Permacol

[Anonymous]

How do you guys feel about Permacol? I've heard mixed reports. I know we can make a lot of $, but a lot of people are saying this is a bad product.

 

[Anonymous]

..

 

[Anonymous]

All of my Dr.'s have already tried it and refuse to use it again. They are all using either Alloderm, or Allomax now.

 

[Anonymous]

This stuff is awsome. I just plowed my entire 401k into Covidian based on this product alone. Go get em' guys.

 

[Anonymous]

All of my Dr.'s have already tried it and refuse to use it again. They are all using either Alloderm, or Allomax now.

I would be interested to know why they won't use it again (other than the SMELL). Did they have case failures, explant any? What features didn't they like about it?

Thanks!

 

[Anonymous]

Good Question, Here is the answer:

1. Permacol is cross linked, cross linking facilitates a foreign body response, which leads to encapsulation. Encapsulation, by definition means little to no blood flow. For Biologic grafts to be successful there must be vascularization. (I won't go deeper than this because I would have 3 pages)

2. Biologic grafts are typically used in contaminated situations or high risk patients. As mentioned above, Permacol gets very little blood flow. In a contaminated situation this means diminished macrophages (white blood cells), and diminished delivery of antibiotics. In a contaminated situation macrophages and antibiotics are critical to avoid infection. Permacol gets infected just like a synthetic and must be removed.

3. Permacol cross links through a process called EDC. The EDC process forms the cross links by leaving small amounts of foreign bodies behind (the cross links between the molecules are foreign bodies). This leads to increased foreign body response.

4. The only real advantage to cross-linked porcine dermis is the size of the grafts. However, this isn't really an advantage. Study after study have shown that bridging defects with biologics doesn't work. Regardless of which one you use. The defect must be closed primarily. On larger defects this means using a component separation technique. Because these grafts are only successful when buttressing you only need smaller pieces. This effectively eliminates the need for larger grafts.

5. It does smell really bad

6. Most Dr.'s at this point have had poor experiences with cross linking. Either through Permacol or Collamend.

7. It sutures like leather.

8. Tyco bought a product that most Dr's were moving away from and increased (or soon will increase) the price 30-40%. They also eliminated the consignment program and told customers if they want to keep it, they have to buy it. This makes converting these Dr.'s even easier.

9. Tyco has a long hard road ahead of them. Learning about biologic grafts is a painful experience. Ask LifeCell or Bard. They learned the hard way. Ethicon is going through it now. Particularly with the small territories Tyco reps have. Once they burn the 5-10 accounts they have, where will they go?

I realize that Tyco corporate is going to feed you a bunch of company kool aid and you guys are going to be pushing the hell out of this. You have a sweet talk track. Cheaper, bigger, lasts longer, no hydration time, no quilting pieces together, etc... As a competitor, I say please, push the hell out of this. It will only benefit us in the long run. After your Permacol fails, how likely is it that Dr. Jones will try your Polyester?

I also realize I have given you a lot of our talking points. I don't care!!! This is a shit bag product. No matter what you say, you can't change that. Even if you know what your competitor is saying about it.

 

[Anonymous]

Good Question, Here is the answer:

1. Permacol is cross linked, cross linking facilitates a foreign body response, which leads to encapsulation. Encapsulation, by definition means little to no blood flow. For Biologic grafts to be successful there must be vascularization. (I won't go deeper than this because I would have 3 pages)

2. Biologic grafts are typically used in contaminated situations or high risk patients. As mentioned above, Permacol gets very little blood flow. In a contaminated situation this means diminished macrophages (white blood cells), and diminished delivery of antibiotics. In a contaminated situation macrophages and antibiotics are critical to avoid infection. Permacol gets infected just like a synthetic and must be removed.

3. Permacol cross links through a process called EDC. The EDC process forms the cross links by leaving small amounts of foreign bodies behind (the cross links between the molecules are foreign bodies). This leads to increased foreign body response.

4. The only real advantage to cross-linked porcine dermis is the size of the grafts. However, this isn't really an advantage. Study after study have shown that bridging defects with biologics doesn't work. Regardless of which one you use. The defect must be closed primarily. On larger defects this means using a component separation technique. Because these grafts are only successful when buttressing you only need smaller pieces. This effectively eliminates the need for larger grafts.

