Development of the Acellular Dermal Matrix and Experimental Substantiation of Its Use in the Anterior Abdominal Wall hernia Repair

   Objective: To develop a biological implant that is an acellular dermal matrix (ADM), evaluate its use as a support material in tensionfree hernioplasty for ventral hernia, and compare it to that of the commercially available implant Permacol^TM.

   Materials and methods: ADM was derived from the porcine dermis (Landrace breed) decellularized using detergents and enzymes. The quality of devitalization was assessed in vitro. We performed sublay hernioplasty in 4-month-old Landrace pigs using ADM (experimental group) and Permacol^TM (control group). The specimens were explanted on day 120 of the experiment for histological and immunohistochemical examination.

   Results: All cellular elements were removed by the detergent-enzymatic treatment of the dermis; the native architecture of the dermis was slightly disrupted. The specimens of the commercially available chemically cross-linked biomaterial Permacol^TM had better mechanical properties than ADM specimens; however, there were no significant differences in terms of cytotoxicity. The state of the tissues after the explantation (number of fibroblasts and endothelial cells) showed no differences in the result of using ADM and Permacol^TM. In 120 days, the materials integrated into the tissues without the formation of adhesions or inflammation.

   Conclusions: Our findings show that ADM does not have cytotoxic properties, has adequate biomechanical parameters to effectively reinforce supporting soft tissues, does not cause an inflammatory response during implantation, and integrates fully into tissues. Our study demonstrates the effectiveness and utility of the developed ADM in surgical treatment of anterior abdominal wall defects.

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