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Bacterial clearance of biologic grafts used in hernia repair: an experimental study

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Abstract

Background

Biologic grafts used in ventral hernia repair are derived from various sources and undergo different post-tissue-harvesting processing, handling, and sterilization techniques. It is unclear how these various characteristics impact graft response in the setting of contamination. We evaluated four materials in an infected hernia repair animal model using fluorescence imaging and quantitative culture studies.

Methods

One hundred seven rats underwent creation of a chronic hernia. They were then repaired with one synthetic polyester control material (n = 12) and four different biologic grafts (n = 24 per material). Biologic grafts evaluated included Surgisis (porcine small intestinal submucosa), Permacol (crosslinked porcine dermis), Xenmatrix (noncrosslinked porcine dermis), and Strattice (noncrosslinked porcine dermis). Half of the repairs in each group were inoculated with Staphylococcus aureus at 104 CFU/ml and survived for 30 days without systemic antibiotics. Animals then underwent fluorescence imaging and quantitative bacterial studies.

Results

All clean repairs remained sterile. Rates of bacterial clearance were as follows: polyester synthetic 0%, Surgisis 58%, Permacol 67%, Xenmatrix 75%, and Strattice 92% (P = 0.003). Quantitative bacterial counts had a similar trend in bacterial clearance: polyester synthetic 1 × 106 CFU/g, Surgisis 4.3 × 105 CFU/g, Permacol 1.7 × 103 CFU/g, Xenmatrix 46 CFU/g, and Strattice 31 CFU/g (P = 0.001). Fluorescence imaging was unable to detect low bacterial fluorescence counts observed on bacterial studies.

Conclusion

Biologic grafts, in comparison to synthetic material, are able to clear a Staphylococcus aureus contamination; however, they are able to do so at different rates. Bacterial clearance correlated to the level of residual bacterial burden observed in our study. Post-tissue-harvesting processing, handling, and sterilization techniques may contribute to this observed difference in ability to clear bacteria.

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Acknowledgments

The authors acknowledge Joeseph Furlan, BA, and Ki Hoon Jung, MD, for their invaluable contribution to this work. This research was supported by a 2009 SAGES Educational Foundation grant awarded to Dr. Rosen and a Case Western Reserve University CTSA Grant awarded to Dr. Broome (UL1 RR024989).

Disclosures

Dr. Rosen has served as consultant and received honoraria from Covidien, LifeCell, and Gore. Drs. K. C. Harth, A.-M. Broome, M. R. Jacobs, J. A. Blatnik, F. Zeinali, and Mrs. S. Bajaksouzian have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5047, USA

    K. C. Harth, J. A. Blatnik, F. Zeinali & M. J. Rosen

  2. Departments of Biomedical Engineering and Radiology, Case Western Reserve School of Medicine, Cleveland, OH, 44106, USA

    A.-M. Broome

  3. Department of Pathology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, 44106, USA

    M. R. Jacobs & S. Bajaksouzian

Authors
  1. K. C. Harth
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  2. A.-M. Broome
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  3. M. R. Jacobs
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  4. J. A. Blatnik
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  5. F. Zeinali
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  6. S. Bajaksouzian
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  7. M. J. Rosen
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Corresponding author

Correspondence to M. J. Rosen.

Additional information

Presented at the 12th WCES, April 14--17, 2010, National Harbor, MD

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Harth, K.C., Broome, AM., Jacobs, M.R. et al. Bacterial clearance of biologic grafts used in hernia repair: an experimental study. Surg Endosc 25, 2224–2229 (2011). https://doi.org/10.1007/s00464-010-1534-8

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  • DOI: https://doi.org/10.1007/s00464-010-1534-8

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