Characterisation and comparison of the host response of 6 tissue-based surgical implants in a subcutaneous in vivo rat model

Hernia repair often involves fascial augmentation using biologic prostheses. Small processing changes during preparation modulate host tissue response, which influence material efficacy and longevity. In this pilot study, a rat model was used to determine the specific influence of tissue origin, decellularisation treatment and 1,6-hexamethylene diisocyanate (HMDI) cross-linking.

Materials (1 cm²) were implanted subcutaneously into 6-week-old Wistar rats (4 materials per animal, n=6/material per time point) for 2, 5, 7, 14 and 28 days. Histologic processing was carried out after resin infiltration, observing classical histopathology and pathologic indexing. Materials comprised 6 tissue-based grafts covering both experimental and commercial porcine decellularised dermal and small intestinal submucosal materials.

Subcutaneous delivery of biologics demonstrated material-specific inflammatory/host responses. Controlled variations of the Permacol^TM manufacturing process showed sodium dodecyl sulfate (SDS) was the most proinflammatory decellularisation reagent, and HMDI cross-linking had no effect on host response. All materials remained recoverable after 28 days, although Surgisis^TM had partially resorbed.

Differences in host responses exist between biologic implants for hernia repair in this rat model. It is postulated that these modifications are induced during processing and may have an effect on the clinical outcome of hernia repair.