title: Clinical application of a silk fibroin protein biologic scaffold for abdominal wall fascial reinforcement.
abstract: BACKGROUND
  Preclinical studies have demonstrated that macroporous silk fibroin protein scaffolds are capable of promoting physiologically durable supportive tissue, which favors application of these engineered tissues for clinical implantation. The safety and effectiveness of a long-lasting, transitory, 510(k)-cleared purified silk fibroin biologic scaffold (SBS) are investigated for soft-tissue support and repair of the abdominal wall.
  
  
  METHODS
  We conducted a multicenter retrospective review of all consecutive patients who underwent abdominal wall soft-tissue reinforcement with an SBS device between 2011 and 2013. Indications, comorbid conditions, surgical technique, complications, and outcomes were evaluated.
  
  
  RESULTS
  We reviewed the records of 172 consecutive patients who received an SBS for soft-tissue support. Of those, 77 patients underwent abdominal wall fascial repair, with a mean follow-up of 18.4 ± 7.5 months. Procedures using an SBS included reinforcement of an abdominal-based flap donor site (31.2%), ventral hernia repair (53.2%), and abdominoplasty (15.6%). The overall complication rate was 6.5%, consisting of 2 wound dehiscences, 1 with device exposure, 1 seroma, 1 infection with explantation, and a perioperative bulge requiring reoperation. There were no reports of hernia.
  
  
  CONCLUSIONS
  Postoperative complication rates after 18 months were low, and most surgical complications were managed nonoperatively on an outpatient basis without mesh removal. To our knowledge, this is the only series to report on a long-lasting, transitory SBS for abdominal wall repair and reinforcement. Procedure-specific outcome studies are warranted to delineate optimal patient selection and define potential device characteristic advantages.
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Clemens
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Susan
authors.initials: S
authors.lastname: Downey
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Frank
authors.initials: F
authors.lastname: Agullo
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Max R
authors.initials: MR
authors.lastname: Lehfeldt
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Kind
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Humberto
authors.initials: H
authors.lastname: Palladino
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Marshall
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Jewell
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Anshu B
authors.initials: AB
authors.lastname: Mathur
authors.affiliation: Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, Tex.; Department of Plastic Surgery, University of Southern California, Keck School of Medicine, Los Angeles, Calif.; Southwest Plastic Surgery, El Paso, Tex.; Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Tex.; Teleos Plastic Surgery, Pasadena, Calif.; Kind-Chang Plastic Surgery, California-Pacific Medical Center, San Francisco, Calif.; Marshall Cosmétique Center, Miami, Fla.; Division of Plastic Surgery, Oregon Health and Science University, Portland, Ore.; Bengtson Center for Aesthetics and Plastic Surgery, Grand Rapids, Mich.; Michigan State University, Grand Rapids, Mich.
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Bengtson