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• W2026551036 abstract "OBJECTIVE: The objective of this study was to determine the effects of interposition of biologic graft to augment repair of the fibromuscular layer of the posterior vaginal wall. METHODS: A standardized posterior vaginal wall defect was created in 18 New Zealand white rabbits. Thereafter, 15 of the defects were randomized to reapproximation with 3 polypropylene sutures (n=5), repair with polypropylene sutures, and a graft of SIS (Cook OB/GYN) interposed between the fibromuscular layer and the vaginal epithelium (n=8) or no repair (n=5). Three rabbits served as controls to establish baseline properties of the posterior fibromuscular wall. After 6 weeks, biomechanical testing was conducted on vaginal muscularis from control and repaired animals by investigators blinded to treatment. Histomorphology was determined using hematoxylin & eosin and Masson's trichrome stains of full-thickness sagittal sections of the posterior vaginal wall and rectum. RESULTS: After 6 weeks, stiffness of the vaginal wall was increased in the grafted vaginal wall compared with either repaired or control fascia (10.0 ± 1.7, graft; 5.6 ± 0.7, repair; 2.6 ± 0.17 gm/mm, control; mean ± SEM, P=0.06), indicating that the grafted vaginal wall was more resistant to stretch (ie, less elastic) than site-specific repair. The grafted muscularis also exhibited significantly less recoil compared with control or repaired muscularis. Maximal stress before failure was increased significantly in the grafted vagina (69.2 ± 2.8, graft; 35.5 ± 11.3, repair; 10.1 ± 1.5 × 104 N/m2, control, P=0.03), suggesting increased load-bearing capacity. Histologic analysis revealed that both repairs resulted in increased thickness of the vaginal fibromuscular layer compared with no repair. Morphology of vaginal muscularis from the repair group was similar to nonoperated controls except for mild fibrosis surrounding suture placement. Analysis of grafted vaginal muscularis revealed the presence of a dense core of acellular collagen with infiltrating aggregates of monocytes, eosinophils, and lipid-laden macrophages in the periphery. In 2 grafted animals, the fibromuscular layer appeared completely regenerated by smooth muscle bundles and fibroblasts in a dense collagenous matrix. CONCLUSIONS: Results from this 6-week study indicate that graft augmentation of site-specific repairs of the posterior vaginal wall results in increased load-bearing capacity and decreased elasticity of the muscularis compared with site-specific closure alone. These changes were accompanied by a marked inflammatory response in most animals. Studies are in progress to assess the long-term consequences of graft augmentation of site-specific repairs in this animal model." @default.
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• W2026551036 date "2005-01-01" @default.
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• W2026551036 title "Poster 51: Effects of Interposition of Small Intestinal Submucosa Graft to Augment Repair of Posterior Vaginal Wall Defects: 6 Weeks After Implantation" @default.
• W2026551036 doi "https://doi.org/10.1097/01.spv.0000178944.88059.9b" @default.
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