Feasibility Study of The Use of FLEX HD® Surgical Implant or STRATTICE® Reconstructive Tissue Matrix in The Closure of Abdominal Wall Defects With Component Separation in Clean or Contaminated Cases (Flex HD)

This study examines the feasibility of using Flex HD® Surgical Implant or STRATTICE® Reconstructive Tissue Matrixin the repair of hernias.

Study Overview

• Status: Completed
• Conditions: Hernia Repair With Compartment Syndrome
• Intervention / Treatment: Device: Flex HD; Device: Strattice

Detailed Description

At least 100,000 ventral hernia repairs are performed in the U.S. each year. Recently, biologically-based implants derived from acellular human dermis, porcine small intestinal submucosa, and porcine dermis have been reported in a variety of complex abdominal wall repair procedures. A variety of surgical techniques and implant placement methods have been described, with no one standard technique achieving precedence. Biologic implant reinforcement of a myofascial closure by means of component separation, or at a minimum, where three-layer fascial approximation is not possible, sublay placement (i.e., closure of the posterior rectus sheath under the implant) are described strategies. These techniques allow placement of the implant against an intact fascial layer and may improve implant incorporation into host tissue.

The Musculoskeletal Transplant Foundation (MTF) has manufactured and processed Flex HD Acellular Hydrated Dermis. This acellular dermis is derived from human skin. In complicated ventral hernia repairs, this type of graft tissue is necessary. Flex HD has been shown to reduce operative time, lower operative costs and provides minimal elasticity.

The Musculoskeletal Transplant Foundation (MTF) is a non-profit service organization dedicated to providing quality allograft tissue through a commitment to excellence in education, research, recovery and care for recipients, donors and their families. MTF is a national consortium comprised of academic medical institutions, organ procurement organizations and tissue recovery organizations. From their inception, they have been both donor-focused and surgeon-driven. Since their inception in 1987, MTF has recovered more than 60,000 donors and distributed more than 3 million grafts for transplantation.

The Foundation was established by surgeons and teaching institutions to meet the need for a high quality and consistent allograft supply.

• Study Type: Interventional
• Enrollment (Actual): 35
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Kentucky
    • Lexington, Kentucky, United States, 40536
      • University of Kentucky Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 85 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:• Have given written Informed Consent

• Be 18-85 years of age (inclusive)

• Patient has a ventral or incisional hernia with at least one of the following characteristics

  • Hernia is at least 6cm in transverse dimension
  • History of 2 or more prior ventral or incisional hernia repairs
  • Active or prior infection of the abdominal wall
  • Enterocutaneous fistula to the anterior abdominal wall
  • Mesh requiring mesh removal which would result in a hernia at least 6cm in transverse dimension
• Patients is scheduled to undergo component separation hernia repair
• Have an ASA Score of 3 or less
• Have a BMI between 20 and 55
• Be a candidate for primary approximation of skin and wound following hernia repair
• Have a life expectancy of at least 2 years

Exclusion Criteria:

• Have loss of abdominal domain such that the operation would be impractical or would adversely effect respiratory or cardiovascular function to an unacceptable degree
• Be a candidate for emergency surgery that would make giving valid Informed Consent impractical
• Be currently taking part in another clinical study that conflicts with the current study
• Have active generalized peritonitis or intraperitoneal sepsis
• Have active necrotizing fasciitis
• Have active abdominal compartment syndrome
• Have active untreated metabolic or systemic illness
• Have known active malignancy present
• Be unable to give valid informed consent or comply with required follow-up schedule
• Suffer from mental capacity sufficiently severe to make informed consent unobtainable

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NON_RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Flex HD; Mesh Type	Device: Flex HD; Flex HD mesh for hernia repair
ACTIVE_COMPARATOR: Strattice; Use of a second mesh type	Device: Strattice; Strattice mesh for hernia repair

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hernia Recurrence	Recurrence of hernia based on physical exam and /or CT scan.	12 months
Wound Occurrence	superficial or deep wound infection, abscess, seroma, cellulitis, necrosis, hematoma or wound dehiscence.	12 months
Wound Occurrence: Deep Wound Infection		12 Months
Wound Occurrence: Wound Abscess		12 Months
Wound Occurrence: Wound Seroma		12 Months
Wound Occurrence: Wound Cellulitis		12 Months
Wound Occurrence: Wound Dehiscence		12 Months
Wound Occurrence: Superficial Wound Infection	Superficial wound infection	12 months
Change in SF12 Physical Component Score Between Pre-operation and 12 Months Post-operation	Change in SF12 Physical Component Score from pre-operation to 12 months post-operation: Scores were normalized with 50 equal to the national norm and 40 equal to one standard deviation below the norm, so a 12 month difference of 10 would equal a 1 standard deviation change; An increase is better.	12 months
Change in SF12 Mental Component Score Between Pre-operation and 12 Months Post-operation	Change in SF12 Mental Component Score from pre-operation to 12 months post-operation: Scores were normalized with 50 equal to the national norm and 40 equal to one standard deviation below the norm; An increase is better.	12 months

Collaborators and Investigators

• Sponsor: John Roth
• Investigators: Principal Investigator: John S Roth, M.D., University of Kentucky

Publications and helpful links

Helpful Links

• Musculoskeletal Transplant Foundation

Study record dates

Study Major Dates

• Study Start: March 1, 2011
• Primary Completion (ACTUAL): May 1, 2015
• Study Completion (ACTUAL): May 1, 2015

Study Registration Dates

• First Submitted: May 9, 2012
• First Submitted That Met QC Criteria: May 10, 2012
• First Posted (ESTIMATE): May 11, 2012

Study Record Updates

• Last Update Posted (ACTUAL): March 16, 2017
• Last Update Submitted That Met QC Criteria: January 26, 2017
• Last Verified: October 1, 2016

More Information

Terms related to this study

• Keywords: Hernia; mesh; human tissue
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Musculoskeletal Diseases; Muscular Diseases; Pathological Conditions, Anatomical; Hernia; Compartment Syndromes
• Other Study ID Numbers: 11-0080-P6A