Biomedical Engineering Reference
In-Depth Information
10.5.1
Abdominal wall reconstruction
The use of traditional synthetic mesh materials for reconstruction of the abdominal
wall are plagued by the occurrence of visceral adhesions, susceptibility to infec-
tion, palpable rigidity and discomfort associated with limited mobility (Butler,
2006). Similar to the results seen during skin graft application, AlloDerm embod-
ies an RTM scaffold supportive of biological revitalization while simultaneously
providing the mechanical strength necessary for successful closure of an abdomi-
nal wall defect. AlloDerm's strength under these conditions has been shown to be
comparable to synthetic meshes (Choe
et al
., 2001). Preclinical hernia repair
models demonstrate AlloDerm RTM provides greater strength than surrounding
fascia (Silverman
et al
., 2004), while its integration into the fascia creates a strong
repair (Silverman
et al.
, 2004). In addition, AlloDerm RTM was found to support
rapid revascularization (Menon
et al
., 2003) and to reduce the formation of bowel
adhesions (Butler and Prieto, 2004). Successful clinical use resulting in a low
occurrence of complications (Buinewicz & Rosen, 2004) has been demonstrated
in incisional hernia repair (Buinewicz and Rosen, 2004; Butler
et al.
, 2005),
abdominal and chest wall reconstruction (Butler
et al.
, 2005; Hirsch, 2004) and
transverse rectus abdominis myocutaneous (TRAM) flap reinforcement (Buinewicz
and Rosen, 2004). Moreover, because the RTM does not elicit an inflammatory
response, it does not impede the body in targeting the sources of potential infection
notable in abdominal interventions. Owing to these properties, AlloDerm RTM
has been used safely and successfully in abdominal wall reconstruction wherein
the surgical field was known to be contaminated (Patton,
et al.
, 2007).
10.5.2 Breast reconstruction
Tissue expansion of the pectoralis muscle together with mastectomy skin flaps is
currently one of the most common procedures employed for the reconstruction of
the breast. Since many patients lack the necessary tissue to accomplish complete
lateral coverage of the implant, a repositioning of the serratus anterior muscle is
required. Use of the acellular RTM as a sub-pectoral sling provides an alternative
to techniques involving serratus muscle by creating a complete pocket for recon-
struction (Breuing and Warren, 2005). Besides the obvious advantage of a reduction
in donor site morbidity, this technique also reduces, or sometimes eliminates, the
need for tissue expansion and allows immediate reconstruction after mastectomy
(Breuing and Warren, 2005; Salzberg, 2006). Although relatively new, applica-
tions of AlloDerm RTM for use in breast reconstruction via this procedure are
growing (Baxter, 2003; Bindingnavele
et al
., 2007; Breuing and Colwell, 2007;
Breuing and Warren, 2005; Gamboa-Bobadilla, 2006; Glasberg and D'Amico,
2006; Margulies
et al
., 2005; Salzberg, 2006; Zienowicz and Karacaoglu, 2007).
Results have further demonstrated that the RTM provides a viable graft with
recellularization and revascularization noticeable up to 6 months (limit of study)
