V2-04: Allograft Dermis for Female Pelvic Floor Repair
Annually, over 200,000 women undergo surgical correction of pelvic organ prolapse in the United States. Several materials are used including allograft tissue and synthetic grafts. In 2011, the FDA issued a statement that serious complications are not rare with the use of surgical mesh in transvaginal repair of pelvic organ prolapse (POP). Dermal allografts represent an alternative to mesh and consist of solvent-dehydrated, gamma-irradiated, preserved human collagen. This video will demonstrate the detailed surgical technique for placement of a dermal allograft in the correction of POP, review contemporary indications for this procedure and discuss potential challenges encountered during the procedure. _x000D_
A retrospective review was performed using medical records of patients at our center who have undergone placement of dermal allografts for POP from August 2013 to October 2015. The graft material was soaked in a solution of neomycin sulfate and polymyxin B sulfate then prepared in a standard fashion. The graft was then secured to the sacrospinous ligaments bilaterally using a suture passing device, then trimmed to fit the patient anatomy. _x000D_
Forty-six female pelvic floor repairs were performed in 42 patients using allograft dermis of which 7/42 (17%) patients had undergone previous prolapse repair. Mean age was 66 years with 30/46 (65%) Grade 3 prolapse and 15/46 (33%) with Grade 4 prolapse using the Baden-Walker system. Simultaneous pubovaginal sling placement for concomitant stress urinary incontinence was performed in 29/42 (67%) patients. Complications related to graft placement including wound dehiscence in 1/46 (2.2%) and hematoma requiring evacuation in 1/46 (2.2%). No patient complained of or demonstrated on exam clinically significant recurrence at follow up. _x000D_ _x000D_
Allograft dermis for female pelvic floor repair is an effective and safe procedure in the era of FDA warnings regarding the use of surgical mesh in transvaginal repair of pelvic organ prolapse. _x000D_
Funding: Coloplast Corp. provided funding for video editing services.