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Medtronic / Covidien Products / Hernia Repair / Permacol™ Surgical Implant / The biological choice for chest wall reconstruction

Permacol™ surgical implant

Apply the (bio)logic

The (bio)logical choice for thoracic surgery

CE approved: Permacol™ surgical implant is now clearly indicated for chest wall reconstruction.

What are the risks of thoracic surgery?

In cases of chest wall resection and reconstruction caused by pulmonary disease, infection, trauma, oncologic treatment or tumours, there are risks for patients.

Even if a patient is undergoing minimally invasive thoracic surgery, there are several complications that could potentially occur including:
Infection, including pneumonia1
Pain1
Bleeding1
Air leakage from lungs1

Which patients are most at risk?

Each patient will be reviewed for thoracic surgery based on their own individual risks. However, some main risk factors include:2

  • Pre-existing lung diseases or cancer
  • Pre-existing heart diseases or conditions
  • Undergoing chemotherapy
  • Previous thoracic surgery

  • Taking certain medications
  • Being overweight
  • Being a smoker

Care for the thoracic wall

Whether it’s as a result of trauma, oncological treatment, infection or disease, thoracic surgery requires making insertions into the chest wall. Even in the case of minimally invasive surgery, some incisions will need to be made.

Typically, incisions of less than 5cm do not require any form of reconstruction3, although this might not be the case depending on the patient and location or specificity of surgery required. In the case of larger incisions, mesh may be required to support the soft tissue in the chest wall.

Meshes present the advantages of easy manipulation and handling and comply with the characteristics of ideal prosthetic material as determined by Le Roux and Sherma:3

Rigidity

to abolish paradoxical movement

Inertness

to allow in-growth of fibrous tissue and decrease the likelihood of infection

Malleability

to fashion to the appropriate shape at the time of operation

Radiolucency

to create an anatomic reference to do a better follow up and identify a possible local neoplastic relapse

Synthetic vs bioprosthetic mesh in thoracic surgery

Synthetic mesh

Typically, synthetic mesh has been the material of choice for thoracic surgery because it’s simple to use and usually well-tolerated.3

Bioprosthetic mesh

Bioprosthetic meshes have been shown to be beneficial in chest wall resection and reconstruction surgery.4-6,† 

Although bioprosthetic meshes can be more expensive and difficult to handle, they do have significant benefits when used in thoracic surgery, including:

  • The ability to revascularize and integrate quickly into native tissues.7-9 
  • Excellent infection resistance.8,† 
  • Effective wound healing and long-term stability, even in large surgeries.6-9 
  • A crosslinked structure that provides strength, durability and flexibility thanks to their microfibrils made of chemically connected collagen molecules.7-9 

In short, choosing bioprosthetic meshes rather than synthetic meshes for thoracic surgery, particularly in large or contaminated cases, can improve patient outcomes.7,8,10,11,12 

Make the (bio)logical choice

Choose Permacol™ surgical implant

Permacol™ surgical implant is a tough and flexible fibrous flat sheet of crosslinked acellular porcine dermal collagen and constituent elastin fibres.§

There are three main advantages that Permacol™ provides over biosynthetic implants:
Biocompatibility

Studies have shown that Permacol™ has good fibroblastic and neovascular infiltration, excellent biocompatibility and resistance to degradation in potentially contaminated sites.7-9,‡ 
Strength and durability

Permacol™ has shown greater tensile strength compared to non-crosslinked implants. While human cadaveric grafts and other non-crosslinked grafts may initially be successful, many lose tensile strength and have increased tissue laxity over time.15-20
Dimensional stability

Optimal cross-linking and gentle processing methods means the Permacol™ surgical implant offers long-lasting dimensional stability. This ensures the integrity of the collagen graft through the body’s wound healing process.7-9 

CE approved
Permacol™ surgical implant is intended for use as a soft tissue implant to reinforce soft tissue where weakness exists in surgical procedures involving:§

 

  • Primary ventral and incisional hernia repair
  • Abdominal wall reconstruction and closure
  • Abdominal muscle flap reinforcement
  • Plastic and reconstructive surgery of the face and head
  • Pelvic floor reconstruction and reinforcement during colorectal surgery
  • Chest wall reconstruction
     

Resistant and durable7-9,†† 

Permacol™ surgical implant is a well-proven biologic implant that has been used globally in more than 350,000 patients over 12 years.7-10,13,14

 

Find out more about the benefits Permacol™ surgical implant can offer you and your patients.

 

Visit the product page

Contact us today to learn more about the (bio)logical benefits of the Permacol™ surgical implant

Get your trial

Additional resources

Brochure "Permacol™ surgical implant in Thoracic"
View brochure
Real surgical cases "Permacol™ surgical implant in Thoracic"
View booklet
References:

† Use of Permacol™ surgical implant in a contaminated or infected field may lead to a weakening or breakdown of the implant. 
Treat any existing or suspected infection according to accepted medical practice before implanting the device.

§ See IFU_PT00099456 Permacol™ surgical implant

‡ Use of Permacol™ surgical implant in a contaminated or infected field may lead to a weakening or breakdown of the implant. Treat any existing or suspected infection according to accepted medical practice before implanting the device.

