pp 1-16 | Cite as

Porcine Acellular Lung Matrix in Wound Healing and Hernia Repair

  • Vishwanath Chegireddy
  • Koby D. Caplan
  • Joseph S. Fernandez-Moure
Part of the Recent Clinical Techniques, Results, and Research in Wounds book series


The introduction of synthetic polypropylene mesh in hernia repair has improved the results of herniorrhaphy. To introduce mesh is to introduce foreign bodies that can impact the human body and may lead to inflammation, infection, fibrosis, calcification, seromas, or adhesions to vital organs such as the bowel. Bioprosthetic meshes, generated from source organs source such as the dermis or small intestine, have emerged as commercially available products for use in hernia repair. The authors discuss the ideal mesh, tissue engineering and hernia repair, bioprosthetic mesh and use in the contaminated field, and porcine acellular lung matrix (PALM) as a natural scaffold capable of cell attachment, while maintaining cell viability was investigated as a novel prosthetic for repair and has demonstrated enhanced incorporation and short-term mechanical stability in a chronic ventral incisional hernia model with bridging repair.


  1. 1.
    Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D, Beck W, Holzman MD (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183Google Scholar
  2. 2.
    Goodenough CJ, Ko TC, Kao LS, Nguyen MT, Holihan JL, Alawadi Z, Nguyen DH, Flores JR, Arita NT, Roth JS, Liang MK (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (The HERNIA Project). J Am Coll Surg 220(4):405–413Google Scholar
  3. 3.
    Martindale RG, Deveney CW (2013) Preoperative risk reduction: strategies to optimize outcomes. Surg Clin North Am 93(5):1041–1055Google Scholar
  4. 4.
    FitzGerald JF, Kumar AS (2014) Biologic versus synthetic mesh reinforcement: what are the pros and cons? Clin Colon Rectal Surg 27(4):140–148Google Scholar
  5. 5.
    Garcia A, Baldoni A (2015) Complex ventral hernia repair with a human acellular dermal matrix and component separation: a case series. Ann Med Surg (Lond) 4(3):271–278Google Scholar
  6. 6.
    Beadles CA, Meagher AD, Charles AG (2015) Trends in emergent hernia repair in the United States. JAMA Surg 150(3):194–200Google Scholar
  7. 7.
    Basile F, Biondi A, Donati M (2013) Surgical approach to abdominal wall defects: history and new trends. Int J Surg 11(Suppl 1):S20–S23Google Scholar
  8. 8.
    Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25(4):835–839Google Scholar
  9. 9.
    Chand M, On J, Bevan K, Mostafid H, Venkatsubramaniam AK (2012) Mesh erosion following laparoscopic incisional hernia repair. Hernia 16(2):223–226Google Scholar
  10. 10.
    Gandhi D, Marcin S, Xin Z, Asha B, Kaswala D, Zamir B (2011) Chronic abdominal pain secondary to mesh erosion into cecum following incisional hernia repair: a case report and literature review. Ann Gastroenterol 24(4):321–324Google Scholar
  11. 11.
    Collage RD, Rosengart MR (2010) Abdominal wall infections with in situ mesh. Surg Infect 11(3):311–318Google Scholar
  12. 12.
    Kuehnert N, Kraemer NA, Otto J, Donker HC, Slabu I, Baumann M, Kuhl CK, Klinge U (2012) In vivo MRI visualization of mesh shrinkage using surgical implants loaded with superparamagnetic iron oxides. Surg Endosc 26(5):1468–1475Google Scholar
  13. 13.
    Schoenmaeckers EJ, van der Valk SB, van den Hout HW, Raymakers JF, Rakic S (2009) Computed tomographic measurements of mesh shrinkage after laparoscopic ventral incisional hernia repair with an expanded polytetrafluoroethylene mesh. Surg Endosc 23(7):1620–1623Google Scholar
  14. 14.
    Campanelli G, Bertocchi V, Cavalli M, Bombini G, Biondi A, Tentorio T, Sfeclan C, Canziani M (2013) Surgical treatment of chronic pain after inguinal hernia repair. Hernia 17(3):347–353Google Scholar
  15. 15.
    Aroori S, Spence RAJ (2007) Chronic pain after hernia surgery—an informed consent issue. Ulster Med J 76(3):136–140Google Scholar
  16. 16.
