Review Article

Biomaterials for Pelvic Floor Reconstructive Surgery: How Can We Do Better?

Table 3

Allografts.

AuthorSampleBiomechanical propertiesHost response

Sclafani et al., 2000 [37]Human cadaveric dermis (AlloDerm) disk implanted subdermally behind a patient’s ear. Micronized human cadaveric dermis (AlloDerm) injected intradermally and subdermally in 2 different locations behind a patient’s ear. Both implants were examined 3 months and 1 month after implantation, respectively. (i) Both materials extensively invaded by host fibroblasts.
(ii) Both materials present new collagen ingrowth.

Kim et al., 2001 [22]Human cadaveric fascia implanted in 20 rats randomized into 2 survival groups (2 and 4 months).No significant decrease of the fracture toughness calculated by the trouser tear test.

Walter et al., 2003 [34]Freeze-dried and gamma-irradiated human cadaveric lata fascia implanted in 18 rabbits and excised 12 weeks after implantation. Significant decrease of biomechanical properties after 12 weeks of implantation.

Spiess et al., 2004 [35]Human cadaveric fascia lata implanted subcutaneously on the abdominal wall of 20 rats randomized into 2 survival groups (6 and 12 weeks).No significant decrease of tensile strength with time.

Yildirim et al., 2005 [38]Human cadaveric lata fascia implanted subcutaneously on the abdominal wall in 20 rabbits randomized into 4 survival groups (2, 7, 15, and 30 days). (i) Acute inflammation by high cell infiltration predominantly of polymorphous granulocytes.
(ii) Integration in host tissue by moderate fibrotic process and muscle infiltration on day 30, with persistent inflammatory response.

Krambeck et al., 2006 [26]Cadaveric fascia lata implanted subcutaneously on the anterior rectus fascia of 10 rabbits randomized into 2 survival groups (6 and 12 weeks). (i) Moderate to high focal fibrosis.
(ii) Minimal to moderate degree of scar.
(iii) High degree of inflammatory infiltrate.

Hilger et al., 2006 [20]Human cadaveric dermis and lata fascia implanted in 20 rabbits randomized into 2 survival groups (6 and 12 weeks). Half implanted on the rectus fascia and half on the posterior vagina fascia.Very significant decrease of biomechanical properties after 12 weeks of implantation.(i) Two missing or fragmented materials implanted on the vagina after 12 weeks.
(ii) Moderate inflammatory response.
(iii) Minimal neovascularization.
(iv) Minimal collagen ingrowth without significant cell infiltration.

Woodruff et al., 2008 [27]Human cadaveric dermis slings explanted after revision from 2 women, due to different complications, between 2 and 65 months after implantation.(i) Moderate levels of encapsulation.
(ii) High levels of degradation.
(iii) Peripheries of the grafts invaded by fibroblasts but central portions remained acellular.

VandeVord et al., 2010 [39]Human cadaveric dermis and fascia lata implanted in 16 rats, respectively, and both randomized into 4 survival groups (2, 4, 8, and 12 weeks). Implantation around the bladder neck, anchored to the surrounding tissues. (i) Thin fibrous capsule formation.
(ii) Moderate cell infiltration and angiogenesis.

Rice et al., 2010 [36]Human cadaveric dermis (AlloDerm) implanted in 18 rats randomized into 2 survival groups (30 and 60 days). Subcutaneous implantation on abdominis rectus muscle defect.Increase of tensile strength after 30 days and, again, increase of tensile strength after 60 days, respectively, to 30 days.(i) Moderate amounts of collagen deposition well organized.
(ii) Abundant revascularization.

Kolb et al., 2012 [40]Human cadaveric dermis (AlloDerm) implanted subcutaneously in 5 pigs randomized into 4 survival groups (7, 21, 90, and 180 days).(i) Robust inflammatory response after 7 days of implantation, which achieved maximal level at 21 days, with formation of granulomas and areas of necrosis noted within the graft.
(ii) Moderate fibroblast infiltration, collagen ingrowth, and neovascularisation.
(iii) Moderate levels of encapsulation.