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Clinical application of a silk fibroin protein biologic scaffold for abdominal wall fascial reinforcement.

Clemens MW, Downey S, Agullo F, Lehfeldt MR, Kind GM, Palladino H, Marshall D, Jewell ML, Mathur AB, Bengtson BP - Plast Reconstr Surg Glob Open (2014)

Bottom Line: Indications, comorbid conditions, surgical technique, complications, and outcomes were evaluated.Procedures using an SBS included reinforcement of an abdominal-based flap donor site (31.2%), ventral hernia repair (53.2%), and abdominoplasty (15.6%).Procedure-specific outcome studies are warranted to delineate optimal patient selection and define potential device characteristic advantages.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.

ABSTRACT

Background: Preclinical studies have demonstrated that macroporous silk fibroin protein scaffolds are capable of promoting physiologically durable supportive tissue, which favors application of these engineered tissues for clinical implantation. The safety and effectiveness of a long-lasting, transitory, 510(k)-cleared purified silk fibroin biologic scaffold (SBS) are investigated for soft-tissue support and repair of the abdominal wall.

Methods: We conducted a multicenter retrospective review of all consecutive patients who underwent abdominal wall soft-tissue reinforcement with an SBS device between 2011 and 2013. Indications, comorbid conditions, surgical technique, complications, and outcomes were evaluated.

Results: We reviewed the records of 172 consecutive patients who received an SBS for soft-tissue support. Of those, 77 patients underwent abdominal wall fascial repair, with a mean follow-up of 18.4 ± 7.5 months. Procedures using an SBS included reinforcement of an abdominal-based flap donor site (31.2%), ventral hernia repair (53.2%), and abdominoplasty (15.6%). The overall complication rate was 6.5%, consisting of 2 wound dehiscences, 1 with device exposure, 1 seroma, 1 infection with explantation, and a perioperative bulge requiring reoperation. There were no reports of hernia.

Conclusions: Postoperative complication rates after 18 months were low, and most surgical complications were managed nonoperatively on an outpatient basis without mesh removal. To our knowledge, this is the only series to report on a long-lasting, transitory SBS for abdominal wall repair and reinforcement. Procedure-specific outcome studies are warranted to delineate optimal patient selection and define potential device characteristic advantages.

No MeSH data available.


Related in: MedlinePlus

Abdominoplasty with mesh onlay reinforcement: Patient was a 33-year-old multiparous woman (A and B) status post 60-pound weight loss who presented with significant musculofascial laxity after 60-pound weight loss. C, Following a standard abdominoplasty approach, a vertically oriented silk fibroin scaffold as an onlay reinforcement of the midline fascial plication (D). Postoperatively at 6 months (E and F).
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Figure 3: Abdominoplasty with mesh onlay reinforcement: Patient was a 33-year-old multiparous woman (A and B) status post 60-pound weight loss who presented with significant musculofascial laxity after 60-pound weight loss. C, Following a standard abdominoplasty approach, a vertically oriented silk fibroin scaffold as an onlay reinforcement of the midline fascial plication (D). Postoperatively at 6 months (E and F).

Mentions: Abdominoplasty with fascial plication and SBS mesh onlay reinforcement was performed in 12 women (Fig. 3). The patients’ mean age was 43 years (range, 25–54), and their mean body mass index was 27.1 ± 3.2 kg/m2. The mean area of mesh used was 234 cm2 (range, 180–250 cm2). All patients received one drain that was placed subcutaneously and removed at a mean of 5.2 days (SD ± 1.8 days).


Clinical application of a silk fibroin protein biologic scaffold for abdominal wall fascial reinforcement.

Clemens MW, Downey S, Agullo F, Lehfeldt MR, Kind GM, Palladino H, Marshall D, Jewell ML, Mathur AB, Bengtson BP - Plast Reconstr Surg Glob Open (2014)

Abdominoplasty with mesh onlay reinforcement: Patient was a 33-year-old multiparous woman (A and B) status post 60-pound weight loss who presented with significant musculofascial laxity after 60-pound weight loss. C, Following a standard abdominoplasty approach, a vertically oriented silk fibroin scaffold as an onlay reinforcement of the midline fascial plication (D). Postoperatively at 6 months (E and F).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4255889&req=5

Figure 3: Abdominoplasty with mesh onlay reinforcement: Patient was a 33-year-old multiparous woman (A and B) status post 60-pound weight loss who presented with significant musculofascial laxity after 60-pound weight loss. C, Following a standard abdominoplasty approach, a vertically oriented silk fibroin scaffold as an onlay reinforcement of the midline fascial plication (D). Postoperatively at 6 months (E and F).
Mentions: Abdominoplasty with fascial plication and SBS mesh onlay reinforcement was performed in 12 women (Fig. 3). The patients’ mean age was 43 years (range, 25–54), and their mean body mass index was 27.1 ± 3.2 kg/m2. The mean area of mesh used was 234 cm2 (range, 180–250 cm2). All patients received one drain that was placed subcutaneously and removed at a mean of 5.2 days (SD ± 1.8 days).

Bottom Line: Indications, comorbid conditions, surgical technique, complications, and outcomes were evaluated.Procedures using an SBS included reinforcement of an abdominal-based flap donor site (31.2%), ventral hernia repair (53.2%), and abdominoplasty (15.6%).Procedure-specific outcome studies are warranted to delineate optimal patient selection and define potential device characteristic advantages.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.

ABSTRACT

Background: Preclinical studies have demonstrated that macroporous silk fibroin protein scaffolds are capable of promoting physiologically durable supportive tissue, which favors application of these engineered tissues for clinical implantation. The safety and effectiveness of a long-lasting, transitory, 510(k)-cleared purified silk fibroin biologic scaffold (SBS) are investigated for soft-tissue support and repair of the abdominal wall.

Methods: We conducted a multicenter retrospective review of all consecutive patients who underwent abdominal wall soft-tissue reinforcement with an SBS device between 2011 and 2013. Indications, comorbid conditions, surgical technique, complications, and outcomes were evaluated.

Results: We reviewed the records of 172 consecutive patients who received an SBS for soft-tissue support. Of those, 77 patients underwent abdominal wall fascial repair, with a mean follow-up of 18.4 ± 7.5 months. Procedures using an SBS included reinforcement of an abdominal-based flap donor site (31.2%), ventral hernia repair (53.2%), and abdominoplasty (15.6%). The overall complication rate was 6.5%, consisting of 2 wound dehiscences, 1 with device exposure, 1 seroma, 1 infection with explantation, and a perioperative bulge requiring reoperation. There were no reports of hernia.

Conclusions: Postoperative complication rates after 18 months were low, and most surgical complications were managed nonoperatively on an outpatient basis without mesh removal. To our knowledge, this is the only series to report on a long-lasting, transitory SBS for abdominal wall repair and reinforcement. Procedure-specific outcome studies are warranted to delineate optimal patient selection and define potential device characteristic advantages.

No MeSH data available.


Related in: MedlinePlus