    Starling JR, Harms BA, Schroeder ME, Eichman PL (1987) Diagnosis and treatment of genitofemoral and ilioinguinal entrapment neuralgia. Surgery 102(4):581–586Google Scholar
  17. 17.
    Rastegarpour A, Cheung M, Vardhan M, Ibrahim MM, Butler CE, Levinson H (2016) Surgical mesh for ventral incisional hernia repairs: Understanding mesh design. Plast Surg (Oakv) 24(1):41–50Google Scholar
  18. 18.
    Bellows CF, Alder A, Helton WS (2006) Abdominal wall reconstruction using biological tissue grafts: present status and future opportunities. Expert Rev Med Devices 3(5):657–675Google Scholar
  19. 19.
    Franklin ME Jr, Gonzalez JJ Jr, Glass JL (2004) Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up. Hernia 8(3):186–189Google Scholar
  20. 20.
    Cevasco M, Itani KM (2012) Ventral hernia repair with synthetic, composite, and biologic mesh: characteristics, indications, and infection profile. Surg Infect 13(4):209–215Google Scholar
  21. 21.
    Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B, Parra-Davila E, Ramshaw B, Schumpelick V (2010) Hernia repair: the search for ideal meshes. Hernia 14(1):81–87Google Scholar
  22. 22.
    Gandolfo L, Donati M, Palmeri S, Brancato G, Donati A (2006) Late cutaneous fistula after inguinal hernia repair. A case report. Ann Ital Chir 77(5):447–450Google Scholar
  23. 23.
    Klinge U, Klosterhalfen B, Müller M, Schumpelick V (1999) Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 165(7):665–673Google Scholar
  24. 24.
    Bowman KL, Birchard SJ, Bright RM (1998) Complications associated with the implantation of polypropylene mesh in dogs and cats: a retrospective study of 21 cases (1984-1996). J Am Anim Hosp Assoc 34(3):225–233Google Scholar
  25. 25.
    Aguirre DA, Santosa AC, Casola G, Sirlin CB (2005) Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi–detector row CT. Radiographics 25(6):1501–1520Google Scholar
  26. 26.
    Brown C, Finch J (2010) Which mesh for hernia repair? Ann R Coll Surg Engl 92(4):272–278Google Scholar
  27. 27.
    Junge K, Klinge U, Rosch R, Mertens PR, Kirch J, Klosterhalfen B, Lynen P, Schumpelick V (2004) Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbeck’s Arch Surg 389(1):17–22Google Scholar
  28. 28.
    Klosterhalfen B, Junge K, Klinge U (2005) The lightweight and large porous mesh concept for hernia repair. Expert Rev Med Devices 2(1):103–117Google Scholar
  29. 29.
    Cavallaro A, Lo Menzo E, Di Vita M, Zanghì A, Cavallaro V, Veroux PF, Cappellani A (2010) Use of biological meshes for abdominal wall reconstruction in highly contaminated fields. World J Gastroenterol 16(15):1928–1933Google Scholar
  30. 30.
    Bilsel Y, Abci I (2012) The search for ideal hernia repair; mesh materials and types. Int J Surg 10(6):317–321Google Scholar
  31. 31.
    Ferzoco SJ (2013) A systematic review of outcomes following repair of complex ventral incisional hernias with biologic mesh. Int Surg 98(4):399–408Google Scholar
  32. 32.
    Baumann DP, Butler CE (2012) bioprosthetic mesh in abdominal wall reconstruction. Semin Plast Surg 26(1):18–24Google Scholar
  33. 33.
    Holton LH 3rd, Kim D, Silverman RP, Rodriguez ED, Singh N, Goldberg NH (2005) Human acellular dermal matrix for repair of abdominal wall defects: review of clinical experience and experimental data. J Long-Term Eff Med Implants 15(5):547–558Google Scholar
  34. 34.
    Primus FE, Harris HW (2013) A critical review of biologic mesh use in ventral hernia repairs under contaminated conditions. Hernia 17(1):21–30Google Scholar
  35. 35.
    Deeken CR, Melman L, Jenkins ED, Greco SC, Frisella MM, Matthews BD (2011) Histologic and biomechanical evaluation of crosslinked and non-crosslinked biologic meshes in a porcine model of ventral incisional hernia repair. J Am Coll Surg 212(5):880–888Google Scholar
  36. 36.
    Misra S, Raj PK, Tarr SM, Treat RC (2008) Results of AlloDerm use in abdominal hernia repair. Hernia 12(3):247–250Google Scholar
  37. 37.