5. It does smell really bad

6. Most Dr.'s at this point have had poor experiences with cross linking. Either through Permacol or Collamend.

7. It sutures like leather.

8. Tyco bought a product that most Dr's were moving away from and increased (or soon will increase) the price 30-40%. They also eliminated the consignment program and told customers if they want to keep it, they have to buy it. This makes converting these Dr.'s even easier.

9. Tyco has a long hard road ahead of them. Learning about biologic grafts is a painful experience. Ask LifeCell or Bard. They learned the hard way. Ethicon is going through it now. Particularly with the small territories Tyco reps have. Once they burn the 5-10 accounts they have, where will they go?

I realize that Tyco corporate is going to feed you a bunch of company kool aid and you guys are going to be pushing the hell out of this. You have a sweet talk track. Cheaper, bigger, lasts longer, no hydration time, no quilting pieces together, etc... As a competitor, I say please, push the hell out of this. It will only benefit us in the long run. After your Permacol fails, how likely is it that Dr. Jones will try your Polyester?

I also realize I have given you a lot of our talking points. I don't care!!! This is a shit bag product. No matter what you say, you can't change that. Even if you know what your competitor is saying about it.

Please.......enlighten us more Mr. Marketing guy!

 

[Anonymous]

Good Question, Here is the answer:

1. Permacol is cross linked, cross linking facilitates a foreign body response, which leads to encapsulation. Encapsulation, by definition means little to no blood flow. For Biologic grafts to be successful there must be vascularization. (I won't go deeper than this because I would have 3 pages)

2. Biologic grafts are typically used in contaminated situations or high risk patients. As mentioned above, Permacol gets very little blood flow. In a contaminated situation this means diminished macrophages (white blood cells), and diminished delivery of antibiotics. In a contaminated situation macrophages and antibiotics are critical to avoid infection. Permacol gets infected just like a synthetic and must be removed.

3. Permacol cross links through a process called EDC. The EDC process forms the cross links by leaving small amounts of foreign bodies behind (the cross links between the molecules are foreign bodies). This leads to increased foreign body response.

4. The only real advantage to cross-linked porcine dermis is the size of the grafts. However, this isn't really an advantage. Study after study have shown that bridging defects with biologics doesn't work. Regardless of which one you use. The defect must be closed primarily. On larger defects this means using a component separation technique. Because these grafts are only successful when buttressing you only need smaller pieces. This effectively eliminates the need for larger grafts.

5. It does smell really bad

6. Most Dr.'s at this point have had poor experiences with cross linking. Either through Permacol or Collamend.

7. It sutures like leather.

8. Tyco bought a product that most Dr's were moving away from and increased (or soon will increase) the price 30-40%. They also eliminated the consignment program and told customers if they want to keep it, they have to buy it. This makes converting these Dr.'s even easier.

9. Tyco has a long hard road ahead of them. Learning about biologic grafts is a painful experience. Ask LifeCell or Bard. They learned the hard way. Ethicon is going through it now. Particularly with the small territories Tyco reps have. Once they burn the 5-10 accounts they have, where will they go?

I realize that Tyco corporate is going to feed you a bunch of company kool aid and you guys are going to be pushing the hell out of this. You have a sweet talk track. Cheaper, bigger, lasts longer, no hydration time, no quilting pieces together, etc... As a competitor, I say please, push the hell out of this. It will only benefit us in the long run. After your Permacol fails, how likely is it that Dr. Jones will try your Polyester?

I also realize I have given you a lot of our talking points. I don't care!!! This is a shit bag product. No matter what you say, you can't change that. Even if you know what your competitor is saying about it.

Exactly how has Lifecell "Learned the hard way"? WTF? Not sure how being purchased for 1.8 Billion fits your idiotic statement? please help?

 

[Anonymous]

Lifecell and Bard have learned a number of hard lessons.....Biologic meshes behave differently than synthetics. As such, different techniques must be used. When, where and how, those are the difficult lessons that were learned. All of which are irrelevant for TYCO. No matter what you do, cross-linked porcine will fail.

