A A Winkler1, M L Milburn, L H Holton, L T Holton, N H Goldberg, R P Silverman. 1. University of Maryland Department of Otorhinolaryngology, Head and Neck Surgery, University of Maryland Medical Center, 16 South Eutaw Street, Suite 500, Baltimore, MD 21201, USA. AWinkler@smail.umaryland.edu
Abstract
BACKGROUND: Repair of ventral hernias represents a challenging problem for surgeons. AlloDerm (LifeCell, Branchburg, NJ, USA), an acellular dermal matrix (ADM) product derived from cadaveric human skin, has gained in popularity in the management of abdominal hernias because of its ability to support neovascularization and therefore resist infection. Surgeons have traditionally used nonabsorbable suture when using ADM in this setting, perhaps because of concerns regarding wound strength. This study was undertaken to examine the influence of suture material on wound breaking strength and complication rates in abdominal wall defects closed with ADM. METHODS: Full-thickness abdominal defects were created in athymic rats and immediately repaired with an ADM interposition graft using either interrupted Prolene or Maxon suture. Complications were recorded over time and the animals were sacrificed at 1 month intervals. The abdominal repair complex was harvested and wound strength was measured using a tensiometer. RESULTS: There were no hernias in any of the groups. There were also no cases of major adhesions to the AlloDerm. Two rats in the Prolene group developed a stitch extrusion through the ventral skin. Wound breaking strength increased significantly from the second to third month after surgery in both suture groups (p=0.0000, LSD test). The breaking strength of the abdominal fascia-ADM complex increased over the course of the experiment in both test groups, but no significant difference was found between the groups at any time point (p=0.3157). At 3 months, the breaking strength of the Prolene group and Maxon group was nearly identical (27.1 N +/- SD 7.4 and 29.7 N +/- SD 9.6, respectively). CONCLUSIONS: We were unable to identify a significant difference in breaking strength at the interface between ADM and normal, native fascia when using permanent versus resorbable sutures.
BACKGROUND: Repair of ventral hernias represents a challenging problem for surgeons. AlloDerm (LifeCell, Branchburg, NJ, USA), an acellular dermal matrix (ADM) product derived from cadaveric human skin, has gained in popularity in the management of abdominal hernias because of its ability to support neovascularization and therefore resist infection. Surgeons have traditionally used nonabsorbable suture when using ADM in this setting, perhaps because of concerns regarding wound strength. This study was undertaken to examine the influence of suture material on wound breaking strength and complication rates in abdominal wall defects closed with ADM. METHODS: Full-thickness abdominal defects were created in athymic rats and immediately repaired with an ADM interposition graft using either interrupted Prolene or Maxon suture. Complications were recorded over time and the animals were sacrificed at 1 month intervals. The abdominal repair complex was harvested and wound strength was measured using a tensiometer. RESULTS: There were no hernias in any of the groups. There were also no cases of major adhesions to the AlloDerm. Two rats in the Prolene group developed a stitch extrusion through the ventral skin. Wound breaking strength increased significantly from the second to third month after surgery in both suture groups (p=0.0000, LSD test). The breaking strength of the abdominal fascia-ADM complex increased over the course of the experiment in both test groups, but no significant difference was found between the groups at any time point (p=0.3157). At 3 months, the breaking strength of the Prolene group and Maxon group was nearly identical (27.1 N +/- SD 7.4 and 29.7 N +/- SD 9.6, respectively). CONCLUSIONS: We were unable to identify a significant difference in breaking strength at the interface between ADM and normal, native fascia when using permanent versus resorbable sutures.
Authors: R W Luijendijk; W C Hop; M P van den Tol; D C de Lange; M M Braaksma; J N IJzermans; R U Boelhouwer; B C de Vries; M K Salu; J C Wereldsma; C M Bruijninckx; J Jeekel Journal: N Engl J Med Date: 2000-08-10 Impact factor: 91.245