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Porcine dermal collagen (Permacol) for abdominal wall reconstruction
David M Parker1, Peter J Armstrong, James D Frizzi
1Eisenhower Army Medical Center, Fort Gordon, Georgia, USA.
Objective:
A review of Eisenhower Army Medical Center's experience using Permacol (Tissue Science Laboratories, Covington, Georgia) for the repair of abdominal wall defects.
Methods:
Retrospective review of medical records of patients undergoing abdominal wall reconstruction with Permacol.
Results:
From July 30, 2003 to February 12, 2005, 9 patients underwent repair of complicated fascial defects with Permacol. Indications for surgery included reoperative incisional hernia repair after removal of a infected mesh (3 patients), reconstruction of a fascial defect after resection of an abdominal wall tumor (2 patients), incisional hernia repair in a patient with a previous abdominal wall infection after a primary incisional hernia repair (1 patient), incisional hernia repair in a patient with an ostomy and an open midline wound (1 patient), emergent repair of incisional hernia with strangulated bowel and multiple intra-abdominal abscesses (1 patient), and excision of infected mesh and drainage of intra-abdominal abscess with synchronous repair of the abdominal wall defect (1 patient). At a median follow-up of 18.2 months, 1 recurrent hernia existed after intentional removal of the Permacol. This patient developed an abdominal wall abscess 7 months after hernia repair secondary to erosion from a suture. Overall, 1 patient developed exposure of the Permacol after a skin dehiscence. The wound was treated with local wound care, and the Permacol was salvaged. Despite the presence of contamination (wound classification II, III, or IV) in 5 of 9 patients (56%), no infectious complications occurred.
Conclusion:
Complex reconstruction of the abdominal wall can be associated with a high complication rate. Placement of a permanent prosthetic mesh in a contaminated field is associated with a high rate of wound infections and subsequent mesh removal. Permacol becomes incorporated by tissue ingrowth and neovascularization. Permacol is a safe and acceptable alternative to prosthetic mesh in the repair of complicated abdominal wall defects.
Insights
Permacol offers a safe alternative for abdominal wall defect repair, even in contaminated cases. This study found Permacol to be effective in complex reconstructions with low infection rates.
Area of Science:
- Surgical Innovation
- Biomaterials Science
- Gastrointestinal Surgery
Background:
- Abdominal wall reconstruction presents challenges, especially in contaminated fields.
- Prosthetic mesh use in infected surgical sites can lead to high complication rates and mesh explantation.
- Novel biomaterials are needed for complex abdominal wall defect repair.
Purpose of the Study:
- To evaluate the efficacy and safety of Permacol for abdominal wall defect repair.
- To assess the outcomes of Permacol in complex and contaminated surgical cases.
- To determine if Permacol is a viable alternative to traditional prosthetic meshes.
Main Methods:
- Retrospective review of medical records at Eisenhower Army Medical Center.
- Analysis of 9 patients undergoing abdominal wall reconstruction with Permacol.
- Evaluation of outcomes including recurrence, infection, and complications at a median follow-up of 18.2 months.
Main Results:
- Permacol was used for various complex defects including reoperative hernias and tumor resections.
- One recurrent hernia occurred after Permacol removal; one case of Permacol exposure was managed with local wound care.
- No infectious complications were observed in 56% of patients with contaminated wounds (wound classification II, III, or IV).
Conclusions:
- Permacol demonstrates safety and efficacy in complex abdominal wall reconstructions.
- The biomaterial integrates via tissue ingrowth and neovascularization.
- Permacol is a suitable alternative to prosthetic mesh in challenging abdominal wall defect repairs, even in contaminated settings.
