Autologous skin graft, human dura mater and polypropylene mesh for the repair of ventral abdominal hernias: an experimental study.

摘要

OBJECTIVE: To compare primary repair and grafting with one of two materials (one biological human dura mater, and one synthetic polypropylene mesh) or autologous skin, with primary repair alone in abdominal wall hernias in rats. DESIGN: Randomised experiment. SETTING: Teaching hospital, Turkey. ANIMALS: 72 male Wistar albino rats randomised into 4 groups of 18 rats each. These were further randomly divided into subgroups of 6 each that were killed on days 15, 30,and 45 postoperatively. INTERVENTIONS: Each test material was sutured to the abdominal wall by an onlay technique. MAIN OUTCOME MEASURES: Macroscopic and microscopic appearance, and strength of the abdominal wall. RESULTS: Macroscopically, dura mater grafts lost their original shape, but polypropylene and skin did not. When completely incorporated the skin grafts had developed a new fascia. Dura mater and polypropylene induced a pronounced inflammatory reaction at all three times postoperatively, and there were significantly more fibroblasts in the dura mater group on days 15 and 30, and in the skin graft group on day 45, than in the other groups (p < 0.05). Mechanical resistance and mean breaking strength were significantly greater in the skin graft group than in the other groups at all times tested (p < 0.05). CONCLUSION: Full thickness autologous skin grafts were stronger than both human dura mater and polypropylene mesh when used to reinforce primary repairs of abdominal wall hernias in rats.