title: Effectiveness and properties of the biological prosthesis Permacol™ in pediatric surgery: A large single center experience.
abstract: BACKGROUND
  The use of prosthetic patches of non-absorbable materials represents a valid tool in the treatment of abdominal wall and diaphragmatic defects in pediatric age. In recent years research has developed biological dermal scaffolds made from a sheet of acellular matrix that can provide the desired support and reduce the occurrence of complications from non-absorbable implant. We present our experience and a systematic review to evaluate the use of biologic prosthesis for abdominal wall closure in pediatric patients.
  
  
  METHODS
  The study from January 2009 to January 2015 involved 20 patients treated with Permacol™ implant. We observed postoperative complications only in patients treated for abdominal wall closure, which is the major indication for the use of Permacol™. We conducted a systematic review and meta-analysis (according to PRISMA) on PubMed/Medline, Scopus and EMBASE regarding the use of biological prosthesis in pediatric population considering the incidence of complications as the primary outcome.
  
  
  RESULTS
  3/20 patients experienced complications: 2 patients with skin necrosis healed conservatively and 1 of them developed laparocele. Thus only 1 patient with incisional hernia had significant surgery complication. In patients who were permanently implanted with Permacol™ it has not determined adverse reactions with optimal functional outcome.
  
  
  CONCLUSIONS
  In accordance with the few data (case reports and case series) reported in literature about pediatric patients, our experience in different pathologies and applications has shown the effectiveness of Permacol™, in particular for the non-occurrence of infections, that often affect the use of prosthesis.
authors.affiliation: "V. Buzzi" Children Hospital, Milan, Italy; Department of Surgery, PhD School of Experimental Medicine, University of Pavia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Filisetti
authors.affiliation: "V. Buzzi" Children Hospital, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Costanzo
authors.affiliation: "V. Buzzi" Children Hospital, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Marinoni
authors.affiliation: "V. Buzzi" Children Hospital, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Vella
authors.affiliation: Servizio di Biometria e Statistica, Direzione Scientifica, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klercy
authors.affiliation: "V. Buzzi" Children Hospital, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Riccipetitoni
keywords: Abdominal wall; Biological prosthesis; Pediatric patients; Permacol