title: Long-term histologic and mechanical results of a Permacol™ abdominal wall explant.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. Julie.O'Brien@umassmemorial.org
authors.forename: J A
authors.initials: JA
authors.lastname: O'Brien
authors.forename: R
authors.initials: R
authors.lastname: Ignotz
authors.forename: R
authors.initials: R
authors.lastname: Montilla
authors.forename: G B
authors.initials: GB
authors.lastname: Broderick
authors.forename: A
authors.initials: A
authors.lastname: Christakis
authors.forename: R M
authors.initials: RM
authors.lastname: Dunn
mesh_terms: D034861:Abdominal Wall / Q000473:pathology* / Q000601:surgery*; D001672:Biocompatible Materials / Q000737:chemistry; D003094:Collagen / Q000737:chemistry / Q000502:physiology*; D024042:Collagen Type I / Q000032:analysis; D024061:Collagen Type III / Q000032:analysis; D004549:Elastin / Q000032:analysis; D005260:Female; D005347:Fibroblasts / Q000502:physiology; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008422:Materials Testing; D008875:Middle Aged; D013718:Tensile Strength
chemical_list: D001672:Biocompatible Materials; D024042:Collagen Type I; D024061:Collagen Type III; C422414:Permacol; D003094:Collagen; D004549:Elastin