Pig skin for muscle repair revision? (photos)

Question

Hello, I am 4 months out from lipo of the upper abdomen/flanks and a tummy tuck with muscle repair. My muscle repair failed and my surgeon is giving me the option of a revision with or without the use of pig skin. What are the pros and cons of using the pig skin (outside of the price)? Also, what should I expect in regards to recovery in comparison to my original tummy tuck? Thank you.

Howard Webster, MBBS (Hons), FRACS · Answer

Hi there,I'm sorry to hear of your failed muscle repair.Firstly, a muscle repair that fails is uncommon.Possible causes are:Your anatomy (weak or thin fascia over the muscle which tears at the stitch holes of the sutures and does not "hold" the stitch, or it is possible you have too much visceral fat ( if you lie on your back, is your tummy full and protruding above your rib cage, or hollow?  If full, then a repair will not work well as it would need ot be closed too tightly and will not hold. In this case, you must lose some weight before re repair to deflate the visceral fat. Plastic surgery cannot access fat behind the muscle).Your post op activity. A muscle repair is really a hernia repair, and should not be stressed by any resisted activities for around 6 weeks post op.Your surgeon's chosen suture material - if it is dissolving, or was a weak suture, it might not hold.Your surgeons technique - the repair was not strongly enough constructed.Whatever the cause: ensure your visceral fat content is low before a re repair. Then, from your surgeons point of view, a RE REPAIR WITH REINFORCEMENT is necessary to cover all bases and give you the strongest possible repair so that this time it will hold.In my hands I use a permanent external mesh about 5cm wide overlaid on any repair I do if I judge that it may be weak - ie the fascia is thin. I've never used pigskin. I'm not saying there is anything wrong with it.Your surgeons is saying to you that reinforcement of the repair is necessary. This is logical and correct. If I were you I would have the repair reinforced this time. Maybe ask your surgeon why pigskin (allplastic ADM) as the reinforcement. Synthetic mesh made of similar materials to sutures is cheaper and when placed externally does not carry the risk of mesh placed intraabdominally. It is a safe use of mesh, and is cheap. Your surgeon might have great reasons to prefer pigskin, so worth asking why, and if there are cheaper reinforcement materials - there are!hope this helps,Please post how you go!Howard WebsterPlastic Surgeon.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thanks for the question and the photograph. With respect to the muscle repair, what was the cause of it failing? Did your surgeon explain why he thought it had failed. This will help to determine whether using the ADM (that you are referring to as pig skin) will be needed.Generally, if you do not have enough of a muscle layer or it is weaker and you need reinfocing then you have the options of a mesh or acellular dermal matrix (ADM). The ADM is derived from but is not pig skin as such. It provides the scaffold for your cells to grow into in and integrate into the scaffold. This will help to increase the strength of the repair. My only question is why it wasnt used initially if he/she felt this was needed or did he ?I hope this is of some help

Robert Oliver Jr., MD · Answer

it would be rare to need mesh to reinforce all but the worst types of abdominal wall diastasis, so I’m skeptical about your case. Usually this represents either a busted running suture used in the first procedure or a patIent with high intraabdominal pressures that cause the abdomen to rebulge by stretching  laterally. If you did in fact need mesh, we would usually use a light weight synthetic polyester (Prolene) rather then a biologic mesh as it tends to produce a better repair and costs 80%+ less for the mesh. It is also much less prone to infection or seroma (fluid collections) then a large pig skin mesh piece would be.Looking at your picture, it really looks more like that your upper abdomen fat is thicker rather then a recurring diastasis bulge to me. That could just be the picture fooling me though.

Raja Mohan, MD · Answer

Pig skin or any bioprosthetic is usually reserved for patients with an abdominal wall hernia. It is extremely expensive. In a situation where the muscle plication repair failed, I believe a different technique or type of suture material will produce a more robust repair that will last. A surgeon can really only diagnose what's going on when performing the revision. Hope this helps and best of luck.

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