    Novitsky YW, Rosen MJ (2012) The biology of biologics: basic science and clinical concepts. Plast Reconstr Surg 130(5 Suppl 2):9s–17sGoogle Scholar
  38. 38.
    Sandor M, Leamy P, Assan P, Hoonjan A, Huang LT, Edwards M, Zuo W, Li H, Xu H (2017) Relevant In vitro predictors of Human Acellular Dermal Matrix-associated inflammation and capsule formation in a nonhuman primate subcutaneous tissue expander model. Eplasty 17:e1Google Scholar
  39. 39.
    Zenn MR, Salzberg CA (2016) A direct comparison of alloderm-ready to use (RTU) and DermACELL in immediate breast implant reconstruction. Eplasty 16:e23Google Scholar
  40. 40.
    Weiss SR, Tenney JM, Thomson JL, Anthony CT, Chiu ES, Friedlander PL, Woltering EA (2010) The effect of AlloDerm on the initiation and growth of human neovessels. Laryngoscope 120(3):443–449Google Scholar
  41. 41.
    Newman MI, Samson MC, Berho M (2009) AlloDerm in breast reconstruction: 2 years later. Plast Reconstr Surg 123(6):205e–206eGoogle Scholar
  42. 42.
    Romain B, Story F, Meyer N, Delhorme JB, Brigand C, Rohr S (2016) Comparative study between biologic porcine dermal meshes: risk factors of postoperative morbidity and recurrence. J Wound Care 25(6):320–325Google Scholar
  43. 43.
    Butler CE, Burns NK, Campbell KT, Mathur AB, Jaffari MV, Rios CN (2010) Comparison of cross-linked and non-cross-linked porcine acellular dermal matrices for ventral hernia repair. J Am Coll Surg 211(3):368–376Google Scholar
  44. 44.
    Broyles JM, Abt NB, Sacks JM, Butler CE (2013) Bioprosthetic tissue matrices in complex abdominal wall reconstruction. Plast Reconstr Surg Glob Open 1(9):e91Google Scholar
  45. 45.
    Patel KM, Albino FP, Nahabedian MY, Bhanot P (2013) Critical analysis of Strattice performance in complex abdominal wall reconstruction: intermediate-risk patients and early complications. Int Surg 98(4):379–384Google Scholar
  46. 46.
    Garvey PB, Giordano SA, Baumann DP, Liu J, Butler CE (2017) Long-term outcomes after abdominal wall reconstruction with Acellular Dermal Matrix. J Am Coll Surg 224(3):341–350Google Scholar
  47. 47.
    Li J, Ren N, Qiu J, Jiang H, Zhao H, Wang G, Boughton RI, Wang Y, Liu H (2013) Carbodiimide crosslinked collagen from porcine dermal matrix for high-strength tissue engineering scaffold. Int J Biol Macromol 61:69–74Google Scholar
  48. 48.
    Butler CE (2006) The role of bioprosthetics in abdominal wall reconstruction. Clin Plast Surg 33(2):199–211Google Scholar
  49. 49.
    Dieterich M (2013) Biological matrices and synthetic meshes used in implant-based breast. Geburtshilfe Frauenheilkd 73(11):1100–1106Google Scholar
  50. 50.
    Fernandez-Moure JS, Van Eps JL, Peterson LE, Shirkey BA, Menn ZK, Cabrera FJ, Karim A, Tasciotti E, Weiner BK, Ellsworth WA 4th (2017) Cross-linking of porcine acellular dermal matrices negatively affects induced neovessel formation using platelet-rich plasma in a rat model of hernia repair. Wound Repair Regen 25(1):98–108Google Scholar
  51. 51.
    Parker DM, Armstrong PJ, Frizzi JD, North JH Jr (2006) Porcine dermal collagen (Permacol) for abdominal wall reconstruction. Curr Surg 63(4):255–258Google Scholar
  52. 52.
    Lantz GC, Badylak SF, Coffey AC, Geddes LA, Blevins WE (1990) Small intestinal submucosa as a small-diameter arterial graft in the dog. J Investig Surg 3(3):217–227Google Scholar
  53. 53.
    Sandusky GE, Lantz GC, Badylak SF (1995) Healing comparison of small intestine submucosa and ePTFE grafts in the canine carotid artery. J Surg Res 58(4):415–420Google Scholar
  54. 54.
