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Role of 4-hydroxybutyrate in increased resistance to surgical site infections associated with surgical meshes. Biomaterials 2020; 267:120493. [PMID: 33202331 DOI: 10.1016/j.biomaterials.2020.120493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/26/2022]
Abstract
An increased resistance to surgical site infections has been associated with surgical meshes composed of naturally occurring materials, including poly-4-hydroxybutrate (4HB). 4HB is a naturally occurring short-chain fatty acid that has been shown to promote endogenous expression of the Cramp gene coding for the antimicrobial peptide (AMP) cathelicidin LL-37 in murine bone marrow-derived macrophages. The molecular pathways involved in the 4HB-induced cathelicidin LL-37 expression have not yet been identified. The present study showed that transcriptional activation of the Cramp gene by 4HB is independent of inhibition of histone deacetylase (HDAC) activity, and that upregulation of Cramp is modulated by the G-protein coupled receptor GPR109A. Furthermore, an intracellular signaling cascade that promotes the activation of the MAP kinases, p38 and JNK, and a subsequent NF-κB phosphorylation downstream from p38 is essential for the AMP transcriptional response in 4HB-stimulated macrophages. The findings provide a solid scientific basis and rationale for the decreased incidence of surgical site infections with the use of this type of surgical meshes. Further clinical significance is found in the fact that the 4HB activated molecular pathway includes common targets of frequently used nonsteroidal anti-inflammatory drugs (NSAIDs) and other FDA approved drugs recognizing G-protein coupled receptors.
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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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Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall Hernia Repair. World J Surg 2020; 45:443-450. [PMID: 33025154 DOI: 10.1007/s00268-020-05808-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The goal of this article was to report the results about the efficacy of treatment of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in one-stage management, with complete mesh explantation of infected prosthesis and simultaneous reinforcement with a biosynthetic poly-4-hydroxybutyrate absorbable (P4HB) mesh. METHODS This is a retrospective analysis of all patients that needed mesh removal for CMI between September 2016 and January 2019 at a tertiary center. Epidemiological data, hernia characteristics, surgical, and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. RESULTS Of the 32 patients who required mesh explantation, 30 received one-stage management of CMI. In 60% of the patients, abdominal wall reconstruction was necessary after the infected mesh removal: 8 cases (26.6%) were treated with Rives-Stoppa repair, 4 (13.3%) with a fascial plication, 1 (3.3%) with anterior component separation, and 1 (3.3%) with transversus abdominis release to repair hernia defects. Three Lichtenstein (10%) and 1 Nyhus repairs (3.3%) were performed in patients with groin hernias. The most frequent postoperative complications were surgical site occurrences: seroma in 5 (20%) patients, hematoma in 2 (6.6%) patients, and wound infection in 1 (3.3%) patient. During the mean follow-up of 34.5 months (range 23-46 months), the overall recurrence rate was 3.3%. Persistent, recurrent, or new CMIs were not observed. CONCLUSIONS In our experience, single-stage management of CMI with complete removal of infected prosthesis and replacement with a P4HB mesh is feasible with acceptable results in terms of mesh reinfection and hernia recurrence.
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Breast Reconstruction Using a Three-Dimensional Absorbable Mesh Scaffold and Autologous Fat Grafting: A Composite Strategy Based on Tissue-Engineering Principles. Plast Reconstr Surg 2020; 146:409e-413e. [DOI: 10.1097/prs.0000000000007172] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van Rooijen MM, Jairam AP, Tollens T, Jørgensen LN, de Vries Reilingh TS, Piessen G, Köckerling F, Miserez M, Windsor AC, Berrevoet F, Fortelny RH, Dousset B, Woeste G, van Westreenen HL, Gossetti F, Lange JF, Tetteroo GW, Koch A, Kroese LF, Jeekel J. Outcomes of a new slowly resorbable biosynthetic mesh (Phasix™) in potentially contaminated incisional hernias: A prospective, multi-center, single-arm trial. Int J Surg 2020; 83:31-36. [PMID: 32931978 DOI: 10.1016/j.ijsu.2020.08.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Resorbable biomaterials have been developed to reduce the amount of foreign material remaining in the body after hernia repair over the long-term. However, on the short-term, these resorbable materials should render acceptable results with regard to complications, infections, and reoperations to be considered for repair. Additionally, the rate of resorption should not be any faster than collagen deposition and maturation; leading to early hernia recurrence. Therefore, the objective of this study was to collect data on the short-term performance of a new resorbable biosynthetic mesh (Phasix™) in patients requiring Ventral Hernia Working Group (VHWG) Grade 3 midline incisional hernia repair. MATERIALS AND METHODS A prospective, multi-center, single-arm trial was conducted at surgical departments in 15 hospitals across Europe. Patients aged ≥18, scheduled to undergo elective Ventral Hernia Working Group Grade 3 hernia repair of a hernia larger than 10 cm2 were included. Hernia repair was performed with Phasix™ Mesh in sublay position when achievable. The primary outcome was the rate of surgical site occurrence (SSO), including infections, that required intervention until 3 months after repair. RESULTS In total, 84 patients were treated with Phasix™ Mesh. Twenty-two patients (26.2%) developed 32 surgical site occurrences. These included 11 surgical site infections, 9 wound dehiscences, 7 seromas, 2 hematomas, 2 skin necroses, and 1 fistula. No significant differences in surgical site occurrence development were found between groups repaired with or without component separation technique, and between clean-contaminated or contaminated wound sites. At three months, there were no hernia recurrences. CONCLUSION Phasix™ Mesh demonstrated acceptable postoperative surgical site occurrence rates in patients with a Ventral Hernia Working Group Grade 3 hernia. Longer follow-up is needed to evaluate the recurrence rate and the effects on quality of life. This study is ongoing through 24 months of follow-up.
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Affiliation(s)
- Mathilde Mj van Rooijen
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands.
| | - An P Jairam
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - Tim Tollens
- Imelda Hospital, Department of General Surgery, Bonheiden, Belgium
| | - Lars N Jørgensen
- University of Copenhagen, Bispebjerg Hospital, Department of Surgery, Copenhagen, Denmark
| | | | | | | | - Marc Miserez
- University Hospital Leuven, Department of Abdominal Surgery, Leuven, Belgium
| | - Alastair Cj Windsor
- University College London Hospital, Department of Colorectal Surgery, London, United Kingdom
| | - Frederik Berrevoet
- University Hospital Ghent, Department of General and Hepatobiliary Surgery, Ghent, Belgium
| | - René H Fortelny
- Wilhelminenhospital, Department of General, Visceral and Oncologic Surgery, Vienna, Austria
| | - Bertrand Dousset
- Hôpital Cochin, Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris, France
| | - Guido Woeste
- Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt Am Main, Germany
| | | | | | - Johan F Lange
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands; IJsselland Ziekenhuis, Department of Surgery, Capelle Aan Den Ijssel, The Netherlands
| | - Geert Wm Tetteroo
- IJsselland Ziekenhuis, Department of Surgery, Capelle Aan Den Ijssel, The Netherlands
| | - Andreas Koch
- Chirurgische Praxis Cottbus, Cottbus Area, Germany
| | - Leonard F Kroese
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - Johannes Jeekel
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
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Affiliation(s)
- Gregory A Dumanian
- Division of Plastic Surgery, Northwestern Memorial Hospital, Northwestern Feinberg School of Medicine, 675 North St. Clair, Suite 19-250, Chicago, IL 60611, USA.
