Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. Julie.O'
Hernia. 2011 Apr;15(2):211-5. doi: 10.1007/s10029-010-0628-5. Epub 2010 Jan 21.
We hypothesize that Permacol™ may allow controlled integration over time while providing long-term mechanical stability and native tissue remodeling. The purpose of this report is to investigate these properties in an explanted piece of Permacol™ after 2 years in vivo.
A 62-year-old female presented with a complex abdominal wall history having undergone a transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction 10 years ago, followed by an abdominal wall repair with Marlex™ mesh for weakness 3 years later. Two years ago, she developed an abdominal bulge repaired with a Permacol™ overlay. Twenty-three months postoperatively, she presented with abdominal distension. Computed tomography (CT) scanning demonstrated a fluid collection behind the Permacol™. She underwent incision and drainage of the hematoma/bursa and quilting repair of the abdominal wall. A 1 × 6-cm Permacol™ section was resected as part of closure. Histology, immunohistochemistry, and mechanical testing of the Permacol™ explant were performed.
Histology showed fibroblast and blood vessel ingrowth with no cellular infiltrates reflective of inflammation. Immunohistochemistry for human-specific collagen types I and III and elastin detected staining throughout. Sections stained with non-specific control antibody exhibited no discernable staining. Elastin highlighted blood vessels. Native Permacol™ had a breaking strength of ~20 N, while for explanted Permacol™, it was ~33 N.
Permacol™ maintained durability while allowing vascular ingrowth without residual inflammation. Explant demonstrated integration with human collagen and elastin remodeling throughout. Increase in mechanical strength may reflect newly synthesized collagen and elastin. These histologic findings and clinical result support the use of Permacol™ in complex abdominal wall reconstruction.
我们假设 Permacol™ 可随时间实现受控整合，同时提供长期机械稳定性和组织重塑。本报告的目的是研究在体内 2 年后取出的 Permacol™ 样本中的这些特性。
一位 62 岁女性，10 年前接受过横行腹直肌肌皮瓣（TRAM）乳房重建术，3 年前因腹壁薄弱接受过 Marlex™ 网片修补术，后来出现复杂的腹壁病史。2 年前，她接受了 Permacol™ 覆盖物的腹壁膨出修复。术后 23 个月，她出现了腹部膨胀。计算机断层扫描（CT）显示 Permacol™ 后面有积液。她接受了血肿/滑囊炎切开引流和腹壁 quilting 修复。作为关闭的一部分，切除了 1×6cm 的 Permacol™ 部分。对 Permacol™ 样本进行了组织学、免疫组织化学和机械测试。
组织学显示成纤维细胞和血管长入，无炎症细胞浸润。人特异性胶原蛋白 I 和 III 以及弹性蛋白的免疫组织化学检测显示整个组织染色。用非特异性对照抗体染色的切片没有可识别的染色。弹性蛋白突出显示血管。原生 Permacol™ 的断裂强度约为 20N，而植入的 Permacol™ 的断裂强度约为 33N。
Permacol™ 在允许血管长入而无残留炎症的情况下保持耐用性。植入物显示与人类胶原蛋白和弹性蛋白的整合重塑。机械强度的增加可能反映了新合成的胶原蛋白和弹性蛋白。这些组织学发现和临床结果支持在复杂的腹壁重建中使用 Permacol™。
