title: Metrics of cellular and vascular infiltration of human acellular dermal matrix in ventral hernia repairs.
abstract: BACKGROUND
  Human acellular dermal matrix is used for ventral hernia repair, as it resists infection and remodels by means of surrounding tissue. However, the tissue source and impact of basement membrane on cell and vessel infiltration have not been determined. The authors hypothesized that musculofascia would be the primary tissue source of cells and vessels infiltrating into human acellular dermal matrix and that the basement membrane would inhibit infiltration.
  
  
  METHODS
  Fifty-six guinea pigs underwent inlay human acellular dermal matrix ventral hernia repair with the basement membrane oriented toward or away from the peritoneum. At postoperative weeks 1, 2, or 4, repair sites were completely excised. Histologic and immunohistochemical analyses were performed to quantify cell and vessel density within repair-site zones, including interface (lateral, beneath musculofascia) and center (beneath subcutaneous fat) zones. Cell and vessel quantities were compared as functions of zone, basement membrane orientation, and time.
  
  
  RESULTS
  Cellular and vascular infiltration increased over time universally. The interface demonstrated greater mean cell density than the center (weeks 1 and 2, p = 0.01 and p < 0.0001, respectively). Cell density was greater with the basement membrane oriented toward the peritoneum at week 4 (p = 0.02). The interface zone had greater mean vessel density than the center zone at week 4 (p < 0.0001). Orienting the basement membrane toward the peritoneum increased vessel density at week 4 (p = 0.0004).
  
  
  CONCLUSIONS
  Cellular and vascular infiltration into human acellular dermal matrix for ventral hernia repairs was greater from musculofascia than from subcutaneous fat, and the basement membrane inhibited cellular and vascular infiltration. Human acellular dermal matrix should be placed adjacent to the best vascularizing tissue to improve fibrovascular incorporation.
authors.affiliation: Houston, Texas From the Departments of Plastic Surgery and Biostatistics, University of Texas M. D. Anderson Cancer Center.
authors.forename: Kristin Turza
authors.initials: KT
authors.lastname: Campbell
authors.forename: Nadja K
authors.initials: NK
authors.lastname: Burns
authors.forename: Joe
authors.initials: J
authors.lastname: Ensor
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
mesh_terms: D000818:Animals; D001485:Basement Membrane / Q000166:cytology; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002452:Cell Count; D049109:Cell Proliferation; D003094:Collagen / Q000627:therapeutic use*; D006168:Guinea Pigs; D006555:Hernia, Ventral / Q000601:surgery*; D055806:Microvessels / Q000254:growth & development; D050151:Subcutaneous Fat / Q000166:cytology; D013526:Surgical Mesh
chemical_list: C440568:Alloderm; D001672:Biocompatible Materials; D003094:Collagen