 

[Anonymous]

the life cell person who wrote all the above stuff was just repeating the wrong info they were told my their marketing department. i do agree that collamend sucks though. and one last question, if porcine dermis doesn't work, why did life cell come out with strattice, a porcine dermis graft that has a matrix stablizer (which is another word for crosslinking).

 

[Anonymous]

the life cell person who wrote all the above stuff was just repeating the wrong info they were told my their marketing department. i do agree that collamend sucks though. and one last question, if porcine dermis doesn't work, why did life cell come out with strattice, a porcine dermis graft that has a matrix stablizer (which is another word for crosslinking).

I thought Permacol and Collamend were basically the same (at least I've heard they both get encapsulated, etc). What's the difference?

 

[Anonymous]

the life cell person who wrote all the above stuff was just repeating the wrong info they were told my their marketing department. i do agree that collamend sucks though. and one last question, if porcine dermis doesn't work, why did life cell come out with strattice, a porcine dermis graft that has a matrix stablizer (which is another word for crosslinking).

It doesn't sound to me like none of the "above stuff" would come from a marketing department. I too agree that collamend sucks. Crosslinking=rejection. Why did Life Cell go from human skin to pig skin when the real problem is with DERMIS . Dermis=elastin. Elastin=recurrence. If not a complete recurrence then at least bulging. The only spot dermis grafts of any source makes sense is in the breast for slings where some degree of relaxation is desirable.

...which leads me to believe the above stuff was not written by a life cell person. Surgisis?

 

[Anonymous]

It doesn't sound to me like none of the "above stuff" would come from a marketing department. I too agree that collamend sucks. Crosslinking=rejection. Why did Life Cell go from human skin to pig skin when the real problem is with DERMIS . Dermis=elastin. Elastin=recurrence. If not a complete recurrence then at least bulging. The only spot dermis grafts of any source makes sense is in the breast for slings where some degree of relaxation is desirable.

...which leads me to believe the above stuff was not written by a life cell person. Surgisis?

This post was clearly written by a covidienista. Just reeks of ignorance.

Before you spout off all the fancy medical words you learned in your on-line training course, perhaps you should know what they mean.

'Rejection' is an entirely different physiological event than encapsulation and/or extrusion. Look it up.

Dermis is not comprised of elastin, alone. Furthemore, the ratios of the various proteins (collagen I, elastin, etc) can be controlled in the manufacturing process so it's not a question of dermis vs SIS vs pericardium, etc.

you guys are dangerous.

 

[Anonymous]

This post was clearly written by a covidienista. Just reeks of ignorance.

Before you spout off all the fancy medical words you learned in your on-line training course, perhaps you should know what they mean.

'Rejection' is an entirely different physiological event than encapsulation and/or extrusion. Look it up.

Dermis is not comprised of elastin, alone. Furthemore, the ratios of the various proteins (collagen I, elastin, etc) can be controlled in the manufacturing process so it's not a question of dermis vs SIS vs pericardium, etc.

you guys are dangerous.

Lighten up buddy. Were you not hugged as a child? Perhaps you were picked on in high school and therefore feel the need to lash out behind the safety and protection of your computer.

The more processing needed to make a graft stronger, the higher likelihood the body perceives it as a foreign body and therefore encapsulates it. So, it ABSOLUTELY IS a question of dermis vs SIS vs pericardium vs a ziploc bag. Collagen and elastin are both proteins, but one is stronger than the other. Pig intestine contains higher contents of collagen, (1,3,4,5 and 6) look it up Einstein... and insignificant amounts of elastin among other things no doubt you will be quick to point out. Pig skin, although not comprised of elastin alone, does contain a very signficant amount resulting in a much weaker repair over time.

Choose love not hate.

 

[Anonymous]

The more processing needed to make a graft stronger, the higher likelihood the body perceives it as a foreign body and therefore encapsulates it. So, it ABSOLUTELY IS a question of dermis vs SIS vs pericardium vs a ziploc bag.

Choose love not hate.

Thank God I get to compete against people like the one who wrote this response.

With this brilliant logic, we might as well put unprocessed grafts in patients. what a r-tard.

