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Lu X, Harman M, Todd Heniford B, Augenstein V, McIver B, Bridges W. Analyzing material changes consistent with degradation of explanted polymeric hernia mesh related to clinical characteristics. Surg Endosc 2022; 36:5121-5135. [PMID: 35257210 PMCID: PMC10851311 DOI: 10.1007/s00464-021-08882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/16/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Proposed mechanisms that potentially contribute to polypropylene mesh degradation after in vivo exposure include oxidizing species and mechanical strains induced by normal healing, tissue integration, muscle contraction, and the immediate and chronic inflammatory responses. METHODS This study explores these potential degradation mechanisms using 63 mesh implants retrieved from patients after a median implantation time of 24 months following hernia repair surgery (mesh explants) and analysis of multivariate associations between the material changes and clinical characteristics. Specifically, polypropylene mesh degradation was characterized in terms of material changes in surface oxidation, crystallinity and mechanical properties, and clinical characteristics included mesh placement location, medical history and mesh selection. RESULTS Compared to pristine control samples, subsets of mesh explants had evidence of surface oxidation, altered crystallinity, or changed mechanical properties. Using multivariate statistical approach to control for clinical characteristics, infection was a significant factor affecting changes in mesh stiffness and mesh class was a significant factor affecting polypropylene crystallinity changes. CONCLUSIONS Highly variable in vivo conditions expose mesh to mechanisms that alter clinical outcomes and potentially contribute to mesh degradation. These PP mesh explants after 0.5 to 13 years in vivo had measurable changes in surface chemistry, crystallinity and mechanical properties, with significant trends associated with factors of mesh placement, mesh class, and infection.
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Affiliation(s)
- Xinyue Lu
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Melinda Harman
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA.
| | - B Todd Heniford
- Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Vedra Augenstein
- Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - Brittney McIver
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - William Bridges
- Department of Mathematical Sciences, Clemson University, Clemson, SC, 29634, USA
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Farr NTH, Roman S, Schäfer J, Quade A, Lester D, Hearnden V, MacNeil S, Rodenburg C. A novel characterisation approach to reveal the mechano-chemical effects of oxidation and dynamic distension on polypropylene surgical mesh. RSC Adv 2021; 11:34710-34723. [PMID: 35494782 PMCID: PMC9042683 DOI: 10.1039/d1ra05944k] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/17/2021] [Indexed: 11/21/2022] Open
Abstract
Polypropylene (PP) surgical mesh, used successfully for the surgical repair of abdominal hernias, is associated with serious clinical complications when used in the pelvic floor for repair of stress urinary incontinence or support of pelvic organ prolapse. While manufacturers claim that the material is inert and non-degradable, there is a growing body of evidence that asserts PP fibres are subject to oxidative damage and indeed explanted material from patients suffering with clinical complications has shown some evidence of fibre cracking and oxidation. It has been proposed that a pathological cellular response to the surgical mesh contributes to the medical complications; however, the mechanisms that trigger the specific host response against the material are not well understood. Specifically, this study was constructed to investigate the mechano-chemical effects of oxidation and dynamic distension on polypropylene surgical mesh. To do this we used a novel advanced spectroscopical characterisation technique, secondary electron hyperspectral imaging (SEHI), which is based on the collection of secondary electron emission spectra in a scanning electron microscope (SEM) to reveal mechanical-chemical reactions within PP meshes.
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Affiliation(s)
- Nicholas T H Farr
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK .,Insigneo Institute for in silico Medicine The Pam Liversidge Building, Sir Robert Hadfield Building, Mappin Street Sheffield UK
| | - Sabiniano Roman
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK
| | - Jan Schäfer
- Leibniz Institute for Plasma Science and Technology (INP e.V.) Felix-Hausdorff-Str. 2 17489 Greifswald Germany
| | - Antje Quade
- Leibniz Institute for Plasma Science and Technology (INP e.V.) Felix-Hausdorff-Str. 2 17489 Greifswald Germany
| | - Daniel Lester
- Polymer Characterisation Research Technology Platform, University of Warwick Library Road CV4 7AL Coventry UK
| | - Vanessa Hearnden
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK
| | - Sheila MacNeil
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK
| | - Cornelia Rodenburg
- Department of Materials Science and Engineering, University of Sheffield Sir Robert Hadfield Building, Mappin Street UK
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Ferreira FV, Otoni CG, Lopes JH, de Souza LP, Mei LHI, Lona LMF, Lozano K, Lobo AO, Mattoso LHC. Ultrathin polymer fibers hybridized with bioactive ceramics: A review on fundamental pathways of electrospinning towards bone regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:111853. [PMID: 33812570 DOI: 10.1016/j.msec.2020.111853] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Filipe V Ferreira
- School of Chemical Engineering, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Caio G Otoni
- Department of Materials Engineering (DEMa), Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - João H Lopes
- Department of Chemistry, Division of Fundamental Sciences (IEF), Technological Institute of Aeronautics (ITA), São Jose dos Campos, SP, Brazil
| | - Lucas P de Souza
- College of Engineering and Physical Sciences, Aston Institute of Materials Research, Aston University, Birmingham, UK
| | - Lucia H I Mei
- School of Chemical Engineering, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Liliane M F Lona
- School of Chemical Engineering, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Karen Lozano
- Department of Mechanical Engineering, The University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Anderson O Lobo
- Interdisciplinary Laboratory for Advanced Materials, BioMatLab, Materials Science and Engineering Graduate Program, Federal University of Piaui, Teresina, PI, Brazil.
| | - Luiz H C Mattoso
- Nanotechnology National Laboratory for Agriculture (LNNA), Embrapa Instrumentation, São Carlos, SP, Brazil.