| | - Simon Moradian
- Division of Plastic Surgery, Northwestern Memorial Hospital, Northwestern Feinberg School of Medicine, 675 North St. Clair, Suite 19-250, Chicago, IL 60611, USA
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Analysis of resorbable mesh implants in short-term human muscular fascia cultures: a pilot study. Hernia 2020; 24:1283-1291. [PMID: 32725294 PMCID: PMC7701128 DOI: 10.1007/s10029-020-02271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/16/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Alteration in fascial tissue collagen composition represents a key factor in hernia etiology and recurrence. Both resorbable and non-resorbable meshes for hernia repair are currently used in the surgical setting. However, no study has investigated so far the role of different implant materials on collagen deposition and tissue remodeling in human fascia. The aim of the present study was to develop a novel ex vivo model of human soft tissue repair mesh implant, and to test its suitability to investigate the effects of different materials on tissue remodeling and collagen composition. METHODS Resorbable poly-4-hydroxybutyrate and non-resorbable polypropylene mesh implants were embedded in human abdominal fascia samples, mimicking common surgical procedures. Calcein-AM/Propidium Iodide vital staining was used to assess tissue vitality. Tissue morphology was evaluated using Mallory trichrome and hematoxylin and eosin staining. Collagen type I and III expression was determined through immunostaining semi-quantification by color deconvolution. All analyses were performed after 54 days of culture. RESULTS The established ex vivo model showed good viability at 54 days of culture, confirming both culture method feasibility and implants biocompatibility. Both mesh implants induced a disorganization of collagen fibers pattern. A statistically significantly higher collagen I/III ratio was detected in fascial tissue samples cultured with resorbable implants compared to either non-resorbable implants or meshes-free controls. CONCLUSION We developed a novel ex vivo model and provided evidence that resorbable polyhydroxybutyrate meshes display better biomechanical properties suitable for proper restoration in surgical hernia repair.
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Rognoni C, Cuccurullo D, Borsoi L, Bonavina L, Asti E, Crovella F, Bassi UA, Carbone G, Guerini F, De Paolis P, Pessione S, Greco VM, Baccarini E, Soliani G, Sagnelli C, Crovella C, Trapani V, De Nisco C, Eugeni E, Zanzi F, De Nicola E, Marioni A, Rosignoli A, Silvestro R, Tarricone R, Piccoli M. Clinical outcomes and quality of life associated with the use of a biosynthetic mesh for complex ventral hernia repair: analysis of the "Italian Hernia Club" registry. Sci Rep 2020; 10:10706. [PMID: 32612131 PMCID: PMC7329869 DOI: 10.1038/s41598-020-67821-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/01/2020] [Indexed: 12/24/2022] Open
Abstract
With the development of newer meshes and approaches to hernia repair, it is currently difficult to evaluate their performances while considering the patients' perspective. The aim of the study was to assess the clinical outcomes and quality of life consequences of abdominal hernia repairs performed in Italy using Phasix and Phasix ST meshes through the analysis of real-world data to support the choice of new generation biosynthetic meshes. An observational, prospective, multicentre study was conducted in 10 Italian clinical centres from May 2015 to February 2018 and in 15 Italian clinical centres from March 2018 to May 2019. The evaluation focused on patients with VHWG grade II-III who underwent primary ventral hernia repair or incisional hernia intervention with a follow-up of at least 18 months. Primary endpoints included complications' rates, and secondary outcomes focused on patient quality of life as measured by the EuroQol questionnaire. Seventy-five patients were analysed. The main complications were: 1.3% infected mesh removal, 4.0% superficial infection requiring procedural intervention, 0% deep/organ infection, 8.0% recurrence, 5.3% reintervention, and 6.7% drained seroma. The mean quality of life utility values ranged from 0.768 (baseline) to 0.967 (36 months). To date, Phasix meshes have proven to be suitable prostheses in preventing recurrence, with promising outcomes in terms of early and late complications and in improving patient quality of life.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milano, Italy.
| | | | - Ludovica Borsoi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milano, Italy
| | - Luigi Bonavina
- IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Emanuele Asti
- IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | | | | | | | | | | | | | | | | | - Carlo Sagnelli
- Ospedale Monaldi, Azienda Ospedaliera dei Colli, Napoli, Italy
| | | | - Vincenzo Trapani
- Azienda Ospedaliero-Universitaria, OCB (Ospedale Civile Baggiovara), Modena, Italy
| | | | | | - Federico Zanzi
- AUSL della Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
| | | | | | | | | | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milano, Italy.,Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - Micaela Piccoli
- Azienda Ospedaliero-Universitaria, OCB (Ospedale Civile Baggiovara), Modena, Italy
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Long term comparative evaluation of two types of absorbable meshes in partial abdominal wall defects: an experimental study in rabbits. Hernia 2020; 24:1159-1173. [PMID: 32388587 DOI: 10.1007/s10029-020-02201-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Synthetic prosthetic materials that are fully absorbable seek to reduce the host foreign body reaction and promote host tissue regeneration. This preclinical trial was designed to analyse, in the long term, the behaviour of two prosthetic meshes, one synthetic and one composed of porcine collagen, in abdominal wall reconstruction. METHODS Partial defects were created in the abdominal walls of New Zealand rabbits and repaired using a synthetic absorbable mesh (Phasix™) or a non-crosslinked collagen bioprosthesis (Protexa™). After 3, 6, 12 and 18 months, specimens were recovered for light microscopy and collagen expression analysis to examine new host tissue incorporation, macrophage response and biomechanical strength. RESULTS Both materials showed good host tissue incorporation in line with their spatial structure. At 18 months postimplant, Protexa™ was highly reabsorbed while the biodegradation of Phasix™ was still incomplete. Collagenization of both materials was good. Macrophage counts steadily decreased over time in response to Phasix™, yet persisted in the collagen meshes. At 18 months, zones of loose tissue were observed at the implant site in the absence of herniation in both implant types. The stress-stretch behaviour of Phasix™ implants decreased over time, being more pronounced during the period of 12-18 months. Nevertheless, the abdominal wall repaired with Protexa™ became stiffer over time. CONCLUSION Eighteen months after the implant both materials showed good compatibility but the biodegradation of Phasix™ and Protexa™ was incomplete. No signs of hernia were observed at 18 months with the stress-stretch relations being similar for both implants, regardless of the more compliant abdominal wall repaired with Protexa™ at short term.
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Levy AS, Bernstein JL, Premaratne ID, Rohde CH, Otterburn DM, Morrison KA, Lieberman M, Pomp A, Spector JA. Poly-4-hydroxybutyrate (Phasix™) mesh onlay in complex abdominal wall repair. Surg Endosc 2020; 35:2049-2058. [PMID: 32385706 DOI: 10.1007/s00464-020-07601-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Poly-4-hydroxybutyric acid (P4HB, Phasix™) is a biosynthetic polymer that degrades by hydrolysis that can be woven into a mesh for use in soft tissue reinforcement. Herein, we describe our initial experience performing complex abdominal wall repair (CAWR) utilizing component separation and P4HB mesh as onlay reinforcement. METHODS All patients undergoing CAWR between June 2014 and May 2017 were followed prospectively for postoperative outcomes. Only those patients who underwent components separation with primary repair of the fascial edges followed by onlay of P4HB mesh were included in this study. RESULTS 105 patients (52 male, 53 female; mean age 59.2 years, range 22-84) met inclusion criteria. Mean BMI was 29.1 (range 16-48); 52% patients had prior attempted hernia repair, most with multiple medical comorbidities (71% of patients with ASA 3 or greater). 30% of cases were not clean at the time of repair (CDC class 2 or greater). Median follow-up was 36 months (range 9-63). Eighteen patients (17%) developed a hernia recurrence ranging from 2 to 36 months postoperatively. Five (5%) patients developed a localized superficial infection treated with antibiotics, three (2.8%) required re-operation for non-healing wounds, and six (6%) patients developed seroma. CONCLUSIONS These data demonstrate a relatively low rate of hernia recurrence, seroma, and other common complications of CAWR in a highly morbid patient population. Importantly, the rate of mesh infection was low and no patients required complete mesh removal, even when placed into a contaminated or infected surgical field.
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Affiliation(s)
- Adam S Levy
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jaime L Bernstein
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Ishani D Premaratne
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York, NY, USA
| | - David M Otterburn
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Kerry A Morrison
- Hansjorg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Michael Lieberman
- Division of General Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Alfons Pomp
- Division of General Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Jason A Spector
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY, USA.
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Cornwell KG, Jessee CB, Adelman DM. Clinically available reinforcing materials for soft tissue reconstruction. Br J Hosp Med (Lond) 2020; 81:1-10. [PMID: 32240006 DOI: 10.12968/hmed.2018.0428b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Navigating the rapidly evolving field of materials for soft tissue reinforcement is challenging given the volume of clinically available options. Additionally, the current generally accepted classifications of these mesh materials confound the understanding of their utility by grouping disparate materials that have attributes overlapping category boundaries and that do not fully consider their clinically functionality. This review article highlights, from a materials science perspective, the most important attributes of these materials to improve the clinical decision-making process in the selection of the most appropriate features and design for the patient, surgery and clinical need. These characteristics include the physical attributes that directly impact the surgical procedure and immediate postoperative mechanical requirements as well as the post-implantation properties such as an adequate reinforcement time, strength of the resulting tissue and infection risk profile.
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Affiliation(s)
| | | | - David M Adelman
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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Amigo N, Zubieta C, Riganti JM, Ramirez M, Renda P, Lovera R, Pascaner A, Vigliano C, Craiem D, Young DA, Gilbert TW, Nieponice A. Biomechanical Features of Reinforced Esophageal Hiatus Repair in a Porcine Model. J Surg Res 2020; 246:62-72. [DOI: 10.1016/j.jss.2019.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
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Overbeck N, Nagvajara GM, Ferzoco S, May BCH, Beierschmitt A, Qi S. In-vivo evaluation of a reinforced ovine biologic: a comparative study to available hernia mesh repair materials. Hernia 2020; 24:1293-1306. [PMID: 32006122 PMCID: PMC7701079 DOI: 10.1007/s10029-019-02119-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022]
Abstract
Purpose Two innovative reinforced biologic materials were studied in a non-human primate hernia repair model. The test articles, which combine layers of ovine decellularized extracellular matrix with minimal amounts of synthetic polymer, were evaluated for their biologic performance as measured by inflammatory response, healing kinetics, integration, and remodeling into functional host tissue. For comparison, seven clinically used biologic and synthetic meshes were also studied. Methods Animals were implanted with test articles in surgically created full-thickness midline abdominal wall defects, and evaluated macroscopically and histologically at 4, 12, and 24 weeks. Results Macroscopically, biologics resorbed and remodeled into naturally appearing tissue; the reinforced biologics appeared similar, but remodeled earlier and were less prone to stretch. Synthetics developed a layer of reactive tissue above and separate from the contracted mesh structure. At early time points, the collagen networks of biologics and reinforced biologics were infiltrated by host cells primarily as a peripheral layer on the biologics. As early as 12 weeks, the collagen networks associated with the reinforced biologics remodeled into organized host collagen. By 24 weeks, both reinforced biologics and biologics had low levels of inflammation. In contrast, a foreign body response persisted at 24 weeks with the synthetics, which had developed less organized collagen, separate in space from the actual mesh. Conclusions The current study shows a favorable response to reinforced biologics, which were associated with an initial inflammatory response, resolving by later time points, followed by active remodeling, and the formation of new morphologically functional collagen. Electronic supplementary material The online version of this article (10.1007/s10029-019-02119-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - S Ferzoco
- Department of Surgery, Atrius Health, Dedham, MA, USA
| | - B C H May
- Aroa Biosurgery Limited, Auckland, New Zealand
| | - A Beierschmitt
- Behavioural Science Foundation, Basseterre, Saint Kitts and Nevis
| | - S Qi
- University of Montreal, Montreal, QC, Canada
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Yu D, Patel AT, Rossi K, Topham NS, Chang EI. Comparison of Phasix, polypropylene, and primary closure of the abdominal donor site after bilateral free flap breast reconstruction: Long-term evaluation of abdominal hernia and bulge formation. Microsurgery 2019; 40:434-439. [PMID: 31815314 DOI: 10.1002/micr.30541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/28/2019] [Accepted: 11/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Abdominal free flap harvest for breast reconstruction may result in significant morbidity in terms of hernias and bulges. Reinforcement of the donor site with mesh has been recommended to minimize the risk of hernias and bulges, but no studies exist evaluating the optimal type of mesh. Polypropylene has traditionally been used but the development of Phasix restorable mesh may be a reasonable alternative. Here, we compared the use of Phasix to polypropylene and primary closure and hypothesize that the former has lower rates of abdominal morbidity in the long term. PATIENTS AND METHODS A retrospective review of all patients undergoing bilateral free flap breast reconstruction from the abdomen was performed while patients with pedicle flaps or alternative donor sites were excluded. Patient demographics, medical/surgical history, cancer treatments, and flap type were analyzed. All patients were monitored for a minimum of 2 years for early donor site complications as well as hernia/bulges. RESULTS Sixty-six consecutive patients were included (40 patients with Phasix, 20 patients with polypropylene, and 6 patients with primary closure). Use of Phasix mesh resulted in higher initial operative costs ($2,750 vs. $72 vs. $0). Two patients with polypropylene mesh and one patient undergoing primary closure developed an abdominal bulge in an average follow-up of 25.2 months (11.5% vs. 0%, p = .04). CONCLUSIONS Mesh placement for abdominal wall reinforcement after bilateral free flap breast reconstruction minimizes the risk of hernias and bulges. Although Phasix results in increased initial costs, abdominal morbidity is significantly decreased after follow-up beyond 2 years.
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Affiliation(s)
- Deborah Yu
- The Institute for Advanced Reconstruction at the Plastic Surgery Center, Shrewsbury, New Jersey
| | - Anika T Patel
- The Institute for Advanced Reconstruction at the Plastic Surgery Center, Shrewsbury, New Jersey
| | - Kristie Rossi
- The Institute for Advanced Reconstruction at the Plastic Surgery Center, Shrewsbury, New Jersey
| | | | - Eric I Chang
- The Institute for Advanced Reconstruction at the Plastic Surgery Center, Shrewsbury, New Jersey
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When the Mesh Goes Away: An Analysis of Poly-4-Hydroxybutyrate Mesh for Complex Hernia Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2576. [PMID: 31942324 PMCID: PMC6908335 DOI: 10.1097/gox.0000000000002576] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 12/16/2022]
Abstract
Mesh reinforcement is a cornerstone of modern ventral hernia repair (VHR); yet, complications with synthetic mesh and cost of biologic have created a need for alternative options. Biosynthetic mesh is a resorbable scaffold that theoretically leverages the benefits and minimizes deficiencies of existing mesh types. This study evaluates 2-year outcomes following poly-4-hydroxybutyrate (P4HB) mesh reinforcement for complex VHR. Methods A retrospective review of all consecutive VHR with P4HB (n = 70) was conducted from 2015 to 2018 by a single surgeon. Clinical outcomes, quality of life (QoL; and cost were assessed. Results Seventy patients were included with an average age and body mass index of 58.6 years and 33 kg/m2, respectively. High-risk comorbidities included hypertension (59%), and smoking history (50%). Cases were primarily modified Ventral Hernia Working Group class 2 (50%), or 3 (36%), with average defect size of 323 cm2 (25-972 cm2). P4HB was placed in the retromuscular (80%) or onlay (20%) plane. Mean follow-up was 24 months (12.2-41 months). Hernia recurrence rate was 5.7% (n = 4) and occurred an average of 285 days (209-368 days) post-repair. Of the 21 surgical site occurrences (SSO), 5 (7%) required surgical intervention. A significant improvement in overall QoL (P = 0.001) was noted following repair. Defect size and SSOPI were independently associated with increased direct cost. Conclusions P4HB mesh for complex VHR is associated with favorable 2-year clinical outcomes, acceptable hernia recurrence rate, and a significant improvement in QoL. This study supports the use of biosynthetic mesh as an effective biomaterial for complex VHR.
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Nair NM, Mills DC. Poly-4-Hydroxybutyrate (P4HB) Scaffold Internal Support: Preliminary Experience with Direct Implant Opposition During Complex Breast Revisions. Aesthet Surg J 2019; 39:1203-1213. [PMID: 30321265 DOI: 10.1093/asj/sjy276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The GalaFLEX scaffold is a mesh composed of resorbable poly-4-hydroxybutyrate (P4HB) monofilament fibers that aids in providing immediate internal soft tissue support, similar to that offered by an underwire bra, after breast reduction, lift, or augmentation. OBJECTIVES Our goal was to explore the possibility of using GalaFLEX as an internal support to prevent future sagging, predominantly in the lower pole of the breast. This preliminary study investigated GalaFLEX as a direct alternative to implants in a variety of complex revisional breast cases. Our intention was to establish a safety and efficacy profile in an effort to promote further investigation. METHODS A retrospective case series of 5 patients over 2 years were evaluated. Inclusion criteria were capsular contracture with concerns over soft tissue coverage and future ptosis, along with complicated muscle coverage deficits secondary to plane switching. RESULTS A retrospective review of photographs taken at the most recent follow-up consistently showed retention of implant position and soft implants. Additionally, patients presented with a mean ± SD Baker Grade Contraction score of 2.8 ± 0.9189 preoperatively compared with a score of 1 ± 0 postoperatively. CONCLUSIONS This preliminary study shows the initial safety of GalaFLEX but indicates the need for a multicenter, exhaustive study. Its versatility for complex revisional cases combined with acceptable aesthetic outcomes makes GalaFLEX an invaluable tool for plastic surgeons to consider. LEVEL OF EVIDENCE: 4
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Miserez M, Jairam AP, Boersema GS, Bayon Y, Jeekel J, Lange JF. Resorbable Synthetic Meshes for Abdominal Wall Defects in Preclinical Setting: A Literature Review. J Surg Res 2019; 237:67-75. [DOI: 10.1016/j.jss.2018.11.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 11/18/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022]
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Schulz KS, Ash KJ, Cook JL. Clinical outcomes after common calcanean tendon rupture repair in dogs with a loop-suture tenorrhaphy technique and autogenous leukoreduced platelet-rich plasma. Vet Surg 2019; 48:1262-1270. [PMID: 30950083 DOI: 10.1111/vsu.13208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/22/2019] [Accepted: 03/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To report outcomes of dogs with common calcanean tendon (CCT) ruptures treated with a platelet-rich plasma (PRP) enhanced nonabsorbable loop-suture technique. STUDY DESIGN Retrospective case series. ANIMALS Client-owned dogs (n = 12). METHODS Medical records (2015-2017) of dogs with CCT ruptures repaired with a loop-suture tenorrhaphy and autogenous leukoreduced PRP were reviewed for signalment, history, type of injury, treatment, and clinical follow-up. Outcomes were assessed by functional anatomic measurements and Canine Orthopedic Index (COI) scores transformed to percentages, with 100% representing no problems. RESULTS Twelve tendons were treated. Two dogs had major complications that were successfully revised. Follow-up was available in 11 of 12 dogs, with a median time of 12 months (range, 4-36), including COI for 11 dogs and anatomic measurements for 6 dogs. Anatomic measurements did not differ between treated and normal contralateral limbs (midthigh muscle mass P > .99, cranial tibial muscle mass P = .37, CCT diameter P = .08, tibiotarsal joint angle P > .99). Owners scored function (COI) as 96.4% (range, 93.3%-97.8%) and quality of life as 94.6% (range, 92%-98.2%). CONCLUSION Loop-suture tenorrhaphy with application of autogenous leukoreduced PRP at the repair site resulted in restoration of functional anatomic measurements, high COI, and client satisfaction. CLINICAL SIGNIFICANCE Loop-suture tenorrhaphy with local application of autogenous leukoreduced PRP appears to offer an acceptable option to treat CCT injuries in dogs.
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Affiliation(s)
- Kurt S Schulz
- Department of Surgery, Peak Veterinary Referral Center at Ethos, Williston, Vermont
| | - Krisitan J Ash
- Department of Surgery, Peak Veterinary Referral Center at Ethos, Williston, Vermont
| | - James L Cook
- Thompson Laboratory for Regenerative Orthopaedics & Mizzou BioJoint® Center, Missouri Orthopedic Institute, Columbia, Missouri
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Comparison of the host macrophage response to synthetic and biologic surgical meshes used for ventral hernia repair. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.regen.2018.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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A Current Review of Long-Acting Resorbable Meshes in Abdominal Wall Reconstruction. Plast Reconstr Surg 2019; 142:84S-91S. [PMID: 30138274 DOI: 10.1097/prs.0000000000004859] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Concern for chronic infection of a permanent synthetic material in contaminated and "high risk" ventral hernia repairs has led to the development and dissemination of slowly resorbable biosynthetic materials at a lower cost compared with biologic mesh counterparts. Here, we review the preclinical and clinical data available for each long-acting resorbable mesh, with a candid comparison to biologic and synthetic equivalents.
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van Rooijen MMJ, Jairam AP, Tollens T, Jørgensen LN, de Vries Reilingh TS, Piessen G, Köckerling F, Miserez M, Windsor ACJ, Berrevoet F, Fortelny RH, Dousset B, Woeste G, van Westreenen HL, Gossetti F, Lange JF, Tetteroo GWM, Koch A, Kroese LF, Jeekel J. A post-market, prospective, multi-center, single-arm clinical investigation of Phasix™ mesh for VHWG grade 3 midline incisional hernia repair: a research protocol. BMC Surg 2018; 18:104. [PMID: 30458747 PMCID: PMC6247668 DOI: 10.1186/s12893-018-0439-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023] Open
Abstract
Background Incisional heia is a frequent complication of midline laparotomy. The use of mesh in hernia repair has been reported to lead to fewer recurrences compared to primary repair. However, in Ventral Hernia Working Group (VHWG) Grade 3 hernia patients, whose hernia is potentially contaminated, synthetic mesh is prone to infection. There is a strong preference for resorbable biological mesh in contaminated fields, since it is more able to resist infection, and because it is fully resorbed, the chance of a foreign body reaction is reduced. However, when not crosslinked, biological resorbable mesh products tend to degrade too quickly to facilitate native cellular ingrowth. Phasix™ Mesh is a biosynthetic mesh with both the biocompatibility and resorbability of a biological mesh and the mechanical strength of a synthetic mesh. This multi-center single-arm study aims to collect data on safety and performance of Phasix™ Mesh in Grade 3 hernia patients. Methods A total of 85 VHWG Grade 3 hernia patients will be treated with Phasix™ Mesh in 15 sites across Europe. The primary outcome is Surgical Site Occurrence (SSO) including hematoma, seroma, infection, dehiscence and fistula formation (requiring intervention) through 3 months. Secondary outcomes include recurrence, infection and quality of life related outcomes after 24 months. Follow-up visits will be at drain removal (if drains were not placed, then on discharge or staple removal instead) and in the 1st, 3rd, 6th, 12th, 18th and 24th month after surgery. Conclusion Based on evidence from this clinical study Depending on the results this clinical study will yield, Phasix™ Mesh may become a preferred treatment option in VHWG Grade 3 patients. Trial registration The trial was registered on March 25, 2016 on clinicaltrials.gov: NCT02720042.
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Affiliation(s)
- M M J van Rooijen
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands.
| | - A P Jairam
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - T Tollens
- Imelda Hospital, Department of General Surgery, Bonheiden, Belgium
| | - L N Jørgensen
- University of Copenhagen, Bispebjerg Hospital, Department of Surgery, Copenhagen, Denmark
| | | | - G Piessen
- Department of Surgery, University Hospital Lille, Lille, France
| | - F Köckerling
- Vivantes Klinikum Spandau, Department of Surgery, Berlin, Germany
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - A C J Windsor
- Department of Colorectal Surgery, University College London Hospital, London, UK
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery, University Hospital Ghent, Ghent, Belgium
| | - R H Fortelny
- Wilhelminenhospital, Department of General, Visceral and Oncologic Surgery, Vienna, Austria
| | - B Dousset
- Hôpital Cochin, Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris, France
| | - G Woeste
- Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
| | | | - F Gossetti
- Università di Roma Sapienza, Rome, Italy
| | - J F Lange
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - G W M Tetteroo
- IJsselland Ziekenhuis, Department of Surgery, Capelle aan den Ijssel, The Netherlands
| | - A Koch
- Chirurgische Praxis Cottbus, Cottbus Area, Germany
| | - L F Kroese
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
| | - J Jeekel
- Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands
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Lanni MA, Tecce MG, Shubinets V, Mirzabeigi MN, Fischer JP. The State of Prophylactic Mesh Augmentation. Am Surg 2018. [DOI: 10.1177/000313481808400129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prophylactic mesh augmentation (PMA) is the implantation of mesh during closure of an index laparotomy to decrease a patient's risk for developing incisional hernia (IH). The current body of evidence lacks refined guidelines for patient selection, mesh placement, and material choice. The purpose of this study is to summarize the literature and identify areas of research needed to foster responsible and appropriate use of PMA as an emerging technique. We conducted a comprehensive review of Scopus, Cochrane, PubMed, and clinicaltrials.gov for articles and trials related to using PMA for IH risk reduction. We further supplemented our review by including select papers on patient-reported outcomes, cost utility, risk modeling, surgical techniques, and available materials highly relevant to PMA. Five-hundred-fifty-one unique articles and 357 trials were reviewed. Multiple studies note a significant decrease in IH incidence with PMA compared with primary suture-only–based closure. No multicenter randomized control trial has been conducted in the United States, and only two such trials are currently active worldwide. Evidence exists supporting the use of PMA, with practical cost utility and models for selecting high-risk patients, but standard PMA guidelines are lacking. Although Europe has progressed with this technique, widespread adoption of PMA requires large-scale pragmatic randomized control trial research, strong evidence-based guidelines, current procedural terminology coding, and resolution of several barriers.
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Affiliation(s)
- Michael A. Lanni
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Michael G. Tecce
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Valeriy Shubinets
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Michael N. Mirzabeigi
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - John P. Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Optimizing donor site closure following bilateral breast reconstruction with abdominal-based free flaps. J Plast Reconstr Aesthet Surg 2017; 71:269-271. [PMID: 29129588 DOI: 10.1016/j.bjps.2017.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/06/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022]
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75
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Roth JS, Anthone GJ, Selzer DJ, Poulose BK, 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, Voeller GR. Prospective evaluation of poly-4-hydroxybutyrate mesh in CDC class I/high-risk ventral and incisional hernia repair: 18-month follow-up. Surg Endosc 2017; 32:1929-1936. [DOI: 10.1007/s00464-017-5886-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/13/2017] [Indexed: 01/30/2023]
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76
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Deeken CR, Lake SP. Mechanical properties of the abdominal wall and biomaterials utilized for hernia repair. J Mech Behav Biomed Mater 2017; 74:411-427. [DOI: 10.1016/j.jmbbm.2017.05.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 12/29/2022]
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Stoikes NFN, Scott JR, Badhwar A, Deeken CR, Voeller GR. Characterization of host response, resorption, and strength properties, and performance in the presence of bacteria for fully absorbable biomaterials for soft tissue repair. Hernia 2017; 21:771-782. [PMID: 28815398 PMCID: PMC5608787 DOI: 10.1007/s10029-017-1638-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 08/06/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective was to evaluate the host response, resorption, and strength properties, and to assess the performance in the presence of bacteria for Phasix™ Mesh (Phasix™) and Gore® Bio-A® Tissue Reinforcement (Bio-A®) in preclinical models. METHODS In a rat model, one mesh (2 × 2 cm) was implanted subcutaneously in n = 60 rats. Animals were euthanized after 2, 4, 8, 12, 16, or 24 weeks (n = 5/mesh/time point), and implant sites were assessed for host inflammatory response and overall fibrotic repair thickness. In a rabbit model, meshes (3.8 cm diameter) were bilaterally implanted in subcutaneous pockets in n = 20 rabbits (n = 10 rabbits/mesh) and inoculated with 108 CFU clinically isolated methicillin-resistant Staphylococcus aureus (MRSA). One mesh type was implanted per animal. Animals were euthanized after 7 days, and implants were assessed for abscess formation, bacterial colonization, and mechanical strength. RESULTS In the rat study, Phasix™ and Bio-A® exhibited similar biocompatibility, although Bio-A® demonstrated a significantly greater inflammatory response at 4 weeks compared to Phasix™ (p < 0.01). Morphometric analysis demonstrated rapid resorption of Bio-A® implants with initially thicker repair sites at 2, 4, 8, and 12 weeks (p < 0.0001), which transitioned to significantly thinner sites compared to Phasix™ at 16 and 24 weeks (p < 0.0001). In the rabbit bacterial inoculation study, Phasix™ exhibited significantly lower abscess score (p < 0.001) and bacterial colonization (p < 0.01), with significantly greater mechanical strength than Bio-A® (p < 0.001). CONCLUSIONS Host response, resorption, repair thickness, strength, and bacterial colonization suggest a more stable and favorable outcome for monofilament, macroporous devices such as Phasix™ relative to multifilament, microporous devices such as Bio-A® over time.
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Affiliation(s)
- N F N Stoikes
- Department of Surgery, University of Tennessee Health Science Center, 6029 Walnut Grove Road, Suite 106, Memphis, TN, 38138, USA.
| | - J R Scott
- Department of Molecular Pharmacology, Physiology and Biotechnology, Brown University, Providence, RI, 02906, USA
- C. R. Bard, Inc. (Davol), Warwick, RI, 02886, USA
| | - A Badhwar
- C. R. Bard, Inc. (Davol), Warwick, RI, 02886, USA
| | - C R Deeken
- Covalent Bio, LLC, St. Louis, MO, 63025, USA
| | - G R Voeller
- Department of Surgery, University of Tennessee Health Science Center, 6029 Walnut Grove Road, Suite 106, Memphis, TN, 38138, USA
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Ventral hernia repair with poly-4-hydroxybutyrate mesh. Surg Endosc 2017; 32:1689-1694. [DOI: 10.1007/s00464-017-5848-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/22/2017] [Indexed: 02/08/2023]
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Early Wound Morbidity after Open Ventral Hernia Repair with Biosynthetic or Polypropylene Mesh. J Am Coll Surg 2017; 225:472-480.e1. [PMID: 28826804 DOI: 10.1016/j.jamcollsurg.2017.07.1067] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recently introduced slow-resorbing biosynthetic and non-resorbing macroporous polypropylene meshes are being used in hernias with clean-contaminated and contaminated wounds. However, information about the use of biosynthetic meshes and their outcomes compared with polypropylene meshes in clean-contaminated and contaminated cases is lacking. Here we evaluate the use of biosynthetic mesh and polypropylene mesh in elective open ventral hernia repair (OVHR) and investigate differences in early wound morbidity after OVHR within clean-contaminated and contaminated cases. STUDY DESIGN All elective, OVHR with biosynthetic mesh or uncoated polypropylene mesh from January 2013 through October 2016 were identified within the Americas Hernia Society Quality Collaborative. Association of mesh type with 30-day wound events in clean-contaminated or contaminated wounds was investigated using a 1:3 propensity-matched analysis. RESULTS Biosynthetic meshes were used in 8.5% (175 of 2,051) of elective OVHR, with the majority (57.1%) used in low-risk or comorbid clean cases. Propensity-matched analysis in clean-contaminated and contaminated cases showed no significant difference between biosynthetic mesh and polypropylene mesh groups for 30-day surgical site occurrences (20.7% vs 16.7%; p = 0.49) or unplanned readmission (13.8% vs 9.8%; p = 0.4). However, surgical site infections (22.4% vs 10.9%; p = 0.03), surgical site occurrences requiring procedural intervention (24.1% vs 13.2%; p = 0.049), and reoperation rates (13.8% vs 4.0%; p = 0.009) were significantly higher in the biosynthetic group. CONCLUSIONS Biosynthetic mesh appears to have higher rates of 30-day wound morbidity compared with polypropylene mesh in elective OVHR with clean-contaminated or contaminated wounds. Additional post-market analysis is needed to provide evidence defining best mesh choices, location, and surgical technique for repairing contaminated ventral hernias.
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Sahoo S, Baker AR, Haskins IN, Krpata DM, Rosen MJ, Derwin KA. Assessment of Human Acellular Dermis Graft in Porcine Models for Ventral Hernia Repair. Tissue Eng Part C Methods 2017; 23:718-727. [PMID: 28602151 DOI: 10.1089/ten.tec.2017.0238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Preclinical evaluation of hernia meshes is commonly performed in porcine models. We recently developed two surgically induced porcine hernia models-an incisional and an excisional model-that formed persistent hernias in the absence of graft repair. Herein, we investigate if these models will continue to form a hernia after graft repair. MATERIALS AND METHODS Ten pigs were used to create two hernia models-a 10-cm partial-thickness incisional defect (n = 5) and an 8 × 8-cm full-thickness excisional defect (n = 5). The defects were repaired using a 12 × 12-cm human acellular dermis graft placed in a preperitoneal/retrorectus sublay position and fixed using transfascial sutures. Postoperative management included the use of suction drainage for 1 week and an abdominal binder for 4 weeks in the more severe excisional model. Hernia development was assessed clinically, and hernia defect size and volume were measured using postoperative computed tomography (CT) imaging over 12 weeks. Radiographic inflation testing (2 L inflation), biaxial mechanical testing, and histological evaluation were also performed at 12 weeks. RESULTS All pigs with the excisional model, but none with the incisional model, developed a clinically relevant hernia. At the end of 12 weeks, the excisional model had a significantly greater hernia defect size (259 ± 51 cm2 vs. 47 ± 16 cm2) and repair volume (865 ± 414 cm3 vs. 85 ± 52 cm3) compared with the incisional model. The excisional model also showed an order of magnitude greater increase in repair volume (280 cm3 vs. 47 cm3) compared with the incisional model upon 2 L inflation. Furthermore, the excisional model showed a trend of having higher dilatational strain at average biaxial load of 250 N and lower stiffness compared with the incisional model. The excisional model had a thin, hypercellular hernia sac spanning the defect, whereas the incisional model had a thick densely fibrotic scar bridging the defect. CONCLUSION The 8 × 8-cm excisional defect model, together with appropriate postoperative wound management, in the pig model is recommended for preclinical investigation of different grafts for hernia repair. Novel CT imaging and biomechanical testing methods are recommended to measure functional outcomes of hernia repair in preclinical models.
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Affiliation(s)
- Sambit Sahoo
- 1 Department of Biomedical Engineering, Lerner Research Institute , Cleveland Clinic, Cleveland, Ohio
| | - Andrew R Baker
- 1 Department of Biomedical Engineering, Lerner Research Institute , Cleveland Clinic, Cleveland, Ohio
| | - Ivy N Haskins
- 2 Comprehensive Hernia Center, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio
| | - David M Krpata
- 2 Comprehensive Hernia Center, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio
| | - Michael J Rosen
- 2 Comprehensive Hernia Center, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio
| | - Kathleen A Derwin
- 1 Department of Biomedical Engineering, Lerner Research Institute , Cleveland Clinic, Cleveland, Ohio
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Buell JF, Sigmon D, Ducoin C, Shapiro M, Teja N, Wynter E, Hanisee MK, Parker G, Kandil E, Darden M. Initial Experience With Biologic Polymer Scaffold (Poly-4-hydroxybuturate) in Complex Abdominal Wall Reconstruction. Ann Surg 2017; 266:185-188. [PMID: 28594679 DOI: 10.1097/sla.0000000000001916] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the use of the new absorbable polymer scaffold poly-4-hydroxybutyrate (P4HB) in complex abdominal wall reconstruction. BACKGROUND Complex abdominal wall reconstruction has witnessed tremendous success in the last decade after the introduction of cadaveric biologic scaffolds. However, the use of cadaveric biologic mesh has been expensive and plagued by complications such as seroma, infection, and recurrent hernia. Despite widespread application of cadaveric biologic mesh, little data exist on the superiority of these materials in the setting of high-risk wounds in patients. P4HB, an absorbable polymer scaffold, may present a new alternative to these cadaveric biologic grafts. METHODS A retrospective analysis of our initial experience with the absorbable polymer scaffold P4HB compared with a consecutive contiguous group treated with porcine cadaveric mesh for complex abdominal wall reconstructions. Our analysis was performed using SAS 9.3 and Stata 12. RESULTS The P4HB group (n = 31) experienced shorter drain time (10.0 vs 14.3 d; P < 0.002), fewer complications (22.6% vs 40.5%; P < 0.046), and reherniation (6.5% vs 23.8%; P < 0.049) than the porcine cadaveric mesh group (n = 42). Multivariate analysis for infection identified: porcine cadaveric mesh odds ratio 2.82, length of stay odds ratio 1.11; complications: drinker odds ratio 6.52, porcine cadaveric mesh odds ratio 4.03, African American odds ratio 3.08, length of stay odds ratio 1.11; and hernia recurrence: porcine cadaveric mesh odds ratio 5.18, drinker odds ratio 3.62, African American odds ratio 0.24. Cost analysis identified that P4HB had a $7328.91 financial advantage in initial hospitalization and $2241.17 in the 90-day postdischarge global period resulting in $9570.07 per case advantage over porcine cadaveric mesh. CONCLUSIONS In our early clinical experience with the absorbable polymer matrix scaffold P4HB, it seemed to provide superior clinical performance and value-based benefit compared with porcine cadaveric biologic mesh.
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Affiliation(s)
- Joseph F Buell
- *Tulane Abdominal Transplant Institute, Tulane University School of Medicine, New Orleans, LA†Tulane University School of Medicine, New Orleans, LA‡Department of Surgery, Tulane University School of Medicine, New Orleans, LA§Department of Surgery, Louisiana State University School of Medicine, New Orleans, LA¶A. B. Freeman School of Business, Tulane University, New Orleans, LA
- Department of Economics, Tulane University, New Orleans, LA
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Development of a critical-sized ventral hernia model in the pig. J Surg Res 2017; 210:115-123. [DOI: 10.1016/j.jss.2016.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/17/2016] [Accepted: 10/27/2016] [Indexed: 11/23/2022]
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Adams WP, Toriumi DM, Van Natta BW. Clinical Use of GalaFLEX in Facial and Breast Cosmetic Plastic Surgery. Aesthet Surg J 2016; 36:S23-S32. [PMID: 27697886 DOI: 10.1093/asj/sjw142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 12/16/2022] Open
Abstract
Resolution of ptosis is a key step to the success of many plastic surgery procedures. Ptosis is a manifestation of tissue stretch. Tissue stretch can occur as a result of the natural aging process or health of the patient, or tissue may stretch under added weight or volume, such as when implants are placed. Surgical rejuvenation of ptotic tissues is very effective and results in marked changes in the patient profile yet the tissue that resulted in the need for the procedure first place has not improved and ptosis can recur. Recent developments in long-term resorbable porous materials have provided surgeons with the opportunity to experiment with tissue reinforcement in plastic surgery procedures. These new materials have a low profile, rapid tissue integration, and a long-term strength retention profile. Long-term resorbable scaffolds such as poly-4-hydroxybutyrate (P4HB) natural scaffold (GalaFLEX scaffold, Galatea Surgical, Inc., Lexington, MA) have shown promise for a host of plastic surgery indications. This article presents clinical experience with GalaFLEX for soft tissue reinforcement in three different clinical applications; including the reinforcement of the superficial muscular aponeurotic system (SMAS) in minimally invasive facelift, reinforcement of the skin envelope in mastopexy, and reinforcement of the breast capsule (pocket) in revisional breast surgery. Soft tissue reinforcement has been shown to provide increased mechanical strength as well as improved maintenance of postoperative results. LEVEL OF EVIDENCE 5 Therapeutic.
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Affiliation(s)
- William P Adams
- Dr Adams is an Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX. Dr Van Natta is a Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Toriumi is Head, Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Dean M Toriumi
- Dr Adams is an Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX. Dr Van Natta is a Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Toriumi is Head, Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Bruce W Van Natta
- Dr Adams is an Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX. Dr Van Natta is a Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Toriumi is Head, Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL
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Abstract
The GalaFLEX Scaffold (Galatea Surgical, Inc., Lexington, MA) for plastic and reconstructive surgery belongs to a new generation of products for soft tissue reinforcement made from poly-4-hydroxybutyrate (P4HB). Other members of this new family of products include MonoMax Suture (Aesculap AG, Tuttlingen, Germany) for soft tissue approximation, BioFiber Scaffold (Tornier, Inc., Edina, MN) for tendon repair, and Phasix Mesh (C.R. Bard, Inc., Murray Hill, NJ) for hernia repair. Each of these fully resorbable products provides prolonged strength retention, typically 50% to 70% strength retention at 12 weeks, and facilitates remodeling in vivo to provide a strong, lasting repair. P4HB belongs to a naturally occurring class of biopolymers and fibers made from it are uniquely strong, flexible, and biocompatible. GalaFLEX Scaffold is comprised of high-strength, resorbable P4HB monofilament fibers. It is a knitted macroporous scaffold intended to elevate, reinforce, and repair soft tissue. The scaffold acts as a lattice for new tissue growth, which is rapidly vascularized and becomes fully integrated with adjacent tissue as the fibers resorb. In this review, we describe the development of P4HB, its production, properties, safety, and biocompatibility of devices made from P4HB. Early clinical results and current clinical applications of products made from P4HB are also discussed. The results of post-market clinical studies evaluating the GalaFLEX Scaffold in rhytidectomy and cosmetic breast surgery demonstrate that the scaffold can reinforce lifted soft tissue, resulting in persistent surgical results in the face and neck at one year, and provide lower pole stability after breast lift at one year.
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Affiliation(s)
- Simon F Williams
- Dr Williams is a Consultant to Tepha, Inc. and a member of the Tepha Board of Directors. Dr Martin is the Chief Scientific Officer of Tepha, Inc. Dr Moses is a Consultant to Tepha, Inc. and is the Founder of Galatea Surgical, Inc. Galatea Surgical, Inc. is a wholly owned subsidiary of Tepha, Inc
| | - David P Martin
- Dr Williams is a Consultant to Tepha, Inc. and a member of the Tepha Board of Directors. Dr Martin is the Chief Scientific Officer of Tepha, Inc. Dr Moses is a Consultant to Tepha, Inc. and is the Founder of Galatea Surgical, Inc. Galatea Surgical, Inc. is a wholly owned subsidiary of Tepha, Inc
| | - Arikha C Moses
- Dr Williams is a Consultant to Tepha, Inc. and a member of the Tepha Board of Directors. Dr Martin is the Chief Scientific Officer of Tepha, Inc. Dr Moses is a Consultant to Tepha, Inc. and is the Founder of Galatea Surgical, Inc. Galatea Surgical, Inc. is a wholly owned subsidiary of Tepha, Inc
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85
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Shishatskaya EI, Nikolaeva ED, Vinogradova ON, Volova TG. Experimental wound dressings of degradable PHA for skin defect repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:165. [PMID: 27655431 DOI: 10.1007/s10856-016-5776-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
The present study reports construction of wound dressing materials from degradable natural polymers such as hydroxy derivatives of carboxylic acids (PHAs) and 3-hydroxybutyrate/4-hydroxybutyrate [P(3HB/4HB)] as copolymer. The developed polymer films and electrospun membranes were evaluated for its wound healing properties with Grafts-elastic nonwoven membranes carrying fibroblast cells derived from adipose tissue multipotent mesenchymal stem cells. The efficacy of nonwoven membranes of P(3HB/4HB) carrying the culture of allogenic fibroblasts was assessed against model skin defects in Wistar rats. The morphological, histological and molecular studies revealed the presence of fibroblasts on dressing materials which facilitated wound healing, vascularization and regeneration. Further it was also observed that cells secreted extracellular matrix proteins which formed a layer on the surface of membranes and promoted the migration of epidermal cells from the neighboring tissues surrounding the wound. The wounds under the P(3HB/4HB) membrane carrying cells healed 1.4 times faster than the wounds under the cell-free membrane and 3.5 times faster than the wounds healing under the eschar (control).The complete wound healing process was achieved at Day 14. Thus the study highlights the importance of nonwoven membranes developed from degradable P(3HB/4HB) polymers in reducing inflammation, enhancing angiogenic properties of skin and facilitating better wound healing process.
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Affiliation(s)
- Ekaterina I Shishatskaya
- Institute of Biophysics of Siberian Branch of Russian Academy of Sciences, 50-50 Akademgorodok, Krasnoyarsk, 660036, Russia
- Siberian Federal University, 79 Svobodniy Ave., Krasnoyarsk, 660041, Russia
| | - Elena D Nikolaeva
- Institute of Biophysics of Siberian Branch of Russian Academy of Sciences, 50-50 Akademgorodok, Krasnoyarsk, 660036, Russia
| | - Olga N Vinogradova
- Siberian Federal University, 79 Svobodniy Ave., Krasnoyarsk, 660041, Russia
| | - Tatiana G Volova
- Institute of Biophysics of Siberian Branch of Russian Academy of Sciences, 50-50 Akademgorodok, Krasnoyarsk, 660036, Russia.
- Siberian Federal University, 79 Svobodniy Ave., Krasnoyarsk, 660041, Russia.
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86
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Kalaba S, Gerhard E, Winder JS, Pauli EM, Haluck RS, Yang J. Design Strategies and Applications of Biomaterials and Devices for Hernia Repair. Bioact Mater 2016; 1:2-17. [PMID: 28349130 PMCID: PMC5365083 DOI: 10.1016/j.bioactmat.2016.05.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/10/2016] [Accepted: 05/20/2016] [Indexed: 12/17/2022] Open
Abstract
Hernia repair is one of the most commonly performed surgical procedures worldwide, with a multi-billion dollar global market. Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias, and despite significant progress, there is no ideal mesh for every surgery. This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias. Next, the major milestones in implant design are discussed. Commonly encountered complications and strategies to minimize these adverse effects are described, followed by a thorough description of the implant characteristics necessary for successful repair. Finally, available implants are categorized and their advantages and limitations elucidated, including non-absorbable and absorbable (synthetic and biologically derived) prostheses, composite prostheses, and coated prostheses. This review not only summarizes the state of the art in hernia repair, but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.
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Affiliation(s)
- Surge Kalaba
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Ethan Gerhard
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Joshua S. Winder
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Eric M. Pauli
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Randy S. Haluck
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
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87
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Holihan JL, Alawadi ZM, Harris JW, Harvin J, Shah SK, Goodenough CJ, Kao LS, Liang MK, Roth JS, Walker PA, Ko TC. Ventral hernia: Patient selection, treatment, and management. Curr Probl Surg 2016; 53:307-54. [DOI: 10.1067/j.cpsurg.2016.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/14/2016] [Indexed: 12/14/2022]
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Scott JR, Deeken CR, Martindale RG, Rosen MJ. Evaluation of a fully absorbable poly-4-hydroxybutyrate/absorbable barrier composite mesh in a porcine model of ventral hernia repair. Surg Endosc 2016; 30:3691-701. [PMID: 27369286 PMCID: PMC4992027 DOI: 10.1007/s00464-016-5057-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/15/2016] [Indexed: 01/31/2023]
Abstract
Background The objective of this study was to evaluate the mechanical and histological properties of a fully absorbable poly-4-hydroxybutyrate/absorbable barrier composite mesh (Phasix™ ST) compared to partially absorbable (Ventralight™ ST), fully absorbable (Phasix™), and biologically derived (Strattice™) meshes in a porcine model of ventral hernia repair. Methods Bilateral abdominal surgical defects were created in twenty-four Yucatan pigs, repaired with intraperitoneal (Phasix™ ST, Ventralight™ ST) or retromuscular (Phasix™, Strattice™) mesh, and evaluated at 12 and 24 weeks (n = 6 mesh/group/time point). Results Prior to implantation, Strattice™ demonstrated significantly higher (p < 0.001) strength (636.6 ± 192.1 N) compared to Ventralight™ ST (324.3 ± 37.1 N), Phasix™ ST (206.9 ± 11.3 N), and Phasix™ (200.6 ± 25.2 N). At 12 and 24 weeks, mesh/repair strength was significantly greater than NAW (p < 0.01 in all cases), and no significant changes in strength were observed for any meshes between 12 and 24 weeks (p > 0.05). Phasix™ mesh/repair strength was significantly greater than Strattice™ (p < 0.001) at 12 and 24 weeks, and Ventralight™ ST mesh/repair strength was significantly greater than Phasix™ ST mesh (p < 0.05) at 24 weeks. At 12 and 24 weeks, Phasix™ ST and Ventralight™ ST were associated with mild inflammation and minimal–mild fibrosis/neovascularization, with no significant differences between groups. At both time points, Phasix™ was associated with minimal–mild inflammation/fibrosis and mild neovascularization. Strattice™ was associated with minimal inflammation/fibrosis, with minimal neovascularization at 12 weeks, which increased to mild by 24 weeks. Strattice™ exhibited significantly less neovascularization than Phasix™ at 12 weeks and significantly greater inflammation at 24 weeks due to remodeling. Conclusions Phasix™ ST demonstrated mechanical and histological properties comparable to partially absorbable (Ventralight™ ST) and fully resorbable (Phasix™) meshes at 12 and 24 weeks in this model. Data also suggest that fully absorbable meshes with longer-term resorption profiles may provide improved mechanical and histological properties compared to biologically derived scaffolds.
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Affiliation(s)
- Jeffrey R Scott
- Department of Molecular Pharmacology, Physiology and Biotechnology, Brown University, 171 Meeting Street, Box G-B, Providence, RI, 02912, USA. .,C. R. Bard, Inc. (Davol), Warwick, RI, USA.
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89
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Rastegarpour A, Cheung M, Vardhan M, Ibrahim MM, Butler CE, Levinson H. Surgical mesh for ventral incisional hernia repairs: Understanding mesh design. Plast Surg (Oakv) 2016; 24:41-50. [PMID: 27054138 DOI: 10.4172/plastic-surgery.1000955] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years.
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Affiliation(s)
- Ali Rastegarpour
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
| | - Michael Cheung
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
| | - Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Pratt School of Engineering, Durham, North Carolina
| | - Mohamed M Ibrahim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center
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90
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Rastegarpour A, Cheung M, Vardhan M, Ibrahim MM, Butler CE, Levinson H. Surgical mesh for ventral incisional hernia repairs: Understanding mesh design. Plast Surg (Oakv) 2016. [DOI: 10.1177/229255031602400110] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years.
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Affiliation(s)
- Ali Rastegarpour
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael Cheung
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Pratt School of Engineering, Durham, North Carolina
| | - Mohamed M Ibrahim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Charles E Butler
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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91
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Boguszewski DV, Wagner CT, Butler DL, Shearn JT. Effect of ACL graft material on anterior knee force during simulated in vivo ovine motion applied to the porcine knee: An in vitro examination of force during 2000 cycles. J Orthop Res 2015; 33:1789-95. [PMID: 26134453 DOI: 10.1002/jor.22958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 05/22/2015] [Indexed: 02/04/2023]
Abstract
This study determined how anterior cruciate ligament (ACL) reconstruction affected the magnitude and temporal patterns of anterior knee force and internal knee moment during 2000 cycles of simulated gait. Porcine knees were tested using a six degree-of-freedom robot, examining three porcine allograft materials compared with the native ACL. Reconstructions were performed using: (1) bone-patellar tendon-bone allograft (BPTB), (2) reconstructive porcine tissue matrix (RTM), or (3) an RTM-polymer hybrid construct (Hybrid). Forces and moments were measured over the entire gait cycle and contrasted at heel strike, mid stance, toe off, and peak flexion. The Hybrid construct performed the best, as magnitude and temporal changes in both anterior knee force and internal knee moment were not different from the native ACL knee. Conversely, the RTM knees showed greater loss in anterior knee force during 2000 cycles than the native ACL knee at heel strike and toe off, with an average force loss of 46%. BPTB knees performed the least favorably, with significant loss in anterior knee force at all key points and an average force loss of 61%. This is clinically relevant, as increases in post-operative knee laxity are believed to play a role in graft failure and early onset osteoarthritis.
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Affiliation(s)
- Daniel V Boguszewski
- Department of Orthopaedic Surgery, University of California Los Angles, Los Angeles, California
| | - Christopher T Wagner
- LifeCell Corporation, Bridgewater, New Jersey.,Department of Biomedical Engineering, The College of New Jersey, Ewing, New Jersey
| | - David L Butler
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio
| | - Jason T Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio
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92
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Zhu LM, Schuster P, Klinge U. Mesh implants: An overview of crucial mesh parameters. World J Gastrointest Surg 2015; 7:226-236. [PMID: 26523210 PMCID: PMC4621472 DOI: 10.4240/wjgs.v7.i10.226] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/17/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Hernia repair is one of the most frequently performed surgical interventions that use mesh implants. This article evaluates crucial mesh parameters to facilitate selection of the most appropriate mesh implant, considering raw materials, mesh composition, structure parameters and mechanical parameters. A literature review was performed using the PubMed database. The most important mesh parameters in the selection of a mesh implant are the raw material, structural parameters and mechanical parameters, which should match the physiological conditions. The structural parameters, especially the porosity, are the most important predictors of the biocompatibility performance of synthetic meshes. Meshes with large pores exhibit less inflammatory infiltrate, connective tissue and scar bridging, which allows increased soft tissue ingrowth. The raw material and combination of raw materials of the used mesh, including potential coatings and textile design, strongly impact the inflammatory reaction to the mesh. Synthetic meshes made from innovative polymers combined with surface coating have been demonstrated to exhibit advantageous behavior in specialized fields. Monofilament, large-pore synthetic meshes exhibit advantages. The value of mesh classification based on mesh weight seems to be overestimated. Mechanical properties of meshes, such as anisotropy/isotropy, elasticity and tensile strength, are crucial parameters for predicting mesh performance after implantation.
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93
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Guillaume O, Teuschl AH, Gruber-Blum S, Fortelny RH, Redl H, Petter-Puchner A. Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio-Functionality to Meshes. Adv Healthc Mater 2015; 4:1763-89. [PMID: 26111309 DOI: 10.1002/adhm.201500201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Indexed: 12/19/2022]
Abstract
Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.
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Affiliation(s)
- Olivier Guillaume
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Andreas Herbert Teuschl
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- University of Applied Sciences Technikum Wien; Department of Biochemical Engineering; Höchstädtplatz 5 1200 Vienna Austria
| | - Simone Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - René Hartmann Fortelny
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Alexander Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
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94
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Petter-Puchner AH, Fortelny RH. The heart of darkness. Hernia 2014; 19:195-6. [DOI: 10.1007/s10029-014-1336-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
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95
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The effect of molecular weight on the material properties of biosynthesized poly(4-hydroxybutyrate). Int J Biol Macromol 2014; 71:124-30. [DOI: 10.1016/j.ijbiomac.2014.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/20/2014] [Accepted: 04/05/2014] [Indexed: 11/17/2022]
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96
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Volova T, Goncharov D, Sukovatyi A, Shabanov A, Nikolaeva E, Shishatskaya E. Electrospinning of polyhydroxyalkanoate fibrous scaffolds: effects on electrospinning parameters on structure and properties. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2013; 25:370-93. [DOI: 10.1080/09205063.2013.862400] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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