Comparative Evaluation of Biomechanical Characteristics of Acellular Dermal Matrix for Hernioplasty

Background. With the introduction of synthetic mesh implants into clinical practice, the recurrence rate of postoperative ventral hernias was signifi cantly reduced. The extensive use of synthetic implants led to the development of specifi c complications. The development of biological implants, based on extensively purifi ed decellularized collagen matrix of xenogeneic origin is highly relevant due to the fact that, unlike synthetic analogues, they have a biological origin and biodegrade in a natural way, gradually being replaced with newly formed connective tissue. The use of bioprostheses reduces the risk of complications.

Objectives. To conduct a comparative evaluation of the biomechanical characteristics of acellular dermal matrix, obtained by detergent-enzymatic decellularization, and commercially distributed Permacol™ matrix.

Methods. Acellular dermal matrix (ADM) was created by using samples of native skin of pig of Landras breed aged 4 months. The dermis was processed by means of detergent-enzymatic method. In order to evaluate and compare the mechanical properties of acellular dermal matrix, the biological samples were divided into 2 groups of 15 samples each. The fi rst group included acellular dermal matrix samples, the second group — native samples of pigs unprocessed dermis. The control group consisted of samples of PermacolTM Surgical Implant, xenotransplant for hernioplasty approved for use in the Russian Federation (Covidien, France). All samples were tested wet using universal testing instrument Instron 1122. MedCalc Statistical Software (Belgium) was used for statistical processing of the study results.

Results. In the present study, pig dermis was processed using a detergent-enzymatic method to produce ADM. Routine histological examination confi rmed the removal of all cellular elements, and at the same time it was proven that the native structure of the dermis remained intact during its processing. The mechanical characteristics of xenogenic ADM were further determined. Its tensile strength was 9.1 ± 0.6 MPa (910 N/cm2 ), elongation to break was 21.1 ± 2.3%, and elastic modulus was 50.0 ± 1.6 MPa. These characteristics largely corresponded to the strength characteristics of native pig dermis and far exceeded the necessary physiological parameters. PermacolTM control was tested in two directions (longitudinal and transverse). In the longitudinal direction, the sample had higher mechanical characteristics: strength — 12.0 ± 1.7 MPa, elongation to break — 29.7 ± 2.4%, stiffness modulus — 47.2 ± 6.5 MPa. In the transverse direction, all indicators were 1.5–2 times lower.

Conclusion. The developed xenogeneic biological implant in the form of ADM demonstrates rather good characteristics of plasticity, tensile strength and elasticity, to be used as a biological endoprosthesis for plasty of hernia defects of the abdominal wall of any size and shape.

1. Feoktistov Ya.E., Nikol’skiy V.I., Titova E.V., Feoktistova E.G., Ogorodnik E.V. Comparative evaluation of the clinical and economic efficiency of intra-abdominal hernioplasty with a combined endoprosthesis (from biological and synthetic materials) and a polypropylene mesh with anti-adhesive coating. University Proceedings. Volga Region. Medical Sciences. 2019; 3(51): 54–65 (In Russ., English abstract). DOI: 10.21685/2072-3032-2019-3-5

2. Demin N.A., Achkasov E.E., Abdurashidova M.R., Kalachev O.A., Ivanov G.V. Surgeon’s view on feature of rehabilitation in patients with large incisional ventral hernia after open retro-rectus hernioplasty. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10(2): 88–95 (In Russ., English abstract). DOI: 10.33029/2308-1198-2022-10-2-88-95

3. Kulchenko N.G. Inguinal hernia repair and male health. Research and Practical Medicine Journal (Issled. prakt. med.). 2019; 6(3): 65–73 (In Russ., English abstract). DOI: 10.17709/2409-2231-2019-6-3-6

4. Kazakova V.V., Yartsev P.A., Blagovestnov D.A., Kirsanov I.I. Abdominal wall prosthetic plastic in treatment of patients with medium abdominal hernia (literature review). Journal of New Medical Technologies. 2021; 15(5): 22–31 (In Russ., English abstract). DOI: 10.24412/2075-4094-2021-5-1-3

5. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018; 22(1): 1–165. DOI: 10.1007/s10029-017-1668-x

6. Faylona J.M. Evolution of ventral hernia repair. Asian. J. Endosc. Surg. 2017; 10(3): 252–258. DOI: 10.1111/ases.12392

