Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

27. The Role of Bioactive Prosthetic Material…
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Technology International XV in July 2006 [ 9 ]. Since then, there have
been many more reports using BPM, acellular dermal matrices, and
other biologic materials for hernia repair. The aim of this chapter is to
review the topic of BPMs and their application to inguinal hernia and
sports hernia repairs.
Basic Differences in Bioactive Prosthetic Materials
Table 27.1 summarizes the BPMs currently on the market in the
United States. They differ based on their mammalian source (animal or
human), tissue of origin (dermal, pericardial, bladder, or intestinal submucosa),
as well as their methods of processing (cross-linked or not
cross-linked) and sterilization. All of these differences may lead to differences
in the healing process and thus clinical outcome. With the
exception of AlloDerm ® , Surgisis
®
, and Strattice TM , peer- reviewed studies
outlining the clinical outcome from implantation of biologic tissue is
significantly lacking.
Mammalian source may be considered when choosing among the
various BPMs available. Human cadaveric tissues offer the advantage of
using allograft (within species) sourcing and thus lacking interspecies
rejection risk. The source of such tissues is donor dependent, with variability
in composition, health, thickness, and age of the tissue.
Additionally, there is risk of disease transmission within species; indeed,
there have been reports of disease transmission in human cadaveric
allograft products of the dura mater in Japan from the 1990s [ 10 ].
Alternatively, animals can be raised to precise specifications to
achieve a more consistent product. The risk of allergic response to their
ECM is low because of the high homology with similar human proteins.
With nonhuman tissues, the risk of tissue rejection remains despite
decellularization, as does the rare possibility of disease transmission.
The specifics of each biologic material should be known prior to implantation,
especially when treating certain populations. For example, an
immune-compromised patient may be at higher risk if undergoing
implant with a human cadaveric allograft that is not sterilized. Similarly,
an atopic patient may be at higher risk of allergic response to a
xenograft.
BPMs vary in their tissue of origin. The dermis remains the preferred
tissue source, though products made from alternative tissues, such as the