Reduction of abdominal adhesions using composite collagen-GAG implants forventral hernia repair

Structural biomaterials can restore abdominal wall integrity but may cause adhesions to the underlying viscera, Collagen-glycosaminoglycan (CG) matric es induce the formation of connective tissue and mag reduce adhesion format ion to permanent biomaterials such as polypropylene (PP) mesh, Composite im plants were created by interposing PP mesh within a porous CG matrix create d composite implants. The implants were cross-linked with glutaraldehyde on e group (CG-G/PP) or left untreated (CG-nG/PP) and compared to PP mesh. At 4 weeks, the abdominal wall was assessed for the degree of adhesions. The c omposite implants developed a nascent connective tissue-like structure that reduced adhesions to the bowel, The thickest connective tissue developed i n the CG-G/PP group (0.7 +/- 0.1 mm) and thinnest in the PP mesh (0.05 +/- 0.01 mm). The surface area covered with adhesions was greatest in the PP gr oup (72 +/- 17%) compared with the CG-G/PP group (28 +/- 15%) or the CG-nG/ PP group (21 +/- 8%). Bowel preferentially adhered to the PP mesh, whereas omentum had some adherence to all constructs. Integrating a biodegradable e xtracellular matrix analog with a permanent structural biomaterial reduced adhesions in this animal model. Alterations in cross-linking of the CG matr ix altered the biological response, This technology may be useful in recons tructive surgery by reducing adhesion formation, while maintaining the stre ngth of permanent structural biomaterials. (C) 2000 John Wiley & Sons. Inc. J Biomed Mater Res (Appl Biomater) 58. 75-80. 2001.