Extracellular matrix biomaterials for soft tissue repair.

The biological and physical augmentation provided by extracellular matrix (ECM) derived implants continues to challenge and refine the conventional wisdom of biomaterials. It is now appreciated that different tissue-processing methodologies can produce ECM devices with characteristic post-implantation responses ranging from the classic foreign body encapsulation of a permanent implant, to one where the implant is degraded and resorbed, to one where the processed ECM implant is populated by local fibroblasts and supporting vasculature to generate a new, metabolically active tissue (gTissue). This article reviews the multiple ECM devices available clinically and highlights the impact of tissue source and processing on physicomechanical properties and host-implant interactions, with regard to surgical applications and clinical considerations.