    Beale EW, Hoxworth RE, Livingston EH, Trussler AP (2012) The role of biologic mesh in abdominal wall reconstruction: a systematic review of the current literature. Am J Surg 204(4):510–517Google Scholar
  55. 55.
    Annor AH, Tang ME, Pui CL, Ebersole GC, Frisella MM, Matthews BD, Deeken CR (2012) Effect of enzymatic degradation on the mechanical properties of biological scaffold materials. Surg Endosc 26(10):2767–2778Google Scholar
  56. 56.
    Edelman DS (2002) Laparoscopic herniorrhaphy with porcine small intestinal submucosa: a preliminary study. JSLS 6(3):203–205Google Scholar
  57. 57.
    Petter-Puchner AH, Fortelny RH (2010) Use of porcine small intestine submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow up assessment; Surg Endosc. (2008) 22: 1941-1946. Surg Endosc 24(1):230–231Google Scholar
  58. 58.
    James NL, Poole-Warren LA, Schindhelm K, Milthorpe BK, Mitchell RM, Mitchell RE, Howlett CR (1991) Comparative evaluation of treated bovine pericardium as a xenograft for hernia repair. Biomaterials 12(9):801–809Google Scholar
  59. 59.
    Limpert JN, Desai AR, Kumpf AL, Fallucco MA, Aridge DL (2009) Repair of abdominal wall defects with bovine pericardium. Am J Surg 198(5):e60–e65Google Scholar
  60. 60.
    Jin J, Rosen MJ, Blatnik J, McGee MF, Williams CP, Marks J, Ponsky J (2007) Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg 205(5):654–660Google Scholar
  61. 61.
    Kapan S, Kapan M, Goksoy E, Karabicak I, Oktar H (2003) Comparison of PTFE, pericardium bovine and fascia lata for repair of incisional hernia in rat model, experimental study. Hernia 7(1):39–43Google Scholar
  62. 62.
    Gurrado A, Franco IF, Lissidini G, Greco G, De Fazio M, Pasculli A, Girardi A, Piccinni G, Memeo V, Testini M (2015) Impact of pericardium bovine patch (Tutomesh((R))) on incisional hernia treatment in contaminated or potentially contaminated fields: retrospective comparative study. Hernia 19(2):259–266Google Scholar
  63. 63.
    Wang Y, Bao J, Wu X, Wu Q, Li Y, Zhou Y, Li L, Bu H (2016) Genipin crosslinking reduced the immunogenicity of xenogeneic decellularized porcine whole-liver matrices through regulation of immune cell proliferation and polarization. Sci Rep 6:24779Google Scholar
  64. 64.
    Hussein KH, Park KM, Kim HM, Teotia PK, Ghim JH, Woo HM (2015) Construction of a biocompatible decellularized porcine hepatic lobe for liver bioengineering. Int J Artif Organs 38(2):96–104Google Scholar
  65. 65.
    Barakat O, Abbasi S, Rodriguez G, Rios J, Wood RP, Ozaki C, Holley LS, Gauthier PK (2012) Use of decellularized porcine liver for engineering humanized liver organ. J Surg Res 173(1):e11–e25Google Scholar
  66. 66.
    Petro CC, Prabhu AS, Liu L, Majumder A, Anderson JM, Rosen MJ (2016) An in vivo analysis of Miromesh—a novel porcine liver prosthetic created by perfusion decellularization. J Surg Res 201(1):29–37Google Scholar
  67. 67.
    Rosen MJ, Krpata DM, Ermlich B, Blatnik JA (2013) A 5-year clinical experience with single-staged repairs of infected and contaminated abdominal wall defects utilizing biologic mesh. Ann Surg 257(6):991–996Google Scholar
  68. 68.
    Xu H, Wan H, Sandor M, Qi S, Ervin F, Harper JR, Silverman RP, McQuillan DJ (2008) Host response to human acellular dermal matrix transplantation in a primate model of abdominal wall repair. Tissue Eng Part A 14(12):2009–2019Google Scholar
  69. 69.
    Jernigan TW, Fabian TC, Croce MA, Moore N, Pritchard FE, Minard G, Bee TK (2003) Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg 238(3):349–355Google Scholar
  70. 70.
    Itani KM, Rosen M, Vargo D, Awad SS, Denoto G 3rd, Butler CE, RICH Study Group (2012) Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: the RICH Study. Surgery 152(3):498–505Google Scholar
  71. 71.