7. Attaar M., Forester B., Chirayil S., Su B., Wong H.J., Kuchta K., Linn J., Denham W., Haggerty S., Ujiki M.B. Mesh in Elective Hernia Repair: 10-Year Experience with over 6,000 Patients. J. Am. Coll. Surg. 2021; 233(1): 51–62. DOI: 10.1016/j.jamcollsurg.2021.03.006

8. Gossetti F., Zuegel N., Giordano P., Pullan R., Schuld J., Delrio P., Montorsi M., van Kerschaver O., Lemaitre J., Griffiths B., D’Amore L. A Biologic Surgical Implant in Complex Abdominal Wall Repair: 3-Year Follow-Up Results of a Multicentric Prospective Study. Med. Devices. (Auckl). 2021; 14: 257–264. DOI: 10.2147/MDER.S297897

9. Melnik I., Mnouskin Y., Verdiger Kurzbart E., Yoffe B. Evaluation of a porcine dermal collagen (permacol) implant for abdominal wall reconstruction in a pediatric multitrauma patient. Case. Rep. Emerg. Med. 2014; 2014: 585723. DOI: 10.1155/2014/585723

10. Murray J.A.B. Técnica quirúrgica para reparar la diástasis de rectos asociada a hernia umbilical. diez años de experiencia. Sociedad Hispanoamericana de Hernia. 2017; 5(2): 52–56. DOI: 10.20960/rhh.34

11. Klosterhalfen B., Junge K., Klinge U. The lightweight and large porous mesh concept for hernia repair. Expert. Rev. Med. Devices. 2005; 2(1): 103–117. DOI: 10.1586/17434440.2.1.103

12. Erkent M., Şahiner İ.T., Kendirci M., Topçu R. İnsizyonel Herni Gelişiminde Risk Faktörlerinin Saptanması. Hitit. Med. J. 2019; 1(1): 15–17.

13. Badyrov R.M., Abatov N.T., Tussupbekova M.M., Alberton J.N., Mussabekov I.K. Results after application of the extracellular bovine-derived peritoneum matrix for abdominal wall reconstruction in the longterm experiment. Science & Healthcare. 2018; 1: 24–35 (In Russ., English abstract). DOI: 10.34689/SH.2018.20.1.002

14. Madani A., Niculiseanu P., Marini W., Kaneva P.A., Mappin-Kasirer B., Vassiliou M.C., Khwaja K., Fata P., Fried G.M., Feldman L.S. Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes. Surg. Endosc. 2017; 31(2): 861–871. DOI: 10.1007/s00464-016-5044-1

15. Costa A., Adamo S., Gossetti F., D’Amore L., Ceci F., Negro P., Bruzzone P. Biological Scaffolds for Abdominal Wall Repair: Future in Clinical Application? Materials (Basel). 2019; 12(15): 2375. DOI: 10.3390/ma12152375

16. Gossetti F., Grimaldi M.R., Ceci F., D’Amore L., Negro P. Comment on: Comparative analysis of biologic versus synthetic mesh outcomes in contaminated hernia repairs. Surgery. 2017; 161(5): 1467–1468. DOI: 10.1016/j.surg.2016.10.014

17. Baylón K., Rodríguez-Camarillo P., Elías-Zúñiga A., Díaz-Elizondo J.A., Gilkerson R., Lozano K. Past, Present and Future of Surgical Meshes: A Review. Membranes (Basel). 2017; 7(3): 47. DOI: 10.3390/membranes7030047

18. Zhukovsky V.A. Polymer implants for reconstructive surgery. Scientific electronic journal «INNOVA». 2016; 2(3): 51–59 (In Russ., English abstract). DOI: 10.21626/innova/2016.2/05

19. Romanowska M., Okniński T., Pawlak J. Modern Materials Applied in Hernioplasty. Pol. Przegl. Chir. 2016; 88(4): 226–231. DOI: 10.1515/pjs-2016-0057

20. Klosterhalfen B., Junge K., Klinge U. The lightweight and large porous mesh concept for hernia repair. Expert. Rev. Med. Devices. 2005; 2(1): 103–117. DOI: 10.1586/17434440.2.1.103

21. Nisiewicz M., Hughes T., Plymale M.A., Davenport D.L., Roth J.S. Abdominal wall reconstruction with large polypropylene mesh: is bigger better? Hernia. 2019; 23(5): 1003–1008. DOI: 10.1007/s10029-019-02026-3

22. Warren J.A., McGrath S.P., Hale A.L., Ewing J.A., Carbonell A.M. 2nd, Cobb W.S. 4th. Patterns of Recurrence and Mechanisms of Failure after Open Ventral Hernia Repair with Mesh. Am. Surg. 2017; 83(11): 1275–1282