may result in infection, fistula formation, and pain. Application of biomaterials in hernia repair causes a reduction in pain, reduced recovery time, and rate of recurrence. The study was undertaken to test the acellular bubaline diaphragm matrix (BDiaM) and acellular caprine rumen matrix (CRuM) for the repaired hernia in clinical cases. Fresh bubaline diaphragm and caprine rumen were decellularized using sodium deoxycholate (1% for CRuM and 2% for BDiaM) for 48h. Acellularity was ascertained histologically and by DNA quantification. Histologically, both the matrices showed complete acellularity and orderly arranged collagen fibers after 48 h. The DNA contents were significantly (P0.05) reduced in both the matrices in comparison to the native matrices. The BDiaM and CRuM matrices were applied in eight and nine clinical cases of abdominal wall defects, respectively. Animals with BDiaM and CRuM matrices recovered uneventfully and remained sound at least up to 3 months. Hematological and immunological findings were unremarkable. BDiaM and CRuM matrices showed good results without complications. Keywords:Biocompatibility, Bubaline diaphragm matrix, Caprine rumen matrix, DNA quantification, ELISA, SDS-PAGE

The effect of TopClosure® TRS in the treatment of large abdominal wall defect

Large abdominal wall defects, which are not suitable for primary closure partly due to the expected high tension closure and the considerable rate of recurrence, represent a substantial reconstructive challenge. The study is aimed to evaluate the clinical value of TopClosure® Tension-Relief System (TRS) in the treatment of large abdominal wall defect. Thirteen patients with large abdominal wall defect were treated using TopClosure® TRS, and the average healing time, patients’ satisfaction, and complication were recorded. After being treated with TopClosure® TRS, 10 cases were primary healing, three-case second-intention healing due to the thickened abdominal wall with mild scar. The average healing time and hospitalization time are shortened, while the primary healing rate and VAS satisfactory value improved. Logistic regression analyses indicated that age, BMI, defect area, wound infection, and diabetes may influence the effect of TopClosure® TRS in the repair of large abdominal wall defect. Large abdominal wall defect can be treated using TopClosure® TRS, effectively and easily, which can be generalized to be used in clinics. Level of evidence: Level IV, therapeutic study.

Abdominal Wall Reconstruction with the Two-step Technique: Procedure Optimization and Three-year Follow-up in 26 Surgeries.

Background:Complex or recurrent abdominal wall defects may be the result of trauma, infection, tumor resection, or a previous failed attempt at closure, among other causes. This article describes a new surgical technique that better addresses these defects and provides safety and efficacy data from 26 consecutive surgeries with a 3-year follow-up.Methods:Prospective study in 18 men and 8 women with serious abdominal wall defects, who were surgically operated on using the two-step technique, which includes a first regenerative and closure step using a vacuum device (vacuum-assisted closure), and a second reconstructive step that does not require the use of any type of surgical mesh. The safety and efficacy results were evaluated through clinical examinations and questionnaires. The severity of patient-experienced pain and both patient and surgeon satisfaction were quantified on a scale from 0 to 10 points. The statistical calculations focused on the mean (m), range (r), and percentage (%).Results:The mean complete surface area of the abdominal wall defects was 250.2 cm2 (r = 78–770 cm2). The patient and surgeon satisfaction rates at the time of hospital discharge were m = 9.0 (r = 3–10) and m = 9.4 (r = 8–10), respectively. After 3 years, these rates were m = 7.2 (r = 3–10) and m = 9.8 (r = 9–10), respectively. No relevant complications were observed in any stage of the study and no recurrence was observed 3 years later. The main complaint of patients was the presence of hypertrophic scars from the surgical wound (57% of cases).Conclusion:The two-step technique is an excellent alternative for the repair of complete abdominal wall defects of up to 800 cm2 because it allows serious complications to be avoided, prevents recurrences, and shows high rates of both patient and surgeon satisfaction.

Responsive Porous Microcarriers With Controllable Oxygen Delivery for Wound Healing.

Microcarriers with oxygen-delivering capacity have attracted increasing interest in the field of tissue regeneration. Here, a kind of molybdenum disulfide quantum dots (MoS2 QDs) integrated responsive porous microcarriers with controllable oxygen-delivering ability for wound healing is presented. The specific gelatin methacryloyl (GelMa) porous microcarriers are derived from inverse opal microparticles which can be decorated with the oxygen-carrying protein hemoglobin. Because of their characteristic porous structure, interconnected nanochannels, and excellent biocompatibility, the resultant microcarriers could carry oxygen extensively and provide support for tissue repair physically and biologically. Besides, since the typical photothermal effect of 2D materials and their derived 2D QDs, the inverse opal particles integrated with MoS2 QDs are imparted with photo-responsive capacity, which makes them able to release oxygen photo-controllably. It is demonstrated that the designed microcarriers can promote the repair of abdominal wall defects effectively with their multifunctional features. These remarkable properties point to the potential value of the microcarriers in wound healing and tissue engineering.