 

[Anonymous]

Good Question, Here is the answer:

1. Permacol is cross linked, cross linking facilitates a foreign body response, which leads to encapsulation. Encapsulation, by definition means little to no blood flow. For Biologic grafts to be successful there must be vascularization. (I won't go deeper than this because I would have 3 pages)

2. Biologic grafts are typically used in contaminated situations or high risk patients. As mentioned above, Permacol gets very little blood flow. In a contaminated situation this means diminished macrophages (white blood cells), and diminished delivery of antibiotics. In a contaminated situation macrophages and antibiotics are critical to avoid infection. Permacol gets infected just like a synthetic and must be removed.

3. Permacol cross links through a process called EDC. The EDC process forms the cross links by leaving small amounts of foreign bodies behind (the cross links between the molecules are foreign bodies). This leads to increased foreign body response.

4. The only real advantage to cross-linked porcine dermis is the size of the grafts. However, this isn't really an advantage. Study after study have shown that bridging defects with biologics doesn't work. Regardless of which one you use. The defect must be closed primarily. On larger defects this means using a component separation technique. Because these grafts are only successful when buttressing you only need smaller pieces. This effectively eliminates the need for larger grafts.

5. It does smell really bad

6. Most Dr.'s at this point have had poor experiences with cross linking. Either through Permacol or Collamend.

7. It sutures like leather.

8. Tyco bought a product that most Dr's were moving away from and increased (or soon will increase) the price 30-40%. They also eliminated the consignment program and told customers if they want to keep it, they have to buy it. This makes converting these Dr.'s even easier.

9. Tyco has a long hard road ahead of them. Learning about biologic grafts is a painful experience. Ask LifeCell or Bard. They learned the hard way. Ethicon is going through it now. Particularly with the small territories Tyco reps have. Once they burn the 5-10 accounts they have, where will they go?

I realize that Tyco corporate is going to feed you a bunch of company kool aid and you guys are going to be pushing the hell out of this. You have a sweet talk track. Cheaper, bigger, lasts longer, no hydration time, no quilting pieces together, etc... As a competitor, I say please, push the hell out of this. It will only benefit us in the long run. After your Permacol fails, how likely is it that Dr. Jones will try your Polyester?

I also realize I have given you a lot of our talking points. I don't care!!! This is a shit bag product. No matter what you say, you can't change that. Even if you know what your competitor is saying about it.

This is not an answer to the original question but an opinion, and in some instances, not a well informed one. For example the crosslinking agent/process in Permacol is NOT EDC (point 3 above). Also, most Doctors have had a bad experience with crosslinking (point 6) is a silly and unsubstantiated exaggeration.

 

[Anonymous]

What about Surgimend from TEI Bioscience. Are you starting to see this product in hospitals?

 

[Anonymous]

What about Surgimend from TEI Bioscience. Are you starting to see this product in hospitals?

GO ETHICON,GO!!!!

 

[Anonymous]

This is interesting debate - but have any of you actually used these products?

As a practicing surgeon with a well established practice of using different biologics over the course of time as well as composites and pure synthetics clearly most of the comment is both uninformed and produced by people tied to different companies. From a practical users perspective, Permacol (and I'll stick to this one as it's the topic here) is indeed cross-linked and having used it for the last 6 years (pre-Tyco/Covidien) I have no problem with it in the situations in which I use it - reconstruction of abdominal walls (separation of components and in pts who have previously infected meshes to be removed), reconstructing defects such as the pelvic floor, and as an adjunct or bridge to allow coverage of an open abdomen following gross intra-peritoneal sepsis.

Perhaps you should take the educated view that the right product, in the hands of the right surgeon, with an understanding of both its properties and weaknesses, is best suited to the right patient.

Clearly most of the comments written here are uneducated, corporate speak with little review of the scientific literature. Perhaps on an even playing field with the different materials compared in the same types of patients the evidence becomes obvious for the benefit or not of each material.

Science always wins, any product that in the hands of a practicing surgeon works will survive the test of time - just look at hip joints!

 

[Anonymous]

Tyco bought a product that most Dr's were moving away from and increased (or soon will increase) the price 30-40%. They also eliminated the consignment program and told customers if they want to keep it, they have to buy it. This makes converting these Dr.'s even easier.