Open Access Open Badges Research article

Effect on the tensile strength of human acellular dermis (Epiflex®) of in-vitro incubation simulating an open abdomen setting

Mario Vitacolonna1, Michael Mularczyk2, Florian Herrle1, Torsten J Schulze3, Hans Haupt2, Matthias Oechsner2, Lothar R Pilz4, Peter Hohenberger1 and Eric Dominic Rössner1*

Author Affiliations

1 Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Centre Mannheim, Heidelberg University, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany

2 Center for structural Materials, State Material Testing Institute Darmstadt (MPA), Chair and Institute for Material Science (IfW), Technische Universität Darmstadt, Darmstadt, Germany

3 German Red Cross Blood Service, Baden Württemberg-Hessen, Medical Faculty of Mannheim, Institute of Transfusion Medicine and Immunology, Heidelberg University, Mannheim, Germany

4 Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany

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BMC Surgery 2014, 14:7  doi:10.1186/1471-2482-14-7

Published: 27 January 2014



The use of human acellular dermis (hAD) to close open abdomen in the treatment process of severe peritonitis might be an alternative to standard care. This paper describes an investigation of the effects of fluids simulating an open abdomen environment on the biomechanical properties of Epiflex® a cell-free human dermis transplant.


hAD was incubated in Ringers solution, blood, urine, upper gastrointestinal (upper GI) secretion and a peritonitis-like bacterial solution in-vitro for 3 weeks. At day 0, 7, 14 and 21 breaking strength was measured, tensile strength was calculated and standard fluorescence microscopy was performed.


hAD incubated in all five of the five fluids showed a decrease in mean breaking strength at day 21 when compared to day 0. However, upper GI secretion was the only incubation fluid that significantly reduced the mechanical strength of Epiflex after 21days of incubation when compared to incubation in Ringer’s solution.


hAD may be a suitable material for closure of the open abdomen in the absence of upper GI leakage and pancreatic fistulae.

Acellular dermis; Open abdomen; Breaking strength; Biologicals