    Finan KR, Kilgore ML, Hawn MT (2009) Open suture versus mesh repair of primary incisional hernias: a cost-utility analysis. Hernia 13(2):173–182Google Scholar
  72. 72.
    Nichols JE, Niles JA, Cortiella J (2012) Production and utilization of acellular lung scaffolds in tissue engineering. J Cell Biochem 113(7):2185–2192Google Scholar
  73. 73.
    Chen F, Date H (2015) Update on ischemia-reperfusion injury in lung transplantation. Curr Opin Organ Transplant 20(5):515–520Google Scholar
  74. 74.
    Ott HC, Clippinger B, Conrad C, Schuetz C, Pomerantseva I, Ikonomou L, Kotton D, Vacanti JP (2010) Regeneration and orthotopic transplantation of a bioartificial lung. Nat Med 16(8):927–933Google Scholar
  75. 75.
    Nichols JE, Niles J, Riddle M, Vargas G, Schilagard T, Ma L, Edward K, La Francesca S, Sakamoto J, Vega S, Ogadegbe M, Mlcak R, Deyo D, Woodson L, McQuitty C, Lick S, Beckles D, Melo E, Cortiella J (2013) Production and assessment of decellularized pig and human lung scaffolds. Tissue Eng Part A 19(17–18):2045–2062Google Scholar
  76. 76.
    Zhou H, Kitano K, Ren X, Rajab TK, Wu M, Gilpin SE, Wu T, Baugh L, Black LD, Mathisen DJ, Ott HC (2017) Bioengineering human lung grafts on porcine matrix. Ann Surg. In publicationGoogle Scholar
  77. 77.
    Gilpin SE, Guyette JP, Gonzalez G, Ren X, Asara JM, Mathisen DJ, Vacanti JP, Ott HC (2014) Perfusion decellularization of human and porcine lungs: bringing the matrix to clinical scale. J Heart Lung Transplant 33(3):298–308Google Scholar
  78. 78.
    Salerno A, Guarnieri D, Iannone M, Zeppetelli S, Netti PA (2010) Effect of micro- and macroporosity of bone tissue three-dimensional-poly(epsilon-caprolactone) scaffold on human mesenchymal stem cells invasion, proliferation, and differentiation in vitro. Tissue Eng Part A 16(8):2661–2673Google Scholar
  79. 79.
    Guaccio A, Guarino V, Perez MA, Cirillo V, Netti PA, Ambrosio L (2011) Influence of electrospun fiber mesh size on hMSC oxygen metabolism in 3D collagen matrices: experimental and theoretical evidences. Biotechnol Bioeng 108(8):1965–1976Google Scholar
  80. 80.
    Nomi M, Atala A, Coppi PD, Soker S (2002) Principals of neovascularization for tissue engineering. Mol Asp Med 23(6):463–483Google Scholar
  81. 81.
    Bramfeldt H, Sabra G, Centis V, Vermette P (2010) Scaffold vascularization: a challenge for three-dimensional tissue engineering. Curr Med Chem 17(33):3944–3967Google Scholar
  82. 82.
    Campbell KT, Burns NK, Ensor J, Butler CE (2012) Metrics of cellular and vascular infiltration of human acellular dermal matrix in ventral hernia repairs. Plast Reconstr Surg 129(4):888–896Google Scholar
  83. 83.
    Fernandez-Moure JS, Van Eps JL, Rhudy JR, Cabrera FJ, Acharya GS, Tasciotti E, Sakamoto J, Nichols JE (2016) Porcine acellular lung matrix for wound healing and abdominal wall reconstruction: a pilot study. J Tissue Eng 7:2041731415626018Google Scholar
  84. 84.
    Schoenmaeckers EJ, Wassenaar EB, Raymakers JT, Rakic S (2010) Bulging of the mesh after laparoscopic repair of ventral and incisional hernias. JSLS 14(4):541–546Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Vishwanath Chegireddy
    • 1
    • 2
  • Koby D. Caplan
    • 1
    • 2
  • Joseph S. Fernandez-Moure
    • 1
    • 2
  1. 1.Department of SurgeryHouston Methodist HospitalHoustonUSA
  2. 2.Department of Biomimetic and Regenerative Medicine, Surgical Advanced Technologies LabHouston Methodist Research InstituteHoustonUSA

Personalised recommendations