Dear editor,
We are thankful for the interest in our work shown by Professor Pawan Agarwal and Professor Dhananjaya Sharma.
Full-thickness grafts without de-epithelialization have been used by our group since 2005 in special cases and in this randomized-controlled study. No transplant-related complications have appeared as described in the published manuscript. A few of the patients have had further surgery for other reasons than hernia and the mentioned problem with cyst, infection, sinus, and metaplastic transformation has not been seen. In a couple of cases, biopsies have been taken during secondary surgery. None of these have shown any hair follicles or sweat glands. The article by Gray 1951 is about an experimental study in dogs, why the reaction in humans might not be the same.
Skin from the abdominal wall has been used as a free transplant when it has been of good quality. When skin covering a hernia sac is used, it constitutes a limited part of the graft. If skin from the abdominal wall is of poor quality, or there is a risk of high tension when closing the abdominal wall, skin from the upper arm or thigh is used instead.
Sincerely,
Karin Strigård, Ass. Prof.
Leonard Clay, Ph.D.
Birgit Stark, Ass. Prof.
Ulf Gunnarsson, Prof.
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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments, or comparable ethical standards. This study was approved by the Regional Board of Ethics (D.nr. 2009/227-31/3) at the Karolinska Institute, Stockholm, March 11, 2009. All experiments in the study comply with the current laws of Sweden.
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The authors confirm that all ongoing and related trials for this intervention are registered. The study was registered at ClinicalTrials.gov (ID NCT01413412).
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Strigård, K., Clay, L., Stark, B. et al. Reply to Comment to: Full-thickness skin graft vs. synthetic mesh in the repair of giant incisional hernia: a randomized-controlled multicenter study. P. Agarwal, D. Sharma. Hernia 22, 1001 (2018). https://doi.org/10.1007/s10029-018-1779-z
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DOI: https://doi.org/10.1007/s10029-018-1779-z