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Bredikhin M, Gil D, Rex J, Cobb W, Reukov V, Vertegel A. Anti-inflammatory coating of hernia repair meshes: a 5-rabbit study. Hernia 2020; 24:1191-1199. [PMID: 32026188 PMCID: PMC7223801 DOI: 10.1007/s10029-020-02122-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/04/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Polymeric mesh implantation has become the golden standard in hernia repair, which nowadays is one of the most frequently performed surgeries in the world. However, many biocompatibility issues remain to be a concern for hernioplasty, with chronic pain being the most notable post-operative complication. Oxidative stress appears to be a major factor in the development of those complications. Lack of material inertness in vivo and oxidative environment formed by inflammatory cells result in both mesh deterioration and slowed healing process. In a pilot in vivo study, we prepared and characterized polypropylene hernia meshes with vitamin E (α-tocopherol)-a potent antioxidant. The results of that study supported the use of vitamin E as potential coating to alleviate post-surgical inflammation, but the pilot nature of the study yielded limited statistical data. The purpose of this study was to verify the observed trend of the pilot study statistically. METHODS In this work, we conducted a 5-animal experiment where we have implanted vitamin E-coated and uncoated control meshes into the abdominal walls of rabbits. Histology of the mesh-adjacent tissues and electron microscopy of the explanted mesh surface were conducted to characterize host tissue response to the implanted meshes. RESULTS As expected, modified meshes exhibited reduced foreign body reaction, as evidenced by histological scores for fatty infiltrates, macrophages, neovascularization, and collagen organization, as well as by the surface deterioration of the meshes. CONCLUSION In conclusion, results indicate that vitamin E coating reduces inflammatory response following hernioplasty and protects mesh material from oxidative deterioration.
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Affiliation(s)
- M Bredikhin
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA
| | - D Gil
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA
| | - J Rex
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA
| | - W Cobb
- Department of Surgery, The Hernia Center, Prisma Health, 2104 Woodruff rd., Greenville, SC, 29607, USA
| | - V Reukov
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA
| | - A Vertegel
- Department of Bioengineering, Clemson University, 301 Rhodes Hall, Clemson, SC, 29634, USA.
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Implantation Time Has No Effect on the Morphology and Extent of Previously Reported "Degradation" of Prolene Pelvic Mesh. Female Pelvic Med Reconstr Surg 2020; 26:128-136. [PMID: 31990801 DOI: 10.1097/spv.0000000000000837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Prolene polypropylene ("Prolene") meshes demonstrate no in vivo degradation, yet some claim degradation continues until no more Prolene polypropylene can be oxidized. We studied whether implantation time affects the morphology/extent of previously reported as cracking/degradation of completely cleaned Prolene explants. METHODS Urogynecological explants (248 patients) were collected. After excluding non-Prolene/unknown meshes and those without known implantation times, completely cleaned explants (n = 205; 0.2-14.4 years implantation) were analyzed with light microscopy, scanning electron microscopy, and Fourier transform infrared spectroscopy. Based on implant times and storage (fixative or dry), representative specimens were randomly selected for comparison. Controls were unused ("exemplar") TVT specimens with and without intentional oxidation via ultraviolet light exposure. RESULTS Prolene explants included 31 dry (18 TVT; 7 Prolift; 4 Gynemesh; 2 others) and 174 wet (87 TVT; 47 Prolift; 10 Gynemesh; 30 others) specimens. Specimens had similar morphologies before cleaning. Progressive cleaning removed tissue and cracked tissue-related material exposing smooth, unoxidized, and nondegraded fibers, with no visible gradient-type/ductile damage. Fourier transform infrared spectroscopy of the explants confirmed progressive loss of proteins. Cleaning intentionally oxidized exemplars did not remove oxidized carbonyl frequencies and showed deep cracks and gross fiber rupture/embrittlement, unlike the explants and nonoxidized exemplars. CONCLUSIONS If in vivo Prolene degradation exists, there should be wide-ranging crack morphology and nonuniform crack penetration, as well as more cracking, degradation, and physical breakage for implants of longer implantation times, but this was not the case. There is no morphologic or spectral/chemical evidence of Prolene mesh degradation after up to 14.4 years in vivo.
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Taylor D. The failure of polypropylene surgical mesh in vivo. J Mech Behav Biomed Mater 2018; 88:370-376. [DOI: 10.1016/j.jmbbm.2018.08.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/01/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
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Abstract
INTRODUCTION Today the use of textile meshes has become a standard for the treatment of abdominal wall hernias and for the reinforcement of any tissue repair as the strength of the implant decreases the recurrence rates. With increasing use, side effects of the textile implants became apparent, as well. AREAS COVERED Based on publications in Medline over the past decade, general and specific benefits, as well as risks, are discussed with the challenge to define individual risk-benefit ratios. For meshes, certain high-risk or low-risk conditions can be defined. In an attempt to eliminate mesh-related risks, quality control for medical devices has meanwhile been revised. In both the USA and the EU post-market surveillance studies are required to keep medical devices approved. EXPERT COMMENTARY The impact of material on the complication rate will vary depending on the patient's co-morbidity or the risks of the procedure. Even the best material can end up with disappointing results in case of poor healing or poor surgery. On the other hand, when using high-risk devices, most of the complications after excellent surgery with excellent indication can be supposed to be mesh-related. Thus, the use of low-risk devices is recommended even though its advantage may not be demonstrable in clinical studies.
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Affiliation(s)
- Uwe Klinge
- a Department of General , Visceral and Transplant Surgery at the University Hospital of the RWTH Aachