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Xu D, Fang M, Wang Q, Qiao Y, Li Y, Wang L. Latest Trends on the Attenuation of Systemic Foreign Body Response and Infectious Complications of Synthetic Hernia Meshes. ACS APPLIED BIO MATERIALS 2022; 5:1-19. [PMID: 35014826 DOI: 10.1021/acsabm.1c00841] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Throughout the past few years, hernia incidence has remained at a high level worldwide, with more than 20 million people requiring hernia surgery each year. Synthetic hernia meshes play an important role, providing a microenvironment that attracts and harbors host cells and acting as a permanent roadmap for intact abdominal wall reconstruction. Nevertheless, it is still inevitable to cause not-so-trivial complications, especially chronic pain and adhesion. In long-term studies, it was found that the complications are mainly caused by excessive fibrosis from the foreign body reaction (FBR) and infection resulting from bacterial colonization. For a thorough understanding of their complex mechanism and providing a richer background for mesh development, herein, we discuss different clinical mesh products and explore the interactions between their structure and complications. We further explored progress in reducing mesh complications to provide varied strategies that are informative and instructive for mesh modification in different research directions. We hope that this work will spur hernia mesh designers to step up their efforts to develop more practical and accessible meshes by improving the physical structure and chemical properties of meshes to combat the increasing risk of adhesions, infections, and inflammatory reactions. We conclude that further work is needed to solve this pressing problem, especially in the analysis and functionalization of mesh materials, provided of course that the initial performance of the mesh is guaranteed.
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Affiliation(s)
- Danyao Xu
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Meiqi Fang
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Qian Wang
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Yansha Qiao
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Yan Li
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science &Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.,Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
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Nessel R, Löffler T, Rinn J, Lösel P, Voss S, Heuveline V, Vollmer M, Görich J, Ludwig YM, Al-Hileh L, Kallinowski F. Primary and Recurrent Repair of Incisional Hernia Based on Biomechanical Considerations to Avoid Mesh-Related Complications. Front Surg 2022; 8:764470. [PMID: 34977141 PMCID: PMC8714753 DOI: 10.3389/fsurg.2021.764470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/25/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Mechanical principles successfully guide the construction of polymer material composites in engineering. Since the abdominal wall is a polymer composite augmented with a textile during incisional hernia repair we ask: can incisional hernia be repaired safely and durably based on biomechanical principles? Material and Methods: Repair materials were assessed on a self-built bench test using pulse loads to elude influences on the reconstruction of the abdominal wall. Tissue elasticity was analyzed preoperatively as needed with computed tomography at rest and during Valsalva's maneuver. Preoperatively, the critical retention force of the reconstruction to pulse loads was calculated and a biomechanically durable repair was designed based on the needs of the individual patient. Intraoperatively, the design was adjusted as needed. Hernia meshes with high grip factors (Progrip®, Dahlhausen® Cicat) were used for the repairs. Mesh sizes, fixation elements and reconstructive details were oriented on the biomechanical design. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved. Results: A total of 163 patients (82 males and 81 females) were treated for incisional hernia in four hospitals by ten surgeons. Primary hernia was repaired in 119 patients. Recurrent hernia was operated on in 44 cases. Recurrent hernia was significantly larger (median 161 cm2 vs. 78 cm2; u-test: p = 0.00714). Re-do surgery took significantly longer (median 229 min vs. 150 min; p < 0.00001) since recurrent disease required more often transversus abdominis release (70% vs. 47%). GRIP tended to be higher in recurrent repair (p = 0.01828). Complication rates (15%) and hospital stay were the same (6 vs. 6 days; p = 0.28462). After 1 year, no recurrence was detected in either group. Pain levels were equally low in both primary and recurrent hernia repairs (median NAS = 0 in both groups at rest and under load, p = 0.88866). Conclusion: Incisional hernia can safely and durably be repaired based on biomechanical principles both in primary and recurrent disease. The GRIP concept provides a base for the application of biomechanical principles in incisional hernia repair.
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Affiliation(s)
- Regine Nessel
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Heilbronn, Germany
| | - Thorsten Löffler
- General and Visceral Surgery, Gesundheitszentrum Rhein-Neckar Hospital Eberbach, Eberbach, Germany
| | - Johannes Rinn
- General and Visceral Surgery, Kreiskrankenhaus Bergstrasse Hospital Bergstrasse, Heppenheim, Germany
| | - Philipp Lösel
- Engineering Mathematics and Computing Lab, Interdisciplinary Center for Scientific Computing, Heidelberg, Germany
| | - Samuel Voss
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Vincent Heuveline
- Engineering Mathematics and Computing Lab, Interdisciplinary Center for Scientific Computing, Heidelberg, Germany
| | - Matthias Vollmer
- Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | | | | | - Luai Al-Hileh
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Heilbronn, Germany
| | - Friedrich Kallinowski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP. J Gastrointest Surg 2022; 26:950-964. [PMID: 35064459 PMCID: PMC9021144 DOI: 10.1007/s11605-022-05248-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023]
Abstract
AIM The aim of this paper was to provide a narrative review of surgical site infection after hernia surgery and the influence of perioperative preventative interventions. METHODS The review was based on current national and international guidelines and a literature search. RESULTS Mesh infection is a highly morbid complication after hernia surgery, and is associated with hospital re-admission, increased health care costs, re-operation, hernia recurrence, impaired quality of life and plaintiff litigation. The American College of Surgeons National Surgical Quality Improvement Program is a particularly useful resource for the study and evidence-based practise of abdominal wall hernia repair. DISCUSSION The three major modifiable patient comorbidities significantly associated with postoperative surgical site infection in hernia surgery are obesity, tobacco smoking and diabetes mellitus. Preoperative optimization includes weight loss, cessation of smoking, and control of diabetes. Intraoperative interventions relate, in particular, to the control of fomite mediated transmission in the operating theatre and prevention of mesh contamination with S. aureus CFUs. Risk management strategies should also target the niche ecological conditions which enable bacterial survival and subsequent biofilm formation on an implanted mesh. Outcomes of mesh infection after hernia surgery are closely related to mesh type and porosity, patient smoking status, presence of MRSA, bacterial adhesion and biofilm production. The use of suction drains and the timing of drain removal are controversial and discussed in detail. Finally, the utility of the ACS-NSQIP Surgical Risk Calculator in predicting complications and outcomes in individual patients and the importance of quality improvement initiatives in surgical units are emphasized.
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Mardina Z, Venezuela J, Maher C, Shi Z, Dargusch M, Atrens A. Design, mechanical and degradation requirements of biodegradable metal mesh for pelvic floor reconstruction. Biomater Sci 2022; 10:3371-3392. [DOI: 10.1039/d2bm00179a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pelvic organ prolapse (POP) is the herniation of surrounding tissue and organs into the vagina and or rectum, and is a result of weakening of pelvic floor muscles, connective tissue,...
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Hope WW, El-Ghazzawy AG, Winterstein BA, Blatnik JA, Davis SS, Greenberg JA, Sanchez NC, Pauli EM, Tseng DM, LeBlanc KA, Roberts KE, Bower CE, Parra-Davila E, Roth JS, Deeken CR, Smith EF. A prospective, multicenter trial of a long-term bioabsorbable mesh with Sepra technology in cohort of challenging laparoscopic ventral or incisional hernia repairs (ATLAS trial). Ann Med Surg (Lond) 2022; 73:103156. [PMID: 34976385 PMCID: PMC8689054 DOI: 10.1016/j.amsu.2021.103156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This prospective, multicenter, single-arm, open-label study evaluated P4HB-ST mesh in laparoscopic ventral or incisional hernia repair (LVIHR) in patients with Class I (clean) wounds at high risk for Surgical Site Occurrence (SSO). METHODS Primary endpoint was SSO requiring intervention <45 days. Secondary endpoints included: surgical procedure time, length of stay, SSO >45 days, hernia recurrence, device-related adverse events, reoperation, and Quality of Life at 1, 3, 6, 12, 18, and 24-months. RESULTS 120 patients (52.5% male), mean age of 55.0 ± 14.9 years, and BMI of 33.2 ± 4.5 kg/m2 received P4HB-ST mesh. Patient-reported comorbid conditions included: obesity (86.7%), active smoker (45.0%), COPD (5.0%), diabetes (16.7%), immunosuppression (2.5%), coronary artery disease (7.5%), chronic corticosteroid use (2.5%), hypoalbuminemia (0.8%), advanced age (10.0%), and renal insufficiency (0.8%). Hernia types were primary ventral (44.2%), primary incisional (37.5%), recurrent ventral (5.8%), and recurrent incisional (12.5%). Patients underwent LVIHR in laparoscopic (55.8%) or robotic-assisted cases (44.2%), mean defect size 15.7 ± 28.3 cm2, mean procedure time 85.9 ± 43.0 min, and mean length of stay 1.0 ± 1.4 days. There were no SSOs requiring intervention beyond 45 days, n = 38 (31.7%) recurrences, n = 22 (18.3%) reoperations, and n = 2 (1.7%) device-related adverse events (excluding recurrence). CONCLUSION P4HB-ST mesh demonstrated low rates of SSO and device-related complications, with improved quality of life scores, and reoperation rate comparable to other published studies. Recurrence rate was higher than expected at 31.7%. However, when analyzed by hernia defect size, recurrence was disproportionately high in defects ≥7.1 cm2 (43.3%) compared to defects <7.1 cm2 (18.6%). Thus, in LVIHR, P4HB-ST may be better suited for small defects. Caution is warranted when utilizing P4HB-ST in laparoscopic IPOM repair of larger defects until additional studies can further investigate outcomes.
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Affiliation(s)
- William W. Hope
- New Hanover Regional Medical Center, Department of Surgery, Wilmington, NC, United States
| | | | | | - Jeffrey A. Blatnik
- Washington University, Department of Surgery, St. Louis, MO, United States
| | - S. Scott Davis
- Emory University, Department of Surgery, Atlanta, GA, United States
| | - Jacob A. Greenberg
- University of Wisconsin, Department of Surgery, Madison, WI, United States
| | - Noel C. Sanchez
- Via-Christi Hospital, Department of Surgery, Wichita, KS, United States
| | - Eric M. Pauli
- Penn State Hershey Medical Center, Department of Surgery, Hershey, PA, United States
| | - Daniel M. Tseng
- Legacy Health, Department of Surgery, Portland, OR, United States
| | - Karl A. LeBlanc
- Our Lady of the Lake Regional Medical Center, Department of Surgery, Baton Rouge, LA, United States
| | - Kurt E. Roberts
- St. Francis Hospital, Department of Surgery, Hartford, CT, United States
| | - Curtis E. Bower
- Carilion Clinic, Department of Surgery, Roanoke, VA, United States
| | | | - J. Scott Roth
- University of Kentucky, Department of Surgery, Lexington, KY, United States
| | | | - Eric F. Smith
- Georgetown Community Hospital, Department of Surgery, Georgetown, KY, United States
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Issa M, Noureldin K, Elgadi A, Abdelaziz A, Badawi M, Makram M. Evaluation of the Sublay Mesh Repair Outcomes in Different Types of Ventral Hernia. Cureus 2021; 13:e20590. [PMID: 35103166 PMCID: PMC8777263 DOI: 10.7759/cureus.20590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction: Ventral hernia repair is one of the challenging surgical operations over time. Several surgical techniques for mesh repair have been described (onlay, inlay, sublay, and underlay repairs). It is suggested that sublay mesh repair has the lowest recurrence and surgical site infection in open anterior abdominal hernia repair. This study aimed to analyze the pros and cons of the sublay mesh in ventral hernia repair to evaluate the significance of this technique as a treatment modality. Hospital stay, acute postoperative complications, and the recurrence rate were the main areas of investigation. Methods: A retrospective study on 79 patients with ventral hernias who were operated on with sublay mesh repair between January 2015 and December 2018 was conducted. Patients were admitted through the elective route. The study included fit patients with first-time ventral hernias (primary and incisional). Recurrent hernia, patients with decompensated cardiopulmonary disorders, and bleeding disorders were excluded from the project. The project pro forma includes patient’s demographics, operative details, length of stay, postoperative complications, and follow-up up to 12 months. Results: All patients underwent open mesh repair using the sublay technique. The ventral hernia was five times more common in females than males. The mean age of presentation was 44.8 years old. The mean operating time was 67 minutes and a one-day hospital stay. Paraumblical and incisional hernias represented the majority of cases. The component separation approach was added in three cases (3.7%). Simultaneous cholecystectomy was performed in two cases (2.5%). Only six cases (6.3%) developed wound-related complications, while two cases (2.5%) had a recurrence. Conclusion: The sublay mesh repair is a perfect choice for the repair of ventral abdominal hernia. It is associated with a smooth and short hospital stay and the least incidence of complications and recurrence.
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Tomaszewska A, Reznikov D. Combined numerical and experimental approach to determine numerical model of abdominal scaffold. Comput Methods Biomech Biomed Engin 2021; 25:1235-1248. [PMID: 34841994 DOI: 10.1080/10255842.2021.2005788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A proper junction of the prosthesis and the abdominal wall is important in successful hernia repair. The number of tacks should be balanced to assure appropriate mesh fixation and not to induce post-operative pain. Numerical simulations help to find this balance. The study is aimed at creating a proper numerical model of a knitted surgical mesh subjected to boundary conditions and load occurring in the abdominal cavity. Continuous, anisotropic constitutive relation is considered to reflect the mesh behaviour. Different sets of material law parameters are determined on the basis of different bi-axial tests setups. Force- and displacement-controlled tests with different ratios are considered. Consequently, some numerical model variants are obtained featuring various reaction distributions in the scaffold fixation points. The proper variant is selected based on comparison of the position of maximal reaction force in the numerical model and in the reference physical model of operated hernia. Force-driven tests have shown anisotropic mesh behaviour, while equibiaxial displacement-driven test has demonstrated reduced anisotropic response. Within seven scenarios of constitutive parameters identification (based on single or combined experimental data), the equibiaxial force-controlled test appeared to produce the most relevant model to follow the prosthesis behaviour under pressure. The position of maximal reaction force in such model is similar to obtained in the physical hernia model. The equibiaxial force-driven test provides most suitable data for Gasser-Ogden-Holzapfel constitutive model identification of a considered surgical mesh to be used to model the mesh under pressure.
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Affiliation(s)
- Agnieszka Tomaszewska
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Daniil Reznikov
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
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Pérez-Köhler B, Benito-Martínez S, Gómez-Gil V, Rodríguez M, Pascual G, Bellón JM. New Insights into the Application of 3D-Printing Technology in Hernia Repair. MATERIALS 2021; 14:ma14227092. [PMID: 34832493 PMCID: PMC8623842 DOI: 10.3390/ma14227092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/29/2022]
Abstract
Abdominal hernia repair using prosthetic materials is among the surgical interventions most widely performed worldwide. These materials, or meshes, are implanted to close the hernial defect, reinforcing the abdominal muscles and reestablishing mechanical functionality of the wall. Meshes for hernia repair are made of synthetic or biological materials exhibiting multiple shapes and configurations. Despite the myriad of devices currently marketed, the search for the ideal mesh continues as, thus far, no device offers optimal tissue repair and restored mechanical performance while minimizing postoperative complications. Additive manufacturing, or 3D-printing, has great potential for biomedical applications. Over the years, different biomaterials with advanced features have been successfully manufactured via 3D-printing for the repair of hard and soft tissues. This technological improvement is of high clinical relevance and paves the way to produce next-generation devices tailored to suit each individual patient. This review focuses on the state of the art and applications of 3D-printing technology for the manufacture of synthetic meshes. We highlight the latest approaches aimed at developing improved bioactive materials (e.g., optimizing antibacterial performance, drug release, or device opacity for contrast imaging). Challenges, limitations, and future perspectives are discussed, offering a comprehensive scenario for the applicability of 3D-printing in hernia repair.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Selma Benito-Martínez
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Verónica Gómez-Gil
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
- Departamento de Ciencias Biomédicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Marta Rodríguez
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Gemma Pascual
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Correspondence:
| | - Juan Manuel Bellón
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
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Kallinowski F, Ludwig Y, Gutjahr D, Gerhard C, Schulte-Hörmann H, Krimmel L, Lesch C, Uhr K, Lösel P, Voß S, Heuveline V, Vollmer M, Görich J, Nessel R. Biomechanical Influences on Mesh-Related Complications in Incisional Hernia Repair. Front Surg 2021; 8:763957. [PMID: 34778367 PMCID: PMC8586217 DOI: 10.3389/fsurg.2021.763957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Hernia repair strengthens the abdominal wall with a textile mesh. Recurrence and pain indicate weak bonds between mesh and tissue. It remains a question which biomechanical factors strengthen the mesh-tissue interface, and whether surgeons can enhance the bond between mesh and tissue. Material and Methods: This study assessed the strength of the mesh-tissue interface by dynamic loads. A self-built bench test delivered dynamic impacts. The test simulated coughing. Porcine and bovine tissue were used for the bench test. Tissue quality, mesh adhesiveness, and fixation intensity influenced the retention power. The influences were condensed in a formula to assess the durability of the repair. The formula was applied to clinical work. The relative strength of reconstruction was related to the individual human abdominal wall. From computerized tomography at rest and during Valsalva's Maneuver, the tissue quality of the individual patient was determined before surgery. Results: The results showed that biomechanical parameters observed in porcine, bovine, and human tissue were in the same range. Tissues failed in distinct patterns. Sutures slackened or burst at vulnerable points. Both the load duration and the peak load increased destruction. Stress concentrations elevated failure rates. Regional areas of force contortions increased stress concentrations. Hernia repair improved strain levels. Measures for improvement included the closure of the defect, use of higher dynamic intermittent strain (DIS) class meshes, increased mesh overlap, and additional fixation. Surgeons chose the safety margin of the reconstruction as desired. Conclusion: The tissue quality has now been introduced into the concept of a critical and a gained resistance toward pressure-related impacts. A durable hernia repair could be designed from available coefficients. Using biomechanical principles, surgeons could minimize pain levels. Mesh-related complications such as hernia recurrence can potentially be avoided in incisional hernia repair.
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Affiliation(s)
- Friedrich Kallinowski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Yannique Ludwig
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dominik Gutjahr
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Gerhard
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Hannah Schulte-Hörmann
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Lena Krimmel
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Carolin Lesch
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Uhr
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Lösel
- Engineering Mathematics and Computing Lab (EMCL), Interdisciplinary Center for Scientific Computing, Heidelberg, Germany
| | - Samuel Voß
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Vincent Heuveline
- Engineering Mathematics and Computing Lab (EMCL), Interdisciplinary Center for Scientific Computing, Heidelberg, Germany
| | - Matthias Vollmer
- Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | | | - Regine Nessel
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Heilbronn, Germany
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A Prospective, Single Arm, Multi-Center Study Evaluating the Clinical Outcomes of Ventral Hernias Treated with OviTex ® 1S Permanent Reinforced Tissue Matrix: The BRAVO Study 12-Month Analysis. J Clin Med 2021; 10:jcm10214998. [PMID: 34768516 PMCID: PMC8584945 DOI: 10.3390/jcm10214998] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/24/2021] [Accepted: 10/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Conflicting results from previous studies have led to dissent over whether surgical mesh is safe and effective in ventral hernia repair. A newer class of mesh known as a reinforced tissue matrix, combining a biologic scaffold and minimal polymer reinforcement, offers promise in reducing inflammatory response and increasing abdominal wall support. This study sought to assess the clinical utility of a reinforced tissue matrix (OviTex) in ventral hernia repair 12 months after implantation. METHODS This is a prospective, single-arm, multi-center study to evaluate the clinical performance of OviTex® 1S Permanent (OviTex) in the repair of primary or recurrent ventral hernias (VH) in consecutive patients (ClinicalTrials.gov/NCT03074474). The rate of surgical site occurrences (SSOs) was evaluated 90 days post-surgery as the primary endpoint. Hernia recurrence and the incidence of postoperative events were evaluated between three and 12 months as secondary endpoints. The incidence of other complications and patient-reported outcomes were also recorded. RESULTS Ninety-two (92) patients were enrolled in the study, of whom seventy-six (76) reached the 12-month follow-up. All patients were at least 18 years of age with a BMI of <40 kg/m2. Hernia defects were <20 × 20 cm, classified as class I-III according to the CDC wound classification system. Of the 76 patients who reached 12-month follow-up, twenty-six (34%) had previous VH repairs and thirteen (17%) had previous surgical infection. Sixty (79%) had factors known to increase the risk of recurrence. Twenty patients (26%) experienced SSOs, with ten (13%) requiring procedural intervention. Two of the 75 patients (2.7%) experienced a recurrence. CONCLUSIONS The low rate of hernia recurrence and SSOs requiring intervention illustrates the potential that reinforced tissue matrices, and OviTex 1S, in particular, have to improve outcomes in VH repairs. Follow-up to 24 months is ongoing.
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García-García C, Carrascal-Morillo MT, Castell Gómez JT, Bernal Guerrero C, García Prada JC. An approach to evaluating and benchmarking the mechanical behavior of a surgical mesh prototype designed for the repair of abdominal wall defects. J Mech Behav Biomed Mater 2021; 125:104909. [PMID: 34736025 DOI: 10.1016/j.jmbbm.2021.104909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
Ventral hernia repair is a common surgical procedure in abdominal surgery in which surgical mesh has become an essential tool to improve outcomes. To avoid recurrences the mesh needs to mimic the mechanical behavior of the abdominal wall. In this scenario the mechanical properties at the interface between the mesh and its surrounding tissue is critical for the performance of the device and, therefore, the success after surgery. We aimed to characterize and compare the mechanical behavior of the patented prototype mesh Spider and four commercial meshes at the mesh-tissue interface. The prototype mesh was designed based on the hypothesis that the best performance for a large-sized defect in a ventral hernia is obtained when the mesh presents an isotropic behavior. In contrast, commercial meshes presented significant anisotropic behavior. Mechanical properties of the meshes were characterized through uniaxial tensile tests. Longitudinal and transverse axes were defined for each mesh, and samples were cut in each axis orientation. Samples underwent uniaxial tensile testing, from which the elastic modulus in each axis was determined. The degree of anisotropy was calculated as the ratio between the elastic modulus in each axis. An in silico model of the ventral hernia defect was designed to simulate the mesh-tissue interface behavior via finite element method. Meshes were modeled by an hyperelastic orthotropic constitutive model, which allowed isotropic symmetry as particular case for the prototype mesh. Abdominal wall was modeled using a Neo-Hookean model. Once the simulations were launched, mesh-tissue interface behavior was evaluated through the difference between Von Mises stress values on either size of the interface, both on the external and the internal face of the mesh and abdominal wall. Mechanical response was anisotropic for all commercial meshes and isotropic for the Spider prototype. Among commercial, Ultrapro® was highly anisotropic. Tests revealed Gore-Tex® to be the stiffest, followed by Repol Angimesh®, Spider and Ultrapro®; Duramesh™ was found to be the most compliant. Concerning mesh-tissue behavior, simulation results revealed the Spider prototype and Duramesh™ to be the best; Spider due to its uniformity and lower stress difference thanks to its nearly isotropic behavior, and Duramesh™ due to its compliant behavior. Our results suggest that the compromise between stiffness and anisotropy must be considered in order to improve the mechanical performance of the meshes, bearing in mind that for large-sized ventral defects, nearly isotropic mesh ensures better performance.
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Affiliation(s)
- C García-García
- PhD Programme in Industrial Engineering Technologies, International PhD School (EIDUNED), The National Distance Education University (UNED), Madrid, Spain.
| | - M T Carrascal-Morillo
- Department of Mechanics, ETSI Industriales, The National Distance Education University (UNED), Madrid, Spain
| | | | - C Bernal Guerrero
- Department of Construction and Manufacturing Engineering , ETSI Industriales, The National Distance Education University (UNED), Madrid, Spain
| | - J C García Prada
- Department of Mechanics, ETSI Industriales, The National Distance Education University (UNED), Madrid, Spain
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A novel in vivo approach to assess strains of the human abdominal wall under known intraabdominal pressure. J Mech Behav Biomed Mater 2021; 125:104902. [PMID: 34717119 DOI: 10.1016/j.jmbbm.2021.104902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
The study concerns mechanical behaviour of a living human abdominal wall. A better mechanical understanding of a human abdominal wall and recognition of its material properties is required to find mechanically compatible surgical meshes to significantly improve the treatment of ventral hernias. A non-invasive methodology, based on in vivo optical measurements is proposed to determine strains of abdominal wall corresponding to a known intraabdominal pressure. The measurement is performed in the course of a standard procedure of peritoneal dialysis. A dedicated experimental stand is designed for the experiment. The photogrammetric technique is employed to recover the three-dimensional surface geometry of the anterior abdominal wall at the initial and terminal instants of the dialysis. This corresponds to two deformation states, before and after filling the abdominal cavity with dialysis fluid. The study provides information on strain fields of living human abdominal wall. The inquiry is aimed at principal strains and their directions, observed at the level from -10% to 17%. The intraabdominal pressure related to the amount of introduced dialysis fluid measured within the medical procedure covers the range 11-18.5 cmH2O. The methodology leads to the deformation state of the abdominal wall according to the corresponding loading conditions. Therefore, the study is a step towards an identification of mechanical properties of living human abdominal wall.
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Fan Z, Zhao X, Li J, Ji R, Shi Y. Cell-based therapies for reinforcing the treatment efficacy of meshes in abdominal wall hernias:A systematic review and meta-analysis. Asian J Surg 2021; 45:1667-1677. [PMID: 34635415 DOI: 10.1016/j.asjsur.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/27/2021] [Accepted: 09/29/2021] [Indexed: 11/02/2022] Open
Abstract
To achieve a tension-free repair and reduce the recurrence rate of abdominal wall hernias (AWHs), various kinds of meshes have been applied in surgery. However, these meshes are reported to have problems with adhesion, infection, chronic pain and foreign body sensation. Recently, the introduction of cellular components on meshes seems to provide a new alternative to resolve these problems. This study aimed to evaluate the treatment efficacy of meshes seeded with cells (mesh-cell group) for AWHs, compared to meshes without cells (mesh group). Cochrane Library, Web of Science and PubMed were searched for studies that provided data about meshes, cells and AWHs. Twenty-six studies involving 578 animals were included. We found that the mesh-cell group could better control hernia recurrent than the mesh group (OR = 0.25, 95% CI = 0.15-0.42). Although the mesh-cell group did not reduce the incidence of adhesions (OR = 0.67, 95% CI = 0.26-1.74), it alleviated the extent of adhesions (WMD = -1.48, 95% CI = -1.86 to -1.10). In addition, the capillary density of mesh-cell group was also higher than that of mesh group (WMD = 26.27, 95% CI = 14.45-38.09). For incidence of infection, the two groups had no significant differences (OR = 0.94, 95% CI = 0.39-2.31). On the basis of our current evidence, AWHs were likely to receive a satisfied outcome in animal models when treated by meshes seeded with cells. Future studies with human trial data are needed to validate these findings.
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Affiliation(s)
- Zun Fan
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Zhao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Jiacheng Li
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Renting Ji
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yang Shi
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Schaaf S, Schwab R, Güsgen C, Vilz TO, Willms A. Recommendations on Postoperative Activities After Abdominal Operations and Incisional Hernia Repair-A National and International Survey. Front Surg 2021; 8:713138. [PMID: 34660675 PMCID: PMC8511488 DOI: 10.3389/fsurg.2021.713138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is no conclusive data on postoperative recommendations after abdominal and hernia surgery, and there is significant variation in the literature on that question. Thus, this study evaluates the status quo of recommendations of postoperative activity restriction after abdominal surgery. Materials and Methods: A national (German) and international survey of general surgeons on postoperative recommendations after abdominal and hernia surgery was pooled and analyzed. Results: A total of 74.6% recommended postoperative reduced activity for 2 weeks or less after laparoscopy. For midline laparotomy, 48.8% considered a reduced activity of 4 weeks or less to be sufficient. A majority from the national survey recommended more than 4 weeks instead (60.2%), whereas only 31.5% from the international survey did so (p = 0.000). In the pooled analysis, 258 of 450 (57.3%) rated 4 weeks or less suitable. However, the recommendations differed significantly between the surveys (4 weeks or less: a national survey, 47.1% vs. international survey, 64.6%; p = 0.000). Conclusion: There was substantial variation in the given recommendations. However, we found no evidence against immediate mobilization, reduced physical activity, and lifting for up to 2 weeks after laparoscopic surgery and for up to 4 weeks after open abdominal surgery and open incisional/ventral hernia repair in uncomplicated and standard cases. There might be individual and socioeconomic benefits to allow patients to return to their whole personal level of activity and work without putting them at risk of complications. Due to lack of evidence, both retrospective and prospective, controlled studies are in need to develop reliable recommendations.
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Affiliation(s)
- Sebastian Schaaf
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Robert Schwab
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Christoph Güsgen
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Tim O. Vilz
- Department of General, Visceral, Thoracic and Vasular Surgery, University Hospital Bonn, Bonn, Germany
| | - Arnulf Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
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O'Dwyer PJ, Chew C, Qandeel H. Long term outcome and elasticity of a polyester mesh used for laparoscopic ventral hernia repair. Hernia 2021; 26:489-493. [PMID: 34426878 PMCID: PMC8382097 DOI: 10.1007/s10029-021-02486-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/01/2021] [Indexed: 01/03/2023]
Abstract
Background Repair of a ventral hernia is increasingly being performed by a laparoscopic approach despite lack of good long term follow up data on outcomes. The aim of this study was to examine the long term performance of a polyester mesh and to assess its elastic properties in patients undergoing laparoscopic ventral hernia repair. Methods All patients being assessed for a ventral hernia repair between August 2011 and November 2013 were placed on a prospective database. Those undergoing laparoscopic repair with a polyester mesh were seen at clinic at one month and one year, while their electronic records were assessed at 34 months (range 24–48 months) and 104 months (range 92–116 months). In addition, CT scans of the abdomen and pelvis performed for any reason on these patients during the follow up period were reviewed by a consultant gastrointestinal radiologist. Mechanical failure testing of the mesh was also performed. Results Thirty-two of the 100 patients assessed for ventral hernia repair had a laparoscopic repair with a polyester mesh. Nineteen (59%) had CT scans performed during the follow-up period. No recurrence was recorded at 34 months, while three (9.4%) had a recurrence at 104 months. Two had central breakdown of the mesh at 81 and 90 months, while 1 presented acutely at 116 months after operation. Mesh had stretched across the defect by an average of 21% (range 5.7–40%) in nine patients. Mechanical testing showed that this mesh lost its elasticity at low forces ranging between 1.8 and 3.2 N/cm.
Conclusion This study shows that late recurrence is a problem following laparoscopic ventral hernia repair with polyester mesh. The mesh loses it elasticity at a low force. This combined with degradation of mesh seems the most likely cause of failure. This is unlikely to be a unique problem of polyester mesh and further long-term studies are required to better assess this operative approach to ventral hernia repair.
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Affiliation(s)
- P J O'Dwyer
- School of Medicine, Dentistry and Medicine, University of Glasgow, Glasgow, UK.
| | - C Chew
- Department of Radiology, University Hospital Hairmyres, Glasgow, UK
| | - H Qandeel
- Department of Surgery, Hashemite University, Zarqa, Jordan
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Tuncay E, Akinci O, Perek A, Aktas Cetin E, Kepil N, Toksoy M, Altan N. The Effect of Adipose-Derived Stromal Vascular Fraction Cells to Abdominal Wall Fascia Defects in Rats: An Experimental Study. J INVEST SURG 2021; 35:926-932. [PMID: 34376096 DOI: 10.1080/08941939.2021.1959680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Various synthetic and biological meshes have been developed to reduce recurrence and complications in ventral incisional hernia repairs. Adipose tissue is a rich reserve for mesenchymal stromal cells. In the present study we aimed to examine the effects of adipose-derived mesenchymal stromal cells (AD-MSCs) on abdominal incisional hernia repairs in rats. MATERIALS AND METHODS The study involved 32 male Wistar-Albino rats, weighing 200-250 g, which were divided into three groups. In Group 1 (control group) only an incisional hernia model was created. In Group 2, the incisional hernia model was created and 1 ml stromal vascular fraction (SVF), obtained from inguinal lipectomy material and containing mesenchymal stromal cells, was injected into the edges of the defect in the same session. In Group 3, only the incisional hernia model was created in the first stage and after 14 days, 1 ml of SVF was injected into the edges of the defect. Skin incisions of rats in Group 1 and 2 were opened on postoperative day 28 while in group 3 were opened on day 42. Peritoneal formation in abdominal wall defect was evaluated macroscopically and histopathologically. RESULTS Peritoneal formation was significantly superior in Groups 2 and 3 than in Group 1 (p: 0.031). In histopathological evaluation, the structural distortion and polymorphonuclear leukocyte (PMNL) levels were significantly higher in Group 1 than in Group 3 (p: 0.048 and p: 0.046, respectively). Granulation, capillary density, fibrosis and collagen organization were higher in Group 2 and 3, however this difference was not statistically significant (p > 0.05). CONCLUSIONS Adipose-derived stromal vascular fraction cells obtained from inguinal lipectomy material in rats positively affect the repair of abdominal incisional hernias by increasing peritoneal formation, and reducing structural distortion and PMNL infiltration.
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Affiliation(s)
- Elif Tuncay
- Department of General Surgery, Bingol State Hospital, Bingol, Turkey
| | - Ozan Akinci
- Department of General Surgery, Istanbul Kartal Dr Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Asiye Perek
- Department of General Surgery, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esin Aktas Cetin
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Nuray Kepil
- Department of Pathology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Toksoy
- Department of General Surgery, Afyon Bolvadin State Hospital, Afyon, Turkey
| | - Nurdan Altan
- Department of General Surgery, Kars Sarikamis State Hospital, Kars, Turkey
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Qiao Y, Zhang Q, Wang Q, Lin J, Wang J, Li Y, Wang L. Synergistic Anti-inflammatory Coating "Zipped Up" on Polypropylene Hernia Mesh. ACS APPLIED MATERIALS & INTERFACES 2021; 13:35456-35468. [PMID: 34293859 DOI: 10.1021/acsami.1c09089] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Violent inflammation has impeded worry-free application of polypropylene (PP) hernia meshes. Efficient anti-inflammatory coatings are urgently needed to alter the situation. Here, we present a zipper-like, two-layer coating with an intermediate antioxidant layer (I) and an outer antifouling layer (II) to endow PP meshes with synergistic anti-inflammatory effects. The controllable antioxidant ability of layer I was obtained by modulating the assembly cycle of the metal-phenolic network (MPN) composed of tannic acid (TA) and Fe3+. Polyzwitterionic (PMAD) brush-based layer II was generated upon multiple interactions between the catechol side groups of PMAD and layer I. To consolidate the entire assembly architecture, aryloxy radical coupling was initiated through alkali-catalyzed oxidation. The reaction is similar to a "zipping up" process to construct covalent bonds in the I-II interface and layer I by coupling adjacent catechol groups, which facilely achieved grafting and cross-linking. The obtained coating (PMAD-TA/Fe) did not affect the original properties of the PP mesh and remained stable during cyclic tensile testing or degradation. Most importantly, the excellent antioxidant and antifouling capacities enabled PMAD-TA/Fe-PP to exhibit desirable anti-inflammatory effects and reduce collagen deposition when compared with the bare material. The synergistic anti-inflammatory coating eliminates a major hindrance in the design of biocompatible meshes, and its potential application in developing medical implants with low immunogenicity is promising.
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Affiliation(s)
- Yansha Qiao
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Qian Zhang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Qian Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Jing Lin
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Junshuo Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Yan Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai 201620, China
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Liu Z, Liu X, Bao L, Liu J, Zhu X, Mo X, Tang R. The evaluation of functional small intestinal submucosa for abdominal wall defect repair in a rat model: Potent effect of sequential release of VEGF and TGF-β1 on host integration. Biomaterials 2021; 276:120999. [PMID: 34273685 DOI: 10.1016/j.biomaterials.2021.120999] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022]
Abstract
Ineffective vessel penetration and extracellular matrix (ECM) remodeling are responsible for the failure of porcine small intestinal submucosa (SIS)-repaired abdominal wall defects. Combined growth factors could be used as directing signals in a nature-mimicking strategy to improve this repair through mesh functionalization. In this work, vascular endothelial growth factor (VEGF) and transforming growth factor β1 (TGF-β1) were incorporated into a silk fibroin membrane via coaxial aqueous electrospinning to exploit their benefits of biological interactions. The membrane was sandwiched into the SIS bilayer as a functional mesh to repair partial-thickness defects in a rat model. Membrane characterization demonstrated that the core-shell structure ensured the independent distribution and sequential release of two regulators and protection of their bioactivities, which were confirmed by cell viability and protein expression. The mesh was further assessed to facilitate vasculature formation and collagen secretion in vitro, and exhibited better host integration than VEGF- or TGF-β1-containing mesh and developed reinforced mechanical properties compared with the VEGF-containing mesh after 28 days in vivo. Determination of the underlying biological interactions revealed that rapid VEGF release promotes angiogenesis and collagen secretion but initially potentiates the inflammatory response. Sustained TGF-β1 release at relatively low concentrations promoted VEGF for vessel permeation and maturation and steadily induced ECM remodeling under milder foreign body reactions. The functionalization of SIS improves repair by sufficient integration with timely remodeling and helps elucidate the related regulatory interactions.
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Affiliation(s)
- Zhengni Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai, 200120, PR China
| | - Xuezhe Liu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, PR China
| | - Luhan Bao
- Group of Microbiological Engineering and Industrial Biotechnology, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, PR China
| | - Jiajie Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai, 200120, PR China
| | - Xiaoqiang Zhu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai, 200120, PR China
| | - Xiumei Mo
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, PR China
| | - Rui Tang
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai, 200120, PR China.
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Qiao Y, Zhang Q, Wang Q, Li Y, Wang L. Filament-anchored hydrogel layer on polypropylene hernia mesh with robust anti-inflammatory effects. Acta Biomater 2021; 128:277-290. [PMID: 33866036 DOI: 10.1016/j.actbio.2021.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
The efficacy of implanted polypropylene (PP) hernia meshes is often compromised by an inflammatory response. Thus, engineering an anti-inflammatory mesh has significant implications for hernioplasty. Here, we report a facile strategy to develop a filament-anchored hydrogel layer (FAHL) on PP mesh (FAHL-P). The network of FAHL, made up of chondroitin sulfate and gelatin (CG), provided a biomimetic surface with immunoregulatory properties. The use of tannic acid (TA) as a crosslinker for CG additionally enhanced its anti-inflammatory properties. In addition, the fabrication protocol ensured that the hydrogel maintained the properties of the knitted mesh and the firmly adherent FAHL during general handling (dry state) and in the simulated body environment (wet state). CG/TA-PP killed 99.99% of S. aureus and retained 73% of its original antioxidant properties after 7 d. The FAHL durably performed with a controlled release of TA for 15 d. The strong anti-inflammatory effects of FAHL-P reduced collagen deposition and increased vascularization, which promoted native tissue generation. The fabrication strategy has potential applications in hernioplasty and may provide new insights into the design of other anti-inflammatory implants. STATEMENT OF SIGNIFICANCE: A hydrogel layer with robust anti-inflammatory effects was anchored firmly on mesh filament for hernia repair. Requiring no drug loading, this chondroitin sulphate -gelatin (CG) based hydrogel itself could inhibit the immunological attack owing to the biomimetic microenvironment created by the CG. Moreover, the hydrogel's crosslinker (tannic acid) content served as an effective scavenger for reducing pro-inflammatory factors, significantly mitigating the inflammation. Interestingly, the antibacterial effect of such hydrogel layer was also observed. In terms of the synergistic outcome of the design, our mesh can remarkably attenuate inflammation and promote constructive tissue regeneration in vivo. Furthermore, considering the relatively simple and easily scaled up formulation process, our strategy may indeed have great potential in alleviating post-implantation outcomes.
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Zhao Y, Li Y, Peng X, Yu X, Cheng C, Yu X. Feasibility study of oxidized hyaluronic acid cross-linking acellular bovine pericardium with potential application for abdominal wall repair. Int J Biol Macromol 2021; 184:831-842. [PMID: 34174314 DOI: 10.1016/j.ijbiomac.2021.06.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Bovine pericardium(BP)is one of the biological membranes with extensive application in tissue engineering. To fully investigate the potential clinical applications of this natural biological material, a suitable cross-linking reagent is hopefully adopted for modification. Glutaraldehyde (GA) is a clinically most common synthetic cross-linking reagent. In the study, oxidized hyaluronic acid (AHA) was developed to substitute GA to fix acellular bovine pericardium (ABP) for lower cytotoxicity, aiming to evaluate the feasibility of AHA as a cross-linking reagent and develop AHA-fixed ABP as a biological patch for abdominal wall repair. The AHA with the feeding ratio (1.8:1.0) has an appropriate molecular weight and oxidation degree, almost no cytotoxicity and good cross-linking effect. The critical cross-linking characteristics and cytocompatibility of AHA-fixed ABP were also investigated. The results demonstrated that 2.0% AHA-fixed ABP had the most suitable mechanical properties, thermal stability, resistance to enzymatic degradation and hydrophilicity. Moreover, 2.0% AHA-fixed samples exhibited an excellent cytocompatibility with human peritoneal mesothelial cells (HPMC) and low antigenicity. It also showed a prominent anti-calcification ability required for abdominal wall repair. Our data provided experimental basis for future research on AHA as a new cross-linking reagent and AHA-fixed ABP for abdominal wall repair.
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Affiliation(s)
- Yang Zhao
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Yanjiang Li
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Xu Peng
- Experimental and Research Animal Institute, Sichuan University, Chengdu 610065, PR China
| | - Xiaoshuang Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Can Cheng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Xixun Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China.
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Sawyer M, Ferzoco S, DeNoto G. A Polymer-Biologic Hybrid Hernia Construct: Review of Data and Early Experiences. Polymers (Basel) 2021; 13:polym13121928. [PMID: 34200591 PMCID: PMC8228560 DOI: 10.3390/polym13121928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Surgical mesh reinforcement of the human abdominal wall has been found to reduce the chance of recurrence in hernia repairs. While traditionally polymer meshes have been used in hernia repair, alternative mesh options have been engineered to prevent the inflammatory foreign body response invoked by polymers. A reinforced tissue matrix (RTM) mesh has been developed by embedding a polymer within a decellularized extracellular matrix. This combination has been attributed to the recruitment of host cells, a pro-healing response, and attenuation of the foreign body response. This has been observed to lead to the regeneration of functional tissue within the repair site that is reinforced by the polymer to offload abdominal pressures over time. This manuscript presents the review of OviTex, an RTM, in several types of hernia repair. The authors have found that the use of RTM in hernia repair is effective in preventing foreign body response, promoting wound healing, and providing reinforcement to lower the risk of hernia recurrence.
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Affiliation(s)
- Michael Sawyer
- Department of Surgery, Oklahoma State University, Comanche County Memorial Hospital, Lawton, OK 73505, USA
- Correspondence:
| | - Stephen Ferzoco
- Department of Surgery, Atrius Health, Dedham, MA 02026, USA;
| | - George DeNoto
- General Surgery Department, St. Francis Hospital, Roslyn, NY 11576, USA;
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Liu Z, Liu J, Liu N, Zhu X, Tang R. Tailoring electrospun mesh for a compliant remodeling in the repair of full-thickness abdominal wall defect - The role of decellularized human amniotic membrane and silk fibroin. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 127:112235. [PMID: 34225876 DOI: 10.1016/j.msec.2021.112235] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/06/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
Tailored electrospun meshes have been increasingly explored for abdominal wall defect repair in preclinical and clinical studies. However, the fabrication of a bioengineered mesh adapts to the intraperitoneal repair for a compliant remodeling remains a great challenge. In this study, we fabricated a functional mesh by combining polycaprolactone (PCL) with silk fibroin (SF) and decellularized human amniotic membrane (HAM) proportionally via electrospinning. SF was integrated with PCL (40:60 w/w) to regulate the structural flexibility. Micronized HAM was incorporated to PCL/SF (10:90 w/w) to provide a biocompatible milieu with functions being conferred to facilitate intraperitoneal repair. After the blend electrospinning, the PCL/SF/HAM mesh was characterized in vitro and implanted into the rat model with a full-thickness defect for a comprehensive evaluation in comparison to the PCL and PCL/SF meshes. The results demonstrated that electrospinning fabricated PCL stabilized the mechanical elongation toward approximating the native counterparts after integrating with SF. After integrating with HAM, which is coupled with diverse biomolecular compositions, the developed PCL/SF/HAM mesh provided a better microenvironment for cell proliferation and vasculogenic network over other meshes without HAM addition and possessed the functions capable of inhibiting transforming growth factor β1 (TGF-β1) expression and collagen secretion under inflammatory conditions. Moreover, the functional mesh developed less-intensive adhesion along with histologically weaker inflammatory response and foreign body reaction than the PCL and PCL/SF meshes after 90 days in vivo. During the remodeling process, the bioactive structure induced more pronounced neovascularization and remarkable incorporation of collagen and elastin fibers and contractile filaments for a mechanically sufficient and physiologically stiffness-matched healing. This tailor-made mesh expands the intraperitoneal applicability of conventional electrospun meshes for a compliant remodeling in the repair of abdominal wall defects.
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Affiliation(s)
- Zhengni Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Jiajie Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Nan Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Xiaoqiang Zhu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Rui Tang
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China.
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Pérez ML, Castells-Sala C, López-Chicón P, Nieto-Nicolau N, Aiti A, Fariñas O, Casaroli-Marano RP, Porta O, Vilarrodona A. Fast protocol for the processing of split-thickness skin into decellularized human dermal matrix. Tissue Cell 2021; 72:101572. [PMID: 34119882 DOI: 10.1016/j.tice.2021.101572] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Dermal scaffolds for tissue regeneration are nowadays an effective alternative in not only wound healing surgeries but also breast reconstruction, abdominal wall reconstruction and tendon reinforcement. The present study describes the development of a decellularization protocol applied to human split-thickness skin from cadaveric donors to obtain dermal matrix using an easy and quick procedure. METHODS Complete split-thickness donor was decellularized through the combination of hypertonic and enzymatic methods. To evaluate the absence of epidermis and dermal cells, and ensure the integrity of the extracellular matrix (ECM) structure, histological analysis was performed. Residual genetic content and ECM biomolecules (collagen, elastin, and glycosaminoglycan) were quantified and tensile strength was tested to measure the effect of the decellularization technique on the mechanical properties of the tissue. RESULTS Biomolecules quantification, residual genetic content (below 50 ng/mg dry tissue) and histological structure assessment showed the efficacy of the decellularization process and the preservation of the ECM. The biomechanical tests confirmed the preservation of native properties in the acellular tissue. CONCLUSIONS The acellular dermal matrix obtained from whole split-thickness skin donor with the newly developed decellualrization protocol, maintains the desired biomechanical and structural properties and represents a viable treatment option for patients.
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Affiliation(s)
- M L Pérez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall Hebron Institute of Research (VHIR), Barcelona, Spain.
| | - C Castells-Sala
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall Hebron Institute of Research (VHIR), Barcelona, Spain.
| | - P López-Chicón
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - N Nieto-Nicolau
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall Hebron Institute of Research (VHIR), Barcelona, Spain
| | - A Aiti
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain
| | - O Fariñas
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - R P Casaroli-Marano
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Department of Surgery, School of Medicine & Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - O Porta
- Gynaecology and Obstetrics Service, Hospital de la Santa Creu i Sant Pau, Spain
| | - A Vilarrodona
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
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A Herniorrhaphy Lamination Technique for the Reconstruction of Midline Abdominal Wall Defects. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3558. [PMID: 33912375 PMCID: PMC8078233 DOI: 10.1097/gox.0000000000003558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/02/2021] [Indexed: 12/04/2022]
Abstract
The primary goal of abdominal wall reconstruction is to prevent hernia recurrence through robust and durable repair. Synthetic mesh utilization can provide sound strength but is susceptible to extrusion, infection, and intestinal fistulization. The use of autologous fasciae latae to reinforce the primary fascial reapproximation has mostly been abandoned, presumably because synthetic patches are readily available. There is a specific demand for a sustainable, less-invasive, and ready-to-use repair method without mesh. The authors devised a herniorrhaphy lamination technique using local musculofascial flaps inspired by composite laminates. In this procedure, the primary fascial reapproximation is reinforced with 3 additional laminated musculofascial layers: (1) turnover hinge flaps of the anterior sheath of the rectus abdominis, (2) bilateral rectus abdominis, and (3) advancement flaps of newly generated edges of the fascia of the rectus sheath. Our technique’s stability is essentially due to the mechanical superiority of the centralized pipe-like structure of musculofascia. Between February 2009 and November 2019, we used the lamination technique to repair midline incisional hernias in 10 patients. The operative procedure was successful in all patients, and there has been no evidence of recurrence. The follow-up period ranged from 12 to 69 months, with a mean follow-up of 35 months. The herniorrhaphy lamination technique to reinforce the primary repair can help prevent hernia recurrence. Although our technique is suitable for a small-sized defect, it is less invasive, and can be readily applied. Because it does not include any mesh, it is suitable for the contaminated abdominal wall reconstruction.
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Raj R, Shenoy SJ, Mony MP, Pratheesh KV, Nair RS, Geetha CS, Sobhan PK, Purnima C, Anilkumar TV. Surface Modification of Polypropylene Mesh with a Porcine Cholecystic Extracellular Matrix Hydrogel for Mitigating Host Tissue Reaction. ACS APPLIED BIO MATERIALS 2021; 4:3304-3319. [DOI: 10.1021/acsabm.0c01627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Reshmi Raj
- Division of Experimental Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biomedical Technology Wing, Thiruvananthapuram 695012, India
| | - Sachin J. Shenoy
- Division of In Vivo Models and Testing, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biomedical Technology Wing, Thiruvananthapuram 695012, India
| | - Manjula P. Mony
- Division of Experimental Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biomedical Technology Wing, Thiruvananthapuram 695012, India
| | - Kanakarajan V. Pratheesh
- Division of Experimental Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biomedical Technology Wing, Thiruvananthapuram 695012, India
| | - Reshma S. Nair
- Division of Experimental Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biomedical Technology Wing, Thiruvananthapuram 695012, India
| | - Chandrika S. Geetha
- Division of Experimental Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biomedical Technology Wing, Thiruvananthapuram 695012, India
| | - Praveen K. Sobhan
- Division of Tissue Culture, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biomedical Technology Wing, Thiruvananthapuram 695012, India
| | - Chandramohanan Purnima
- Division of Experimental Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biomedical Technology Wing, Thiruvananthapuram 695012, India
| | - Thapasimuthu V. Anilkumar
- Division of Experimental Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Biomedical Technology Wing, Thiruvananthapuram 695012, India
- School of Biology, Indian Institute of Science Education and Research—Thiruvananthapuram, Maruthamala, Vithura 695551, India
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Liu Z, Wei N, Tang R. Functionalized Strategies and Mechanisms of the Emerging Mesh for Abdominal Wall Repair and Regeneration. ACS Biomater Sci Eng 2021; 7:2064-2082. [PMID: 33856203 DOI: 10.1021/acsbiomaterials.1c00118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Meshes have been the overwhelmingly popular choice for the repair of abdominal wall defects to retrieve the bodily integrity of musculofascial layer. Broadly, they are classified into synthetic, biological and composite mesh based on their mechanical and biocompatible features. With the development of anatomical repair techniques and the increasing requirements of constructive remodeling, however, none of these options satisfactorily manages the conditional repair. In both preclinical and clinical studies, materials/agents equipped with distinct functions have been characterized and applied to improve mesh-aided repair, with the importance of mesh functionalization being highlighted. However, limited information exists on systemic comparisons of the underlying mechanisms with respect to functionalized strategies, which are fundamental throughout repair and regeneration. Herein, we address this topic and summarize the current literature by subdividing common functions of the mesh into biomechanics-matched, macrophage-mediated, integration-enhanced, anti-infective and antiadhesive characteristics for a comprehensive overview. In particular, we elaborate their effects separately with respect to host response and integration and discuss their respective advances, challenges and future directions toward a clinical alternative. From the vastly different approaches, we provide insight into the mechanisms involved and offer suggestions for personalized modifications of these emerging meshes.
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Affiliation(s)
- Zhengni Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Nina Wei
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Rui Tang
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
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Kallinowski F, Gutjahr D, Harder F, Sabagh M, Ludwig Y, Lozanovski VJ, Löffler T, Rinn J, Görich J, Grimm A, Vollmer M, Nessel R. The Grip Concept of Incisional Hernia Repair-Dynamic Bench Test, CT Abdomen With Valsalva and 1-Year Clinical Results. Front Surg 2021; 8:602181. [PMID: 33937312 PMCID: PMC8080034 DOI: 10.3389/fsurg.2021.602181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/24/2021] [Indexed: 02/03/2023] Open
Abstract
Incisional hernia is a frequent consequence of major surgery. Most repairs augment the abdominal wall with artificial meshes fixed to the tissues with sutures, tacks, or glue. Pain and recurrences plague at least 10-20% of the patients after repair of the abdominal defect. How should a repair of incisional hernias be constructed to achieve durability? Incisional hernia repair can be regarded as a compound technique. The biomechanical properties of a compound made of tissue, textile, and linking materials vary to a large extent. Tissues differ in age, exercise levels, and comorbidities. Textiles are currently optimized for tensile strength, but frequently fail to provide tackiness, dynamic stiction, and strain resistance to pulse impacts. Linking strength with and without fixation devices depends on the retention forces between surfaces to sustain stiction under dynamic load. Impacts such a coughing or sharp bending can easily overburden clinically applied composite structures and can lead to a breakdown of incisional hernia repair. Our group developed a bench test with tissues, fixation, and textiles using dynamic intermittent strain (DIS), which resembles coughing. Tissue elasticity, the size of the hernia under pressure, and the area of instability of the abdominal wall of the individual patient was assessed with low-dose computed tomography of the abdomen preoperatively. A surgical concept was developed based on biomechanical considerations. Observations in a clinical registry based on consecutive patients from four hospitals demonstrate low failure rates and low pain levels after 1 year. Here, results from the bench test, the application of CT abdomen with Valsalva's maneuver, considerations of the surgical concept, and the clinical application of our approach are outlined.
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Affiliation(s)
- Friedrich Kallinowski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dominik Gutjahr
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Harder
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Mohammad Sabagh
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Yannique Ludwig
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Vladimir J. Lozanovski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- General and Visceral Surgery, Gesundheitszentren Rhein-Neckar (GRN) Hospital Eberbach, Eberbach, Germany
| | - Thorsten Löffler
- General and Visceral Surgery, Gesundheitszentren Rhein-Neckar (GRN) Hospital Eberbach, Eberbach, Germany
| | - Johannes Rinn
- General and Visceral Surgery, Kreiskrankenhaus Bergstrasse (KKB) Hospital Bergstrasse, Heppenheim, Germany
| | | | | | - Matthias Vollmer
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Regine Nessel
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Heilbronn, Germany
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In vitro characterisation of low-cost synthetic meshes intended for hernia repair in the UK. Hernia 2021; 26:325-334. [PMID: 33797680 PMCID: PMC8881267 DOI: 10.1007/s10029-021-02401-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/17/2021] [Indexed: 11/20/2022]
Abstract
Purpose Low-cost meshes (LCM) were repurposed for the repair of hernias in the developing world. In vivo studies have shown LCM to have comparable results to commercial meshes (CM) at a fraction of the cost. However, little has been done to characterise the mechanical and biocompatible properties of LCM, preventing its clinical use in the UK. The objectives of the research are to assess mechanical and ultrastructural properties of two UK-sourced low-cost meshes (LCM) and the characterisation of the LCMs in vitro biocompatibility. Methods Mechanical properties of the two LCM were measured through uniaxial tensile test and ultrastructure was evaluated with Scanning Electron Microscopy. LIVE/DEAD® Viability/Cytotoxicity Assay kit and alamarBlue were used to assess cellular viability and proliferation, respectively. Images were acquired with a fluorescence microscope and analysed using ImageJ (NIH, USA). Results LCM1 and LCM2 were both multifilament meshes, with the first having smaller pores than the latter. LCM1 exhibited significantly higher tensile strength (p < 0.05) than LCM2 but significantly lower extensibility (p < 0.0001), while Young’s Modulus of the two samples was not significantly different. No significant difference was found in the cellular viability and morphology cultured in LCM1 and LCM2 conditioned media. Metabolic assay and fluorescence imaging showed cellular attachment and proliferation on both LCMs over 14 days. Conclusion The characterisation of the two UK-sourced LCMs showed in vitro biocompatibility and mechanical and ultrastructural properties comparable to the equivalent CM. This in vitro data represents a step forward for the feasibility of adopting LCM for surgical repair of hernias in the UK.
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Chalony C, Aguilar LE, Kim JY, Park CH, Kim CS. Development of electrospun core-shell polymeric mat using poly (ethyl-2) cyanoacrylate/polyurethane to attenuate biological adhesion on polymeric mesh implants. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 122:111930. [PMID: 33641922 DOI: 10.1016/j.msec.2021.111930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/28/2020] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
Poly (ethyl-2) cyanoacrylate was used to create an adhesion-free biocompatible non-woven material reinforced by polyurethane core via a co-axial electrospinning set-up. The effect of relative humidity (RH) of (18, 30, 40, 60, and 68) % on the electrospinning process was examined, and found that in order to achieve well defined core-shell fiber structure, the optimal RH was 18%. If the RH is >18%, a phenomenon called Taylor cone cyclic destabilization occurs, which results in unfavorable surface and mechanical properties of the mat. The developed composite electrospun mat has the potential to be used in medical devices, such as repairing the viscera layer for intraperitoneal hernia mesh implants, which require the attenuation of biological elements, and adequate mechanical properties.
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Affiliation(s)
- Carmen Chalony
- Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Republic of Korea
| | - Ludwig Erik Aguilar
- Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Republic of Korea
| | - Ju Yeon Kim
- Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Republic of Korea
| | - Chan Hee Park
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju City, 54001, Republic of Korea.
| | - Cheol Sang Kim
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju City, 54001, Republic of Korea.
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Afewerki S, Bassous N, Harb SV, Corat MAF, Maharjan S, Ruiz-Esparza GU, de Paula MMM, Webster TJ, Tim CR, Viana BC, Wang D, Wang X, Marciano FR, Lobo AO. Engineering multifunctional bactericidal nanofibers for abdominal hernia repair. Commun Biol 2021; 4:233. [PMID: 33608611 PMCID: PMC7896057 DOI: 10.1038/s42003-021-01758-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/23/2021] [Indexed: 02/06/2023] Open
Abstract
The engineering of multifunctional surgical bactericidal nanofibers with inherent suitable mechanical and biological properties, through facile and cheap fabrication technology, is a great challenge. Moreover, hernia, which is when organ is pushed through an opening in the muscle or adjacent tissue due to damage of tissue structure or function, is a dire clinical challenge that currently needs surgery for recovery. Nevertheless, post-surgical hernia complications, like infection, fibrosis, tissue adhesions, scaffold rejection, inflammation, and recurrence still remain important clinical problems. Herein, through an integrated electrospinning, plasma treatment and direct surface modification strategy, multifunctional bactericidal nanofibers were engineered showing optimal properties for hernia repair. The nanofibers displayed good bactericidal activity, low inflammatory response, good biodegradation, as well as optimal collagen-, stress fiber- and blood vessel formation and associated tissue ingrowth in vivo. The disclosed engineering strategy serves as a prominent platform for the design of other multifunctional materials for various biomedical challenges.
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Affiliation(s)
- Samson Afewerki
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Health Sciences and Technology, Harvard University ‒ Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Nicole Bassous
- Nanomedicine Laboratory, Department of Chemical Engineering, Northeastern University, Boston, MA, USA
| | - Samarah Vargas Harb
- Nanomedicine Laboratory, Department of Chemical Engineering, Northeastern University, Boston, MA, USA
- Institute of Chemistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Marcus Alexandre F Corat
- Multidisciplinary Center for Biological Research, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Sushila Maharjan
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Health Sciences and Technology, Harvard University ‒ Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Guillermo U Ruiz-Esparza
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Health Sciences and Technology, Harvard University ‒ Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Mirian M M de Paula
- Multidisciplinary Center for Biological Research, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Thomas J Webster
- Nanomedicine Laboratory, Department of Chemical Engineering, Northeastern University, Boston, MA, USA
| | | | - Bartolomeu Cruz Viana
- LIMAV - Interdisciplinary Laboratory for Advanced Materials, Materials Science & Engineering Graduate Program, UFPI - Federal University of Piaui, Teresina, Piaui, Brazil
- Department of Physics, Federal University of Piaui, Teresina, Piaui, Brazil
| | - Danquan Wang
- Nanomedicine Laboratory, Department of Chemical Engineering, Northeastern University, Boston, MA, USA
| | - Xichi Wang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Health Sciences and Technology, Harvard University ‒ Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Fernanda Roberta Marciano
- Nanomedicine Laboratory, Department of Chemical Engineering, Northeastern University, Boston, MA, USA
- Department of Physics, Federal University of Piaui, Teresina, Piaui, Brazil
| | - Anderson Oliveira Lobo
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Health Sciences and Technology, Harvard University ‒ Massachusetts Institute of Technology, Cambridge, MA, USA.
- LIMAV - Interdisciplinary Laboratory for Advanced Materials, Materials Science & Engineering Graduate Program, UFPI - Federal University of Piaui, Teresina, Piaui, Brazil.
- Department of Chemistry, Massachusetts Institute of Technology, MIT, Cambridge, MA, USA.
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Mora-Navarro C, Ozpinar EW, Sze D, Martin DP, Freytes DO. Transcriptome-targeted analysis of human peripheral blood-derived macrophages when cultured on biomaterial meshes. Biomed Mater 2021; 16:025006. [PMID: 33445160 DOI: 10.1088/1748-605x/abdbdb] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgical meshes are commonly used to repair defects and support soft tissues. Macrophages (Mφs) are critical cells in the wound healing process and are involved in the host response upon foreign biomaterials. There are various commercially available permanent and absorbable meshes used by surgeons for surgical interventions. Polypropylene (PP) meshes represent a permanent biomaterial that can elicit both inflammatory and anti-inflammatory responses. In contrast, poly-4-hydroxybutyrate (P4HB) based meshes are absorbable and linked to positive clinical outcomes but have a poorly characterized immune response. This study evaluated the in vitro targeted transcriptomic response of human Mφs seeded for 48 h on PP and P4HB surgical meshes. The in vitro measured response from human Mφs cultured on P4HB exhibited inflammatory and anti-inflammatory gene expression profiles typically associated with wound healing, which aligns with in vivo animal studies from literature. The work herein provides in vitro evidence for the early transcriptomic targeted signature of human Mφs upon two commonly used surgical meshes. The findings suggest a transition from an inflammatory to a non-inflammatory phenotype by P4HB as well as an upregulation of genes annotated under the pathogen response pathway.
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Affiliation(s)
- Camilo Mora-Navarro
- The Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, 4208D Engineering Building III, Raleigh, NC, United States of America. The Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States of America
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Abdominal Stiffness Evaluation in Massage for Constipation. SENSORS 2021; 21:s21041192. [PMID: 33567621 PMCID: PMC7915621 DOI: 10.3390/s21041192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
According to the experience of nurses and physiotherapists, the abdomen of constipated people becomes softer after abdominal massage. However, the relationship between the decrease in abdominal stiffness and the benefits of abdominal massage has not been examined quantitatively and is unclear. Furthermore, devices for measuring stiffness have been designed to measure relatively hard areas such as the shoulders and do not take into account the lateral outflow of the target tissue, which can be a problem when measuring the stiffness of soft areas such as the abdomen. To address these issues, this study presents a stiffness sensor suitable for measuring abdominal stiffness and investigates the relationship between the reduction in abdominal stiffness and the benefits of abdominal massage. The solution to prevent the lateral outflow of the target is the realization of a stopper, including a contact detection device, which enables a wide-area contact around the targeted area. The sensor consists of a stopper, probe, spring, and time-of-flight (ToF) sensors. The probe and spring provide appropriate pressure and deformation to the abdomen, whereas the stopper prevents the probe from being pushed into the abdomen more than necessary. The ToF sensor measures the deformation length when the deformation is stopped by the stopper. The abdominal stiffness can be derived from the deformation length. The investigation results indicate that the reduction in abdominal stiffness corresponds to the improvement of the stool condition or the maintenance of a healthy stool condition, whereas the maintenance of abdominal stiffness indicates the maintenance or deterioration of the stool condition.
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83
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Liu W, Xie Y, Zheng Y, He W, Qiao K, Meng H. Regulatory science for hernia mesh: Current status and future perspectives. Bioact Mater 2021; 6:420-432. [PMID: 32995670 PMCID: PMC7490592 DOI: 10.1016/j.bioactmat.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022] Open
Abstract
Regulatory science for medical devices aims to develop new tools, standards and approaches to assess the safety, effectiveness, quality and performance of medical devices. In the field of biomaterials, hernia mesh is a class of implants that have been successfully translated to clinical applications. With a focus on hernia mesh and its regulatory science system, this paper collected and reviewed information on hernia mesh products and biomaterials in both Chinese and American markets. The current development of regulatory science for hernia mesh, including its regulations, standards, guidance documents and classification, and the scientific evaluation of its safety and effectiveness was first reported. Then the research prospect of regulatory science for hernia mesh was discussed. New methods for the preclinical animal study and new tools for the evaluation of the safety and effectiveness of hernia mesh, such as computational modeling, big data platform and evidence-based research, were assessed. By taking the regulatory science of hernia mesh as a case study, this review provided a research basis for developing a regulatory science system of implantable medical devices, furthering the systematic evaluation of the safety and effectiveness of medical devices for better regulatory decision-making. This was the first article reviewing the regulatory science of hernia mesh and biomaterial-based implants. It also proposed and explained the concepts of evidence-based regulatory science and technical review for the first time.
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Affiliation(s)
- Wenbo Liu
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
- Center for Medical Device Evaluation, National Medical Products Administration, Intellectual Property Publishing House Mansion, Qixiang Road, Haidian District, Beijing, China
| | - Yajie Xie
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Yudong Zheng
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Wei He
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Kun Qiao
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Haoye Meng
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
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Kallinowski F, Ludwig Y, Löffler T, Vollmer M, Lösel PD, Voß S, Görich J, Heuveline V, Nessel R. Biomechanics applied to incisional hernia repair - Considering the critical and the gained resistance towards impacts related to pressure. Clin Biomech (Bristol, Avon) 2021; 82:105253. [PMID: 33401197 DOI: 10.1016/j.clinbiomech.2020.105253] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Incisional hernia repair is burdened with recurrence, pain and disability. The repair is usually carried out with a textile mesh fixed between the layers of the abdominal wall. METHODS We developed a bench test with low cyclic loading. The test uses dynamic intermittent strain resembling coughs. We applied preoperative computed tomography of the abdomen at rest and during Valsalva's maneuver to the individual patient to analyze tissue elasticity. FINDINGS The mesh, its placements and overlap, the type and distribution of fixation elements, the elasticity of the tissue of the individual and the closure of the abdominal defect-all aspects influence the reconstruction necessary. Each influence can be attributed to a relative numerical quantity which can be summed up into a characterizing value. The elasticity of the tissues within the abdominal wall of the individual patient can be assessed with low-dose computed tomography of the abdomen with Valsalva's maneuver. We established a procedure to integrate the results into a surgical concept. We demonstrate potential computer algorithms using non-rigid b-spline registration and artificial intelligence to further improve the evaluation process. INTERPRETATION The bench test yields relative values for the characterization of hernia, mesh and fixation. It can be applied to patient care using established procedures. The clinical application in the first ninety-six patients shows no recurrences and reduced pain levels after one year. The concept has been spread to other surgical groups with the same results in another fifty patients. Future efforts will make the abdominal wall reconstruction more predictable.
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Affiliation(s)
- F Kallinowski
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; General and Visceral Surgery, GRN Hospital Eberbach, Scheuerbergstrasse 3, 69412 Eberbach, Germany.
| | - Y Ludwig
- General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - T Löffler
- General and Visceral Surgery, GRN Hospital Eberbach, Scheuerbergstrasse 3, 69412 Eberbach, Germany
| | - M Vollmer
- Hamburg University of Technology, Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany
| | - P D Lösel
- Engineering Mathematics and Computing Lab (EMCL), Interdisciplinary Center for Scientific Computing, Im Neuenheimer Feld 205, 69120 Heidelberg, Germany; Heidelberg Institute for Theoretical Studies (HITS), Schloss-Wolfsbrunnenweg 35, 69118 Heidelberg, Germany
| | - S Voß
- Department of Fluid Dynamics and Technical Flows, Otto-von-Guericke-Universität Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany; Research Campus STIMULATE, Otto-von-Guericke-Universität Magdeburg, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - J Görich
- Radiological Center, Kellereistrasse 32-34, 69412 Eberbach, Germany
| | - V Heuveline
- Engineering Mathematics and Computing Lab (EMCL), Interdisciplinary Center for Scientific Computing, Im Neuenheimer Feld 205, 69120 Heidelberg, Germany; Heidelberg Institute for Theoretical Studies (HITS), Schloss-Wolfsbrunnenweg 35, 69118 Heidelberg, Germany; Heidelberg University Computing Centre (URZ), Im Neuenheimer Feld 293, 69120 Heidelberg, Germany
| | - R Nessel
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Am Gesundbrunnen 20-26, s Heilbronn, Germany
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Dimassi K, Halouani A, Kammoun A, Ami O, Simon B, Velemir L, Fauck D, Triki A. The extraperitoneal French AmbUlatory cesarean section technique leads to improved pain scores and a faster maternal autonomy compared with the intraperitoneal Misgav Ladach technique: A prospective randomized controlled trial. PLoS One 2021; 16:e0245645. [PMID: 33481875 PMCID: PMC7822305 DOI: 10.1371/journal.pone.0245645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To determine whether the French AmbUlatory Cesarean Section (FAUCS) technique reduces postoperative pain and promotes maternal autonomy compared with the Misgav Ladach cesarean section (MLCS) technique in elective conditions. Study design One hundred pregnant women were randomly, but in a non-blinded manner, assigned to undergo FAUCS or MLCS. The primary outcome was a postoperative mean pain score (PMPS), and secondary outcomes were a combined pain/medication score, time to regain autonomy, surgical duration, calculated blood loss, surgical complications, and neonatal outcome. Results Women in the FAUCS group experienced less pain than those in the MLCS group (PMPS = 1.87 [1.04–2.41] vs. 2.93 [2.46–3.75], respectively; p < 0.001). Six hours after surgery, the combined pain/medication score for FAUCS patients was 33% lower than that for MLCS patients (p < 0.001). FAUCS patients more rapidly regained autonomy, with 94% reaching autonomy within 12 h vs. 4% of MLCS patients (p < 0.001). There were no differences in maternal surgical or neonatal complications between groups. Conclusions Our results indicate that FAUCS can reduce postoperative pain and accelerate recovery, suggesting that this technique might be superior to MLCS and should be more widely used. One potentially key difference between FAUCS and MLCS is that MLCS includes 100 mcg spinal morphine anesthesia in addition to the same anesthesia used by FAUCS. Any interpretation of apparent differences must take the presence/absence of morphine into account.
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Affiliation(s)
- Kaouther Dimassi
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
- * E-mail:
| | - Ahmed Halouani
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Amine Kammoun
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
| | - Olivier Ami
- Ramsay Healthcare France, La Muette, Paris, France
| | - Benedicte Simon
- Ramsay Healthcare France, Les Franciscaines, Versailles, France
| | - Luka Velemir
- Lenval Foundation Polyclinique Santa Maria, Nice, France
| | - Denis Fauck
- Ramsay Healthcare France, Saint Lambert, La Garenne-Colombes, France
| | - Amel Triki
- Obstetrics and Gynecology Department, Mongi Slim University Hospital, La Marsa, Tunisia
- Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
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Giuntoli G, Muzio G, Actis C, Ganora A, Calzone S, Bruno M, Ciardelli G, Carmagnola I, Tonda-Turo C. In-vitro Characterization of a Hernia Mesh Featuring a Nanostructured Coating. Front Bioeng Biotechnol 2021; 8:589223. [PMID: 33553112 PMCID: PMC7856147 DOI: 10.3389/fbioe.2020.589223] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/16/2020] [Indexed: 11/15/2022] Open
Abstract
Abdominal hernia repair is a frequently performed surgical procedure worldwide. Currently, the use of polypropylene (PP) surgical meshes for the repair of abdominal hernias constitutes the primary surgical approach, being widely accepted as superior to primary suture repair. Surgical meshes act as a reinforcement for the weakened or damaged tissues and support tissue restoration. However, implanted meshes could suffer from poor integration with the surrounding tissues. In this context, the present study describes the preliminary evaluation of a PCL-Gel-based nanofibrous coating as an element to develop a multicomponent hernia mesh device (meshPCL-Gel) that could overcome this limitation thanks to the presence of a nanostructured biomimetic substrate for enhanced cell attachment and new tissue formation. Through the electrospinning technique, a commercial PP hernia mesh was coated with a nanofibrous membrane from a polycaprolactone (PCL) and gelatin (Gel) blend (PCL-Gel). Resulting PCL-Gel nanofibers were homogeneous and defect-free, with an average diameter of 0.15 ± 0.04 μm. The presence of Gel decreased PCL hydrophobicity, so that membranes average water contact angle dropped from 138.9 ± 1.1° (PCL) to 99.9 ± 21.6°, while it slightly influenced mechanical properties, which remained comparable to those of PCL (E = 15.7 ± 2.7 MPa, σ R = 7.7 ± 0.6 ε R = 118.8 ± 13.2%). Hydrolytic and enzymatic degradation was conducted on PCL-Gel up to 28 days, with maximum weight losses around 20 and 40%, respectively. The meshPCL-Gel device was obtained with few simple steps, with no influences on the original mechanical properties of the bare mesh, and good stability under physiological conditions. The biocompatibility of meshPCL-Gel was assessed by culturing BJ human fibroblasts on the device, up to 7 days. After 24 h, cells adhered to the nanofibrous substrate, and after 72 h their metabolic activity was about 70% with respect to control cells. The absence of detectable lactate dehydrogenase in the culture medium indicated that no necrosis induction occurred. Hence, the developed nanostructured coating provided the meshPCL-Gel device with chemical and topographical cues similar to the native extracellular matrix ones, that could be exploited for enhancing the biological response and, consequently, mesh integration, in abdominal wall hernia repair.
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Affiliation(s)
- Giulia Giuntoli
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
- POLITO BIOMedLAB, Politecnico di Torino, Turin, Italy
| | - Giuliana Muzio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Chiara Actis
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | | | | | - Gianluca Ciardelli
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
- POLITO BIOMedLAB, Politecnico di Torino, Turin, Italy
- Department for Materials and Devices of the National Research Council, Institute for the Chemical and Physical Processes (CNR-IPCF UOS), Pisa, Italy
| | - Irene Carmagnola
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
- POLITO BIOMedLAB, Politecnico di Torino, Turin, Italy
| | - Chiara Tonda-Turo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
- POLITO BIOMedLAB, Politecnico di Torino, Turin, Italy
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The experimental methodology and comparators used for in vivo hernia mesh testing: a 10-year scoping review. Hernia 2021; 26:297-307. [PMID: 33433739 PMCID: PMC8881265 DOI: 10.1007/s10029-020-02360-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/09/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE Before being marketed, hernia mesh must undergo in vivo testing, which often includes biomechanical and histological assessment. Currently, there are no universal standards for this testing and methods vary greatly within the literature. A scoping review of relevant studies was undertaken to analyse the methodologies used for in vivo mesh testing. METHODS Medline and Embase databases were searched for relevant studies. 513 articles were identified and 231 duplicates excluded. 126 papers were included after abstract and full text review. The data extraction was undertaken using standardised forms. RESULTS Mesh is most commonly tested in rats (53%). 78% of studies involve the formation of a defect; in 52% of which the fascia is not opposed. The most common hernia models use mesh to bridge an acute defect (50%). Tensile strength testing is the commonest form of mechanical testing (63%). Testing strip widths and test speeds vary greatly (4-30 mm and 1.625-240 mm/min, respectively). There is little consensus on which units to use for tensile strength testing. Collagen is assessed for its abundance (54 studies) more than its alignment (18 studies). Alignment is not measured quantitatively. At least 21 histological scoring systems are used for in vivo mesh testing. CONCLUSIONS The current practice of in vivo mesh testing lacks standardisation. There is significant inconsistency in every category of testing, both in methodology and comparators. We would call upon hernia organisations and materials testing institutions to discuss the need for a standardised approach to this field.
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Roth JS, Anthone GJ, Selzer DJ, Poulose BK, Pierce RA, Bittner JG, Hope WW, Dunn RM, Martindale RG, Goldblatt MI, Earle DB, Romanelli JR, Mancini GJ, Greenberg JA, Linn JG, Parra-Davila E, Sandler BJ, Deeken CR, Verbarg J, Salluzzo JL, Voeller GR. Prospective, multicenter study of P4HB (Phasix™) mesh for hernia repair in cohort at risk for complications: 3-Year follow-up. Ann Med Surg (Lond) 2021; 61:1-7. [PMID: 33363718 PMCID: PMC7750179 DOI: 10.1016/j.amsu.2020.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study represents a prospective, multicenter, open-label study to assess the safety, performance, and outcomes of poly-4-hydroxybutyrate (P4HB, Phasix™) mesh for primary ventral, primary incisional, or multiply-recurrent hernia in subjects at risk for complications. This study reports 3-year clinical outcomes. MATERIALS AND METHODS P4HB mesh was implanted in 121 patients via retrorectus or onlay technique. Physical exam and/or quality of life surveys were completed at 1, 3, 6,12, 18, 24, and 36 months, with 5-year (60-month) follow-up ongoing. RESULTS A total of n = 121 patients were implanted with P4HB mesh (n = 75 (62%) female) with a mean age of 54.7 ± 12.0 years and mean BMI of 32.2 ± 4.5 kg/m2 (±standard deviation). Comorbidities included: obesity (78.5%), active smokers (23.1%), COPD (28.1%), diabetes mellitus (33.1%), immunosuppression (8.3%), coronary artery disease (21.5%), chronic corticosteroid use (5.0%), hypo-albuminemia (2.5%), advanced age (5.0%), and renal insufficiency (0.8%). Hernias were repaired via retrorectus (n = 45, 37.2% with myofascial release (MR) or n = 43, 35.5% without MR), onlay (n = 8, 6.6% with MR or n = 24, 19.8% without MR), or not reported (n = 1, 0.8%). 82 patients (67.8%) completed 36-month follow-up. 17 patients (17.9% ± 0.4%) experienced hernia recurrence at 3 years, with n = 9 in the retrorectus group and n = 8 in the onlay group. SSI (n = 11) occurred in 9.3% ± 0.03% of patients. CONCLUSIONS Long-term outcomes following ventral hernia repair with P4HB mesh demonstrate low recurrence rates at 3-year (36-month) postoperative time frame with no patients developing late mesh complications or requiring mesh removal. 5-year (60-month) follow-up is ongoing.
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Affiliation(s)
- John Scott Roth
- Department of Surgery, University of Kentucky Medical Center, Lexington, KY, USA
| | - Gary J. Anthone
- Department of Surgery, Methodist Health System, Omaha, NE, USA
| | - Don J. Selzer
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin K. Poulose
- Center for Abdominal Core Health, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Richard A. Pierce
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James G. Bittner
- Department of Surgery, Saint Francis Hospital, Hartford, CT, USA
| | - William W. Hope
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Raymond M. Dunn
- Department of Surgery, University of Massachusetts Worcester, Worcester, MA, USA
| | | | - Matthew I. Goldblatt
- Department of Surgery, The Medical College of Wisconsin, Inc., Milwaukee, WI, USA
| | - David B. Earle
- Department of Surgery, New England Hernia Center, Lowell, MA, USA
| | - John R. Romanelli
- Department of Surgery, Baystate Medical Center, Springfield, MA, USA
| | - Gregory J. Mancini
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jacob A. Greenberg
- Department of Surgery, Board of Regents of the University of Wisconsin System, Madison, WI, USA
| | - John G. Linn
- Department of Surgery, North Shore University Health System, Evanston, IL, USA
| | | | - Bryan J. Sandler
- Department of Surgery, The Regents of the University of California, San Diego, CA, USA
| | | | | | | | - Guy R. Voeller
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
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Shin CS, Cabrera FJ, Lee R, Kim J, Ammassam Veettil R, Zaheer M, Adumbumkulath A, Mhatre K, Ajayan PM, Curley SA, Scott BG, Acharya G. 3D-Bioprinted Inflammation Modulating Polymer Scaffolds for Soft Tissue Repair. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2003778. [PMID: 33325594 DOI: 10.1002/adma.202003778] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/14/2020] [Indexed: 06/12/2023]
Abstract
Development of inflammation modulating polymer scaffolds for soft tissue repair with minimal postsurgical complications is a compelling clinical need. However, the current standard of care soft tissue repair meshes for hernia repair is highly inflammatory and initiates a dysregulated inflammatory process causing visceral adhesions and postsurgical complications. Herein, the development of an inflammation modulating biomaterial scaffold (bioscaffold) for soft tissue repair is presented. The bioscaffold design is based on the idea that, if the excess proinflammatory cytokines are sequestered from the site of injury by the surgical implantation of a bioscaffold, the inflammatory response can be modulated, and the visceral adhesion formations and postsurgical complications can be minimized. The bioscaffold is fabricated by 3D-bioprinting of an in situ phosphate crosslinked poly(vinyl alcohol) polymer. In vivo efficacy of the bioscaffold is evaluated in a rat ventral hernia model. In vivo proinflammatory cytokine expression analysis and histopathological analysis of the tissues have confirmed that the bioscaffold acts as an inflammation trap and captures the proinflammatory cytokines secreted at the implant site and effectively modulates the local inflammation without the need for exogenous anti-inflammatory agents. The bioscaffold is very effective in inhibiting visceral adhesions formation and minimizing postsurgical complications.
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Affiliation(s)
- Crystal S Shin
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Fernando J Cabrera
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Richard Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - John Kim
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Remya Ammassam Veettil
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Mahira Zaheer
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Aparna Adumbumkulath
- Department of Materials Science and Nanoengineering, Rice University, Houston, TX, 77030, USA
| | - Kirti Mhatre
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Pulickel M Ajayan
- Department of Materials Science and Nanoengineering, Rice University, Houston, TX, 77030, USA
| | - Steven A Curley
- Oncology Institute, Christus Health Institute, 910 East Houston St., Suite 270, Tyler, TX, 75702, USA
| | - Bradford G Scott
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ghanashyam Acharya
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
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El Bojairami I, El-Monajjed K, Driscoll M. Development and validation of a timely and representative finite element human spine model for biomechanical simulations. Sci Rep 2020; 10:21519. [PMID: 33298988 PMCID: PMC7725813 DOI: 10.1038/s41598-020-77469-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/11/2020] [Indexed: 01/31/2023] Open
Abstract
Numerous spine Finite Element (FE) models have been developed to assess spinal tolerances, spinal loadings and low back pain-related issues. However, justified simplifications, in terms of tissue decomposition and inclusion, for such a complex system may overlook crucial information. Thus, the purpose of this research was to develop and validate a comprehensive and representative spine FE model inclusive of an accurate representation of all major torso elements. A comprehensive model comprised of 273 tissues was developed via a novel FE meshing method to enhance computational feasibility. A comprehensive set of indirect validation tests were carried out to validate every aspect of the model. Under an increasing angular displacement of 24°-41°, the lumbar spine recorded an increasing moment from 5.5 to 9.3 Nm with an increase in IVD pressures from 0.41 to 0.66 MPa. Under forward flexion, vertical vertebral displacements simulated a 6% and 13% maximum discrepancy for intra-abdominal and intramuscular pressure results, all closely resembling previously documented in silico measured values. The developed state-of-the-art model includes most physiological tissues known to contribute to spinal loadings. Given the simulation's accuracy, confirmed by its validation tests, the developed model may serve as a reliable spinal assessment tool.
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Affiliation(s)
- Ibrahim El Bojairami
- Musculoskeletal Biomechanics Research Laboratory, Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Macdonald Eng. Bldg. Office #153, Montreal, QC, H3A 0C3, Canada
| | - Khaled El-Monajjed
- Musculoskeletal Biomechanics Research Laboratory, Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Macdonald Eng. Bldg. Office #153, Montreal, QC, H3A 0C3, Canada
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Laboratory, Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Macdonald Eng. Bldg. Office #153, Montreal, QC, H3A 0C3, Canada.
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91
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Pierrat B, Nováček V, Avril S, Turquier F. Mechanical characterization and modeling of knitted textile implants with permanent set. J Mech Behav Biomed Mater 2020; 114:104210. [PMID: 33338783 DOI: 10.1016/j.jmbbm.2020.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
Textile-based implant (mesh) treatment is considered as a standard of care for abdominal wall hernia repair. Computational models and simulations have appeared as one of the most promising approach to investigate biomechanics related to hernia repair and to improve clinical outcomes. This paper presents a novel anisotropic hypo-elastoplastic constitutive model specifically established for surgical knitted textile implants. The major mechanical characteristics of these materials such as anisotropy and permanent set have been reproduced. For the first time ever, we report an extensive mechanical characterization of one of these meshes, including cyclic uniaxial tension, planar equibiaxial tension and plunger type testing. These tests highlight the complex mechanical behavior with strong nonlinearity, anisotropy and permanent set. The novel anisotropic hypo-elasto-plastic constitutive model has been identified based on the tensile experiments and validated successfully against the data of the plunger experiment. In the future, implementation of this characterization and modeling approach to additional surgical knitted textiles should be the direction to follow in order to develop clinical decision support software for abdominal wall repair.
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Affiliation(s)
- Baptiste Pierrat
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France.
| | - Vít Nováček
- New Technologies - Research Centre, University of West Bohemia, Univerzitní 8, 301 00, Plzeň, Czech Republic
| | - Stéphane Avril
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France
| | - Frédéric Turquier
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023, Saint-Etienne, France
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Roisman S, Dotan AL, Lewitus DY. Polycaprolactone‐based hotmelt adhesive for
hernia‐mesh
fixation. POLYM ADVAN TECHNOL 2020. [DOI: 10.1002/pat.5044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sabrina Roisman
- Department of Polymer Materials Engineering Shenkar College Ramat‐Gan Israel
| | - Ana L. Dotan
- Department of Polymer Materials Engineering Shenkar College Ramat‐Gan Israel
| | - Dan Y. Lewitus
- Department of Polymer Materials Engineering Shenkar College Ramat‐Gan Israel
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Patiniott P, Stagg B, Karatassas A, Maddern G. Developing a Hernia Mesh Tissue Integration Index Using a Porcine Model-A Pilot Study. Front Surg 2020; 7:600195. [PMID: 33324674 PMCID: PMC7726018 DOI: 10.3389/fsurg.2020.600195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: With so many prosthetics available, it can be difficult for surgeons to choose the most appropriate hernia mesh. Successful hernia repair mandates an understanding of how the patient's inflammatory response influences surgical outcomes. Failure to appreciate the importance of the biological aspect of hernia repair can be very costly as emerging evidence supports that biofilm formation and reduction in effective mesh porosity gives rise to long-term mesh complications including fibrosis, chronic mesh infection, and pain. In this pilot study, we utilized a large animal (porcine) model to develop a numerical Mesh Tissue Integration (MTI) Index focused on visible tissue ingrowth, fibrosis, adhesion formation and resorption of mesh. The aim is to help surgeons adopt an evidence-based approach in selecting the most appropriate mesh according to its tissue ingrowth characteristics, matched to the patient to achieve improved surgical outcomes and optimal patient-centered care. Methods: Two forty kg female Landrace pigs were recruited for this pilot study. A total of eight commonly used hernia mesh products and two controls measuring 5 × 5cm were surgically implanted in subrectus and intraperitoneal planes. The pigs were euthanised at 2 and 4 weeks, respectively. The abdominal wall was explanted, and the mesh specimens underwent macroscopic, histologic and biomechanical analysis, with engineering and pathology teams blinded to the mesh. Results: Significant differences between the degrees of MTI were observed at 2 weeks and the distinctions were even more apparent at 4 weeks. One of the interesting incidental findings we observed is that mesh products placed in the subrectus plane displayed greater degrees of adhesion strength and integration than those placed intraperitoneally. Conclusion: This pilot study is one of the first to propose a functional, biological standardized model for comparing hernia mesh products. The results are encouraging and demonstrate that this is a robust and transferrable model for assessing MTI in hernia mesh. The intention for this model is that it will be utilized synergistically with long term mesh/patient outcome registries and databases to inform improved matching of mesh to patient, particularly in the setting of the complex hernia repair and abdominal wall reconstruction.
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Affiliation(s)
- Paul Patiniott
- Department of Surgery, University of Adelaide, Adelaide, SA, Australia.,The Queen Elizabeth Hospital (TQEH), Woodville South, SA, Australia
| | - Brendan Stagg
- South Australia Pathology, University of Adelaide, Adelaide, SA, Australia
| | - Alex Karatassas
- Department of Surgery, University of Adelaide, Adelaide, SA, Australia.,The Queen Elizabeth Hospital (TQEH), Woodville South, SA, Australia
| | - Guy Maddern
- Department of Surgery, University of Adelaide, Adelaide, SA, Australia.,The Queen Elizabeth Hospital (TQEH), Woodville South, SA, Australia
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94
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Deeken CR, Gagne DH, Badhwar A. Mechanical and Histological Characteristics of Phasix™ ST Mesh in a Porcine Model of Hernia Repair. J INVEST SURG 2020; 35:415-423. [PMID: 33044098 DOI: 10.1080/08941939.2020.1830318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The objective of this study was to determine mechanical and histological properties of Phasix™ ST Mesh in various defect sizes and characterize the tissue replacing Phasix™ ST Mesh in a porcine model of ventral hernia repair. METHODS Simulated hernia defects were surgically created in the midline of twenty-four (n = 24) Yucatan pigs. Treatment groups included 8 cm defect sutured closed (buttress) and unclosed 4 cm and 8 cm defect groups. Phasix™ ST Mesh (15 cm diameter circle) was implanted laparoscopically and fixated circumferentially with SorbaFix™ Absorbable Fixation System fasteners. The repair sites underwent mechanical, molecular weight, and histological evaluation at 48 and 72 weeks postimplantation. RESULTS Mechanical testing of Phasix™ ST Mesh-repaired sites revealed similar strengths at both time points for all three repair types, p > 0.05 in all cases (48 weeks: 142.4 ± 6.0 N, 142.3 ± 16.5 N, and 168.8 ± 38.5 N; 72 weeks: 110.0 ± 18.3 N, 138.6 ± 42.2 N, and 160.6 ± 42.0 N for 4 cm defect, 8 cm defect, and 8 cm buttress, respectively. mean ± SEM) No significant differences were observed over time except at 72 weeks postimplantation when the 4 cm defect group exhibited significantly lower strength than the T0 strength of Phasix™ ST Mesh (204.6 ± 5.0 N, p < 0.05). The molecular weight of Phasix™ ST Mesh decreased over time, regardless of repair type. Histological analysis showed comparable mature collagen/fibrovascular tissue around and within the Phasix™ ST Mesh interstices, including the segment of mesh overlying the defect. CONCLUSION Phasix™ ST Mesh-repaired sites exhibited similar mechanical strengths and histological properties across all defect sizes in this porcine model.
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Affiliation(s)
| | - Darcy H Gagne
- Becton, Dickinson and Company (BD), Warwick, Rhode Island, USA
| | - Amit Badhwar
- Becton, Dickinson and Company (BD), Warwick, Rhode Island, USA
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95
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Learn GD, Lai EJ, Wilson EJ, von Recum HA. Nonthermal plasma treatment of polymers modulates biological fouling but can cause material embrittlement. J Mech Behav Biomed Mater 2020; 113:104126. [PMID: 33045518 DOI: 10.1016/j.jmbbm.2020.104126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/10/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
Plasma-based treatment is a prevalent strategy to alter biological response and enhance biomaterial coating quality at the surfaces of biomedical devices and implants, especially polymeric materials. Plasma, an ionized gas, is often thought to have negligible effects on the bulk properties of prosthetic substrates given that it alters the surface chemistry on only the outermost few nanometers of material. However, no studies to date have systematically explored the effects of plasma exposure on both the surface and bulk properties of a biomaterial. This work examines the time-dependent effects of a nonthermal plasma on the surface and bulk (i.e. mechanical) properties of polymeric implants, specifically polypropylene surgical meshes and sutures. Findings suggest that plasma exposure improved resistance to fibrinogen adsorption and Escherichia coli attachment, and promoted mammalian fibroblast attachment, although increased duration of exposure resulted in a state of diminishing returns. At the same time, it was observed that plasma exposure can be detrimental to the material properties of individual filaments (i.e. sutures), as well as the structural characteristics of knitted meshes, with longer exposures resulting in further embrittlement and larger changes in anisotropic behavior. Though there are few guidelines regarding appropriate mechanical properties of surgical textiles, the results from this investigation imply that there are ultimate exposure limits for plasma-based treatments of polymeric implant materials when structural properties must be preserved, and that the effects of a plasma on a given biomaterial should be examined carefully before translation to a clinical scenario.
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Affiliation(s)
- Greg D Learn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Emerson J Lai
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | | | - Horst A von Recum
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
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96
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Yang D, Song Z, Lin Y, Dong W, Fu S, Yang J, Zhang P, Gu Y. Prevention of intestinal adhesion and regeneration of abdominal wall tissue with meshes containing an electrostatically spun acellular dermal matrix (ADM)/silk fibroin (SF) fiber composite polypropylene mesh. J Mech Behav Biomed Mater 2020; 112:104087. [PMID: 32980670 DOI: 10.1016/j.jmbbm.2020.104087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022]
Abstract
The repair of abdominal wall defects often requires the use of polypropylene (PP) as the main material. After a PP mesh is implanted in the body, contact with the intestine can cause adhesions between the intestine and the mesh, leading to serious complications such as intestinal fistula. In this study, we used electrostatic spinning technology to coat one side of PP meshes with an electrostatically spun isolating layer of acellular dermal matrix (ADM)/silk fibroin (SF) hybrid material. These meshes were used to repair abdominal wall defects in model rats and were compared with polycaprolactone (PCL) composite polypropylene meshes and PP meshes. The results showed that the adhesion score and area of ADM/SF-PP meshes were smaller than those of PCL-PP and PP meshes. Immunohistochemical assessment revealed that the ADM/SF meshes could effectively reduce the inflammatory response at the contact surface between the meshes and abdominal organs. The tissues regenerated on the abdominal side were rich in new blood vessels. Furthermore, the ADM/SF meshes could effectively reduce the expression levels of the inflammation-related factors IL-6 and TNF-α. The expression levels of tissue regeneration-related factors, such as VEGF and PAX-7, were also higher after ADM/SF-PP mesh-mediated repair than after PCL-PP mesh and PP mesh repair. Thus, ADM/SF-PP meshes can effectively reduce the inflammatory response at the contact surface between the meshes and abdominal organs and quickly promote regeneration of abdominal surface tissue to prevent and reduce abdominal adhesion and support restoration of the abdominal wall.
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Affiliation(s)
- Dongchao Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhicheng Song
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yongjia Lin
- Key Laboratory of Textile Science& Technology, College of Textiles, Donghua University, Shanghai, China
| | - Wenpei Dong
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shaoju Fu
- Key Laboratory of Textile Science& Technology, College of Textiles, Donghua University, Shanghai, China
| | - Jianjun Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Peihua Zhang
- Key Laboratory of Textile Science& Technology, College of Textiles, Donghua University, Shanghai, China
| | - Yan Gu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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97
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Elfanagely O, Othman S, Sanchez JA, Rios-Diaz A, Mellia JA, Fischer JP. Dual Tack Mesh Fixation System on a Cadaveric Porcine Model-Creation of a Mesh Fixation System for Hernia Treatment and Prevention. J Surg Res 2020; 257:317-325. [PMID: 32889330 DOI: 10.1016/j.jss.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/18/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Onlay mesh repair (OMR) has proven to be a widely used, simple, and effective technique for treatment and prevention of hernia occurrence. Despite established benefits, there is still a lack of widespread adoption. In this study, we present the Dual Tacker Device (DTD), an enabling technology that directly addresses the limitations to the adoption of OMR, saving surgical time and effort and making OMR more reproducible across a wide range of patients. METHODS The DTD mesh fixation system is a semiautomated, hand-held, disposable, multipoint onlay mechanical mesh fixation system that is able to rapidly and uniformly tension and fixate mesh for both hernia treatment and prevention. A cadaveric porcine model was used as a pilot test conducted during a 2 day session to assess the usability of the device and to show that the DTD provided equivalent or superior biomechanical support compared with the standard of care (hand-sewn, OptiFix). RESULTS Our study included 37 cadaveric porcine incisional closure abdominal wall models. These were divided into four groups: DTD-mediated OMR (n = 14), hand-sewn OMR (n = 7), OptiFix OMR (n = 9), and suture-only repair (no mesh) (n = 7). Eight surgical residents performed device-mediated and hand-sewn OMR. Average time to completion was fastest in the DTD cohort (45.6s) with a statistically significant difference compared with the hand-sewn cohort (343.1s, P < 0.01). No difference in tensile strength was noted between DTD (195.32N), hand-sewn (200.48N), and OptiFix (163.23N). Discreet hand movements were smallest in the DTD (29N) and significant (P < 0.01) when compared with hand-sewn (202N) and OptiFix (35N). CONCLUSIONS The use of the DTD is not only feasible, but demonstrated improvement in time to completion and economy of movement over current standard of care. While more testing is needed and planned, compared with conventional approaches, the DTD represents a robust proof of principle with promising implications for clinical feasibility and adoptability.
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Affiliation(s)
- Omar Elfanagely
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sammy Othman
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Arturo Rios-Diaz
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph A Mellia
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Paradigm Surgical LLC, Philadelphia, Pennsylvania.
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98
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Knothe Tate ML. Advanced Design and Manufacture of Mechanoactive Materials Inspired by Skin, Bones, and Skin-on-Bones. Front Bioeng Biotechnol 2020; 8:845. [PMID: 32984263 PMCID: PMC7477045 DOI: 10.3389/fbioe.2020.00845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/30/2020] [Indexed: 01/01/2023] Open
Abstract
Life is mechanobiological. Natural living materials exhibit remarkable, emergent and smart properties under mechanical loading. Such materials are classified as mechanoactive, in contrast to electroactive polymers and materials that exhibit advanced properties when subjected to electrical stimulation. Cutting edge, multiscale imaging technologies have proven enabling for the elucidation of molecular to meso-scale structure and function of natural mechanoactive materials. Using Microscopy-Aided Design And ManufacturE, (MADAME) this perspective article describes mechanoactive properties of natural materials including skin-on-bones (periosteum) and bone itself. In so doing, it demonstrates the principle to emulate natural smart properties using recursive logic, the basis of many computer algorithms, and to design and manufacture mechanoactive materials and products using advanced manufacturing methods that also incorporate principles of recursive logic. In sum, the MADAME approach translates physically the computer science paradigm of recursion by implementing Jacquard textile methods, which themselves form a historical basis for computing machines, together with additive manufacturing methods including multidimensional printing, stereolithography, laser sintering, etc. These integrated methods provide a foundation and translational pathway for scaled-up manufacture of disruptive mechanoactive materials that will find use in fields as varied as medicine, safety, transport and sports, for internal (implants) and external (wearables) applications.
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Affiliation(s)
- Melissa Louise Knothe Tate
- Inaugural Paul Trainor Chair of Biomedical Engineering, Director MechBio Team, Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, NSW, Australia
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99
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Lubowiecka I, Tomaszewska A, Szepietowska K, Szymczak C, Śmietański M. In vivo performance of intraperitoneal onlay mesh after ventral hernia repair. Clin Biomech (Bristol, Avon) 2020; 78:105076. [PMID: 32535476 DOI: 10.1016/j.clinbiomech.2020.105076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ventral hernia repair needs to be improved since recurrence, postoperative pain and other complications are still reported in many patients. The behavior of implants in vivo is not sufficiently understood to design a surgical mesh mechanically compatible with the human abdominal wall. METHODS This analysis was based on radiological pictures of patients who underwent laparoscopic ventral hernia repair. The pictures show the trunk of the patient at rest in a standing position and under side bending. The change in the distance between different tacks due to trunk movement was analyzed, which allowed us to determine the in vivo elongation of the mesh incorporated into the abdominal wall. FINDINGS The relative elongations of the surgical mesh varied from a few percent to greater than 100% in two cases. The median of the median relative elongations obtained for all patients is 9.5%, and the median of the maximum relative elongations for all patients is 32.6%. The maximum elongation occurs between tacks that are next to each other. Trunk movement causes implant deformation, and this study provides quantitative information regarding changes in the distance between fasteners. INTERPRETATION The physiological movement of the human abdomen must be regarded as a very important factor in mesh deformation and should be considered in surgical practice to reduce the hernia recurrence rate and postoperative pain.
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Affiliation(s)
- Izabela Lubowiecka
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland.
| | - Agnieszka Tomaszewska
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland
| | - Czesław Szymczak
- Gdansk University of Technology, Faculty of Ocean Engineering and Ship Technology, Gdańsk, Poland
| | - Maciej Śmietański
- Medical University of Gdańsk, 2(nd) Department of Radiology, Hospital Swissmed S.A., Department of Surgery, Poland
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100
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Liu Z, Zhu X, Tang R. Electrospun Scaffold with Sustained Antibacterial and Tissue-Matched Mechanical Properties for Potential Application as Functional Mesh. Int J Nanomedicine 2020; 15:4991-5004. [PMID: 32764931 PMCID: PMC7368590 DOI: 10.2147/ijn.s248970] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/18/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Various materials and approaches have been used to reduce the mesh-induced inflammatory response and modify the mesh with tissue-matched mechanical properties, aiming to improve the repair of abdominal wall defects. Materials and Methods In this study, we fabricated a polycaprolactone (PCL)/silk fibroin (SF) mesh integrated with amoxicillin (AMX)-incorporating multiwalled carbon nanotubes (MWCNTs) via electrospinning, grafting and crosslinking, developing a sustainable antibiotic and flexible mesh. AMX was loaded into the hollow tubular MWCNTs by physical adsorption, and a nanofibrous structure was constructed by electrospinning PCL and SF (40:60 w/w). The AMX@MWCNTs were then chemically grafted onto the surfaces of the PCL/SF nanofibers by treating with 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide/N-hydroxysuccinimide (EDC/NHS) solution for simultaneous crosslinking and coating. The incorporation of AMX into the MWCNTs (AMX@MWCNTs) and the integration of the AMX@MWCNTs with the PCL/SF nanofibers were characterized. Then, the functional mesh was fabricated and fully evaluated in terms of antibacterial activity, mechanical properties and host response. Results Our results demonstrated that the PCL/SF nanofibrous structure was fabricated successfully by electrospinning. After integrating with AMX@MWCNT by grafting and crosslinking, the functional mesh showed undeformed structure, modified surface hydrophilicity and biocompatible interfaces, abdominal wall-matched mechanical properties, and a sustained-release antibiotic profile in E. coli growth inhibition compared to those of PCL/SF mesh in vitro. In a rat model with subcutaneous implantation, the functional mesh incited less mesh-induced inflammatory and foreign body responses than PCL/SF mesh within 14 days. The histological analysis revealed less infiltration of granulocytes and macrophages during this period, resulting in the loosely packed collagen deposition on the functional mesh and prominent collagen incorporation. Discussion Therefore, this designed PCL/SF-AMX@MWCNT nanofibrous mesh, functionalized with antibacterial and tissue-matched mechanical properties, provides a promising alternative for the repair of abdominal wall defects.
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Affiliation(s)
- Zhengni Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
| | - Xiaoqiang Zhu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
| | - Rui Tang
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
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