The efficacy of porcine dermal collagen to treat complex anal fistulae: results of a multicenter cohort

Introduction: The management of complex anal fistulae remains a topical surgical problem. The choice and success of surgical management are based on the balance between healing and continence. Although porcine dermal collagen (Permacol Collagen Paste [PCP]- Covidien plc, Gosport, Hampshire, UK) represents a new generation of non-solid biomaterials, its results in anal fistulae are mixed. Methods: A multicenter observational retrospective analysis of consecutive patients with cryptoglandular anal fistula treated in four colorectal surgery units was performed between 2015 and 2020. Clinical cure of the fistula was the main outcome measure. Adverse events and alterations in anal continence were secondary outcomes. Results: The study included 119 patients (87 males, 71.1%), with a mean age of 53 years (IR 44-65). Most patients had complex (80.6%) and recurrent (91.6%) fistulae. With the first PCP treatment, the overall cure rate was 41.2% (49 patients) and 45.4% with the second treatment (5 out of 17 patients). The mean follow-up period was 17 months (IR 5-25). Healing was not affected by the location and type of fistula, the existence or not of a cavity, the number of tracts, or the administration of prophylactic antibiotics. After the PCP treatment, no patient in the series had worsening of continence. Morbidity affected 22.7% of the patients (27), with postoperative abscesses being the most frequent adverse event. There were no statistical differences between the four hospitals studied. Conclusions: Permacol collagen paste is a safe and easily reproducible therapy for complicated anal fistulae that has moderate efficacy. The overall success rate is slightly over 40%, with no detriment to fecal continence. (AU)

Histopathological Evaluation of Collagen Sheet (Permacol®) after Augmentation Rhinoplasty / 대한이비인후과학회지

In Asian rhinoplasty, allograft materials are often required due to insufficient amount of autologous sources for dorsal augmentation. Nowadays, Silicon and polytetrafluoroethylene are commonly used allograft materials although these can often lead to postoperative complications such as protrusion, migration or infection of implanted graft. Permacol® is a collagen sheet which is indicated for soft tissue reinforcement or repair of the head and face area in plastic and reconstructive surgery. Its clinical safety and stability is well established with low complication rates. However, its histopathology has rarely investigated, especially in human. Thus, we reviewed histopathology of two graft-removal cases of patients who had undergone rhinoplasty using Permacol®. In conclusion, Permacol® can lead to fibrosis of imbedded tissues with or without absorption in long-term follow-up. Although Permacol® is gradually absorbed as time passes, the implanted graft can maintain its volume by replaced fibrotic connective tissues.

Safety and Efficacy of Permacol Injection in the Treatment of Fecal Incontinence

PURPOSE: Permacol has been gaining popularity in recent times for the treatment of fecal incontinence (FI). This study aims to evaluate the safety and efficacy of anal submucosal Permacol injection in the treatment of FI. METHODS: All consecutive patients who underwent Permacol injection for FI over a 3-year period were included. Patients' data relating to obstetric history, anorectal/pelvic operations, type of FI, preoperative anorectal physiology results and follow-up details for outcome measures were collected. Preoperative and postoperative Cleveland Clinic Florida Incontinence Scores (CCFISs) were noted. Patients were surveyed by using a telephone questionnaire to assess the quality of life and other outcome measures. Data were analysed using SPSS ver.19.0. RESULTS: Thirty patients (28 females and 2 males) with a median age of 67 years were included in the study. Of those patients, 37%, 50%, and 13% were noted to have passive, mixed and urge FI, respectively. Six of the patients (20%) had repeat Permacol injections, 5 of whom had sustained responses to the first Permacol injection for a mean of 11 months. There was a significant improvement in the CCFIS from a baseline median of 12.5, mean 12.8 interquartile range [IQR], 6-20), to a median of 3.5, mean 4.8 (IQR, 0-20), P < 0.001. Of the patients surveyed by telephone 89% were satisfied with their overall experience and the improvement in their symptoms following Permacol injections. CONCLUSION: This study has demonstrated that Permacol injection for the treatment of FI is safe and effective and has no associated major complications. However, the results are not permanent; consequently, a significant proportion of the patients with an initial response may require repeat injections.

Result of using a biologic collagen implant (Permacol) for mesenteric defect repair after excision of a huge mesenteric lymphangioma in a child

Mesenteric lymphangiomas, which involve near total mesentery, are extremely rare. A mesenteric lymphangioma should be treated through excision because they can cause invasion of vital structures, bleeding, or infection. After excision of a huge mesenteric lymphangioma, internal herniation may occur through a large mesenteric defect leading to intestinal volvulus, obstruction, and other life-threatening circumstances. We report a case in which a biologic collagen implant (Permacol) was used for mesenteric defect repair after excision of a huge mesenteric lymphangioma. The implant did not cause any symptoms or complications during follow-up for 4 years. When encountering large defects of mesentery, closure with implant can be a feasible choice, and Permacol could be a possible implant for closing the defect.