†† Results may not correlate to performance in humans.

  1. Video Assisted Thoracoscopic Surgery- (VATS) Procedure. University Hospitals Coventry and Warwickshire NHS Trust. Pge3.pdf. HIC/LFT/2407/20 February 2020.
  2. Irons JF, and Martinez G. Complex, high-risk thoracic surgery—does risk always outweigh the benefit or can we manage it safely? Video-Assisted Thoracic Surgery. Vol 2, no.9,2017. https://vats.amegroups.com/article/view/4059.
  3. Sanna S, Brandolini J, Pardolesi A, et al. Materials and techniques in chest wall reconstruction: a review. J Vis Surg. 2017;3:95. Published 2017 Jul 26. doi:10.21037/jovs.2017.06.10.
  4. Barua A, Catton JA, Socci L, Raurell A, Malik M, Internullo E, Martin-Ucar AE. Initial experience with the use of biological implants for soft tissue and chest wall reconstruction in thoracic surgery. Ann Thorac Surg. 2012 Nov;94(5):1701-5. doi: 10.1016/j. athoracsur.2012.07.001. Epub 2012 Sep 7. PMID: 22959570.
  5. Federico Coccolini*, Marco Lotti, et al. Thoracic wall reconstruction with Collamend® in trauma: report of a case and review of the literature. World Journal of Emergency Surgery 2012, 7:39.
  6. D’Amico G, Manfredi R, Nita G, et al. Reconstruction of the Thoracic Wall With Biologic Mesh After Resection for Chest Wall Tumors: A Presentatio
  7. N. J. Smart, N. Bryan, J. A. Hunt. A scientific evidence for the efficacy of biologic implants for soft tissue reconstruction. First published: 08 November 2012; Special Issue: Biologic Meshes in Colorectal Surgery. Volume 14, Issue Supplement s3, pages 1–6, December 2012.|https://doi.org/10.1111/codi.12042.
  8. Smart NJ, Bloor S. Durability of Biologic Implants for Use in Hernia Repair: A Review. Surg Innov, First Published December 4, 2011; 221 -229; https://doi.org/10.1177/1553350611429027.
  9. De Castro Brás LE, Proffitt JL, Bloor S, Sibbons PD. Effect of crosslinking on the performance of a collagen-derived biomaterial as an implant for soft tissue repair: a rodent model. Biomed Mater Res B Appl Biomater. 2010; 95:239-249*. Published online 28 September 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/jbm.b.31704.
  10. Hiles M. et al. Are Biologic Grafts Effective for Hernia Repair? A Systematic Review of the Literature. Surgical Innovation / Vol. 16, No. 1, March 2009; 26-37 © 2009 Sage Publications 10.1177/1553350609331397.
  11. Chand et al. Retrospective Study of the Outcome of Porcine Collagen (Permacol) in Abdominal Wall Defects. AHS 2012 Poster*Permacol™ Surgical Implant Retrospective Study. P-1737 Hernia (March 2012) 16 (Suppl 1): S143-S240.
  12. 0. Gaertner, W.G., et al. Experimental Evaluation of Four Biologic Prostheses for Ventral Hernia Repair. J. Gastrointest Surg. 2007.
  13. Chand B, Indeck M, Needleman B, Finnegan M, Van Sickle KR, Ystgaard B, Gossetti F, Pullan RD, Giordano P, McKinley A. A retrospective study evaluating the use of Permacol™ surgical implant in incisional and ventral hernia repair. Int J Surg. 2014;12(4):296-303.
  14. Neil J. Smart, Morwena Marshall, Ian R. Daniels. Biological meshes: A review of their use in abdominal wall hernia repairs. The Surgeon , Available online March 2012;159-171
  15. Zheng, F, et al. Host Response after reconstruction of abdominal wall defects with porcine dermal collagen in a rat model. American Journal of Obstetrics and Gynecology(2004)191,1961-70.
  16. Novi, J.M., et al. Vaginal Paravaginal Repair using Human Cadaveric versus Porcine Dermal Implant: A Survival Analysis. Ohio Research and Clinical Review Fall 2006.
  17. Jin, J, et al. Abdominal Hernia Repair with Bridging Acellular Dermal Matrix - An Expensive Hernia Sac. American Hernia Society March 2007.
  18. Jin, J, et al. Use of Acellular Dermal Matrix for Complicated Ventral Hernia Repair: Does Technique Affect Outcomes? Journal of the American College of Surgeons Volume 205, Issue 5, November 2007, Pages 654-660.
  19. Rodriguez, Eduardo, et al. Abdominal Wall Reconstruction following Severe Loss of Domain: The R Adams Cowley Shock Trauma Center Algorithm. PRSJournal September 2007 DIO:10.1097/01/prs0000270303.44219.76.
  20. Newcomb, W.; Heniford, T, et al . Long-term Outcomes After Abdominal Wall Reconstruction With Acellular Human Dermis in Patients With Abdominal Injuries. 2007 AAST Session IV, Poster #10.