Bubaline Diaphragm Matrix: Development and Clinical Assessment into Cattle Abdominal Hernia Repair

Abstract The purpose of the study was to develop a xenogenic bubaline diaphragm matrix (BDM) for abdominal hernia repair. A fresh diaphragm was decellularized using aqueous sodium dodecyl sulfate (SDS) solutions (0.5-4% w/v) over a period. Acellularity was confirmed histologically and characterized by Masson's trichrome staining, scanning electron microscopy (SEM), DNA quantification, agarose gel electrophoresis, and Fourier-transform infrared spectroscopy. The BDM was used for clinical abdominal hernia repair in six cattle. Clinical, hemato-biochemical and antioxidant parameters were evaluated to assess biocompatibility of xenogenic BDM. Histologically, the diaphragm treated with 2% SDS for 48 h showed complete acellularity and orderly arranged collagen fibers. The SEM confirmed preservation of collagen structure and integrity. The DNA content was significantly (P < 0.05) reduced in BDM (33.12 ± 5.40 ng/mg) as compared to the native diaphragm (443.96 ± 162.60 ng/mg). DNA extracts from BDM show considerable removal of DNA material, with absence of DNA band in agarose gel. The FTIR spectrum of BDM has shown all characteristic transmittance peaks of bovine skin collagen indicating preserved collagen structure. Six cattle with BDM implant recovered uneventfully and remained sound at least upto 6 months. Hemato-biochemical and antioxidant findings were unremarkable. Bubaline diaphragm matrix shows excellent repair efficiency and biocompatibility for abdominal hernia repair in cattle without complications.

Reparação da parede abdominal com tela dupla de polipropileno e poliglecaprone pós-retalho TRAM em reconstrução mamária / Abdominal wall repair with double-mesh polypropylene/ polyglecaprone after TRAM flap surgery for breast reconstruction

INTRODUÇÃO: A reparação da parede abdominal após reconstrução mamária com retalho TRAM representa um desafio para o cirurgião, ainda sem consenso na literatura em relação à melhor técnica. O objetivo deste estudo foi avaliar a eficiência da tela Ultrapro® em dois planos anatômicos distintos para reparação da parede abdominal pós-retalho TRAM. MÉTODO: Um estudo retrospectivo foi realizado por meio da revisão de prontuários de 24 pacientes submetidas à reconstrução de mama com retalho TRAM pediculado e reparo da área doadora abdominal com tela dupla de polipropileno e poliglecaprone - Ultrapro® pela Divisão de Cirurgia Plástica do HCFMRP-USP. Foram avaliados fatores de risco para hérnias ou abaulamentos abdominais, momento da reconstrução de mama; complicações pós-operatórias, incluindo hérnias ou abaulamentos abdominais, e tempo de seguimento pós-operatório. RESULTADOS: Do total de 24 pacientes com idade média de 51 anos, 10 (41,6%) apresentavam alguma comorbidade. Em 95,8% das pacientes a reconstrução mamária foi tardia e o retalho TRAM foi unipediculado em 58,4% dos casos. As complicações pós-operatórias mais frequentes foram deiscência de sutura (25%) e seroma (21%). Duas pacientes (8,4%) tiveram diagnóstico de hérnia abdominal e três pacientes (12,5%) apresentaram abaulamento abdominal. O tempo de seguimento pós-operatório variou de 5 a 48 meses (média 23,4 meses, DP: 13,28). CONCLUSÃO: O uso da tela híbrida Ultrapro® em dois planos anatômicos demonstrou ser mais uma alternativa para o reparo da parede abdominal pós retalho TRAM em reconstrução mamária, com baixa morbidade da área doadora abdominal e índices de complicações semelhantes aos dados da literatura.

INTRODUCTION: The repair of the abdominal wall after breast reconstruction with a transverse rectus myocutaneous (TRAM) flap is a challenge for the surgeon, and there is still no consensus in the literature about which is the best technique. The objective of this study is to evaluate the efficiency of the Ultrapro® mesh in two different anatomical planes for the repair of the abdominal wall after TRAM flap surgery. METHOD: This is a retrospective study conducted through a medical records review of 24 patients who underwent breast reconstruction with a pedicle TRAM flap, and repair of abdominal donor site with a dual mesh of polypropylene and polyglecaprone - Ultrapro, at the Plastic Surgery Division of the Clinics Hospital of the Medicine Faculty of Ribeirão Preto - University of São Paulo. We evaluated the risk factors for abdominal hernias or bulges, time of breast reconstruction, postoperative complications (including abdominal hernias or bulges), and postoperative follow-up. RESULTS: Of the 24 patients with a mean age of 51 years, 10 (41.6%) had a comorbidity. In 95.8% of the patients, breast reconstruction was late; the TRAM flap was a single pedicle in 58.4% of cases. The most frequent postoperative complications were suture dehiscence (25%) and seroma (21%). Two patients (8.4%) were found to have abdominal hernia, and three patients (12.5%) had abdominal bulging. The postoperative follow-up ranged from 5 to 48 months (average, 23.4 months, SD = 13.28). CONCLUSION: The use of the Ultrapro hybrid mesh at two anatomical planes proved to be an alternative for the repair of the abdominal wall after TRAM flap surgery for breast reconstruction, with low morbidity of the abdominal donor site and complication rates similar to literature data.