A Case of Traumatic Ventral Hernia Repair with a Porcine Dermal Collagen Graft (Permacol)

Resection of the bowel is necessary for the repair of a ventral hernia after recovery from trauma in some cases. In such instances, polyester or polypropylene meshcannot be used due to the possibility of infection; we had to use biological mesh instead. We report a case in which a traumatic hernia was repaired with Permacol (Covidien, Norwalk, CT, USA). A 42-year-old male patient had been injured by a factory machine seven months prior to admission. At that time, he had abdominal wall injury and small bowel perforation. His abdominal wall had been a defect after operation. A CT scan of the abdomen showed that the left abdominal wall, which is lateral to left rectus abdominis muscle had only one muscle layer, an external oblique muscle, and that a previous abdominal incision had a defect along the entire incision. During the exploration, 10 cm of small bowel was removed due to firm adhesion to the previous surgical scar. Permacol mesh was applied and fixed with transfascial fixations and tacks by using the intraperitoneal onlay mesh technique. There were no complications after the surgery and the patient was discharged without any problems.

Implant Breast Reconstruction Using Porcine Dermal Matrix(Permacol(R)): A Comparative Study with Acellular Cadaveric Dermis(AlloDerm(R))

PURPOSE: The use of tissue expander/implant in breast reconstruction using tissue expander-implant is one of the most common surgical procedures. The use of AlloDerm as a sling to reestablish the lower pole of the pectoralis major muscle results a decrease in morbidity compared with more invasive procedures. However the use of AlloDerm is more expensive than other options. We decided to compare AlloDerm with Permacol, which has been safely used in human body reconstruction and is less costly than AlloDerm. METHODS: After mastectomy, the inferolateral origin of the pectoralis major muscle was elevated. Either AlloDerm or Permacol was sutured to the chest wall at the level of the previously marked inframammary fold. The lower border of the pectoralis major muscle and the upper portion of the crescent-shaped piece of either AlloDerm or Permacol was sutured together using a tension free technique, and a tissue expander was subsequently inserted into the subpectoral-subAlloDerm (or Permacol) dual pocket. RESULTS: AlloDerm was used in twenty-one patients(28 breasts) and Permacol was used in six patients(11 breasts) for tissue expander-implant breast reconstruction. During the mean follow-up period of 17 months(8~25 months). Two infections(7%) occurred in AlloDerm cases and four infections(36%) occurred in Permacol cases. CONCLUSION: This study is the first comparison of tissue expander/implant breast reconstruction using AlloDerm and Permacol. The use of Permacol resulted in more postoperative infection compared with the use of AlloDerm. This report is still limited with the small number of cases studied.

Experience with Porcine Acellular Dermal Collagen (Permacol(R)) Implant in Contaminated Fascia Defects

Reconstruction of the fascia defect, especially complicated one is challenging problem. We report our experiences of porcine acellular dermal collagen (Permacol(R)) in contaminated fascia defects. Three patients with contaminated fascia defect were reconstructed using Permacol(R). Permacol(R) was fixed to fascia with 2-0 polypropylene sutures and at least 2 cm of the implant was allowed to overlap the defect. Types of fascia defect consisted of large parastomal hernia in rectal cancer patients, multiple enterocutaneous fistulas in Crohn's disease and evisceration due to surgical site infection. Postoperative complication was 1 case of graft infection in a Crohn's disease patient, but infection was controlled using antibiotics.

Comparison of Survival of SureDerm(R), Permacol(R) Graft in Mouse

PURPOSE: Numerous materials, both autologous and nonautologous, have been used for augmentation of sunken areas and each has its own limitations. The ideal material for augmentation should not be absorbed in any manner. This study is designed to assess the survival of SureDerm(R), Permacol(R) graft according to the volume and histologic change. METHODS: Twenty four mice, weighing about 50 grams and of 5 weeks of age were used. SureDerm(R) is an acellular dermal matix obtained from human cadaveric skin. Permacol(R) is a porcine derived acellular dermal matrix whose manufacture involves trypsinisation, solvent extraction. Graft pieces standardized to 1x1cm size were used in each group. The implanted material were taken 1, 4, 8 and 12 weeks later, respectively. The changes of graft volume during the graft period were measured on initial, 1, 4, 8 and 12 weeks. RESULTS: The initial shape of graft was maintained up to 12 weeks in Permacol(R) graft group and mean survival rate was 80.36+/-8.21% in SureDerm(R), 89.57+/-6.39% in Permacol(R)(p=0.01). The volume of each graft decreased 29% from initial volume on 12 weeks in SureDerm(R), 18% in Permacol(R). The structure of Permacol(R) remained until 12 week after implantation. CONCLUSION: Our experimental study suggests that Permacol(R) could be a safe material as an implant for permanent augmentation. However, There are further study remained for antigenicity of these material, and the choice of graft for augmentation should be remained to the clinical situations.