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Journal of Long-Term Effects of Medical Implants
SJR: 0.133 SNIP: 0.491 CiteScore™: 0.89

ISSN 印刷: 1050-6934
ISSN オンライン: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.v15.i5.70
pages 547-558

Human Acellular Dermal Matrix for Repair of Abdominal Wall Defects: Review of Clinical Experience and Experimental Data

Luther H. Holton, III
University of Maryland and Johns Hopkins Schools of Medicine, Baltimore, Maryland, USA
Daniel Kim
University of Maryland and Johns Hopkins Schools of Medicine, Baltimore, Maryland, USA
Ronald P. Silverman
University of Maryland and Johns Hopkins Schools of Medicine, Baltimore, Maryland, USA
Eduardo D. Rodriguez
University of Maryland and Johns Hopkins Schools of Medicine, Baltimore, Maryland, USA
Navin Singh
University of Maryland and Johns Hopkins Schools of Medicine, Baltimore, Maryland, USA
Nelson H. Goldberg
University of Maryland and Johns Hopkins Schools of Medicine, Baltimore, Maryland, USA

要約

The use of prosthetic mesh for the tension-free repair of incisional hernias has been shown to be more effective than primary suture repair. Unfortunately, prosthetic materials can be a suboptimal choice in a variety of clinical scenarios. In general, prosthetic materials should not be implanted into sites with known contamination or infection because they lack an endogenous vascular network and are thus incapable of clearing bacteria. This is of particular relevance to the repair of recurrent hernias, which are often refractory to repair because of indolent bacterial colonization that weakens the site and retards appropriate healing. Although fascia lata grafts and muscle flaps can be employed for tension-free hernia repairs, they carry the potential for significant donor site morbidity. Recently, a growing number of clinicians have used human acellular dermal matrix as a graft material for the tension-free repair of ventral hernias. This material has been shown to become revascularized in both animal and human subjects. Once repopulated with a vascular network, this graft material is theoretically capable of clearing bacteria, a property not found in prosthetic graft materials. Unlike autologous materials such as fascial grafts and muscle flaps, acellular dermal matrix can be used without subjecting the patient to additional morbidity in the form of donor site complications. This article presents a thorough review of the current literature, describing the properties of human acellular dermal matrix and discussing both animal and human studies of its clinical performance. In addition to the review of previously published clinical experiences, we discuss our own preliminary results with the use of acellular dermal matrix for ventral hernia repair in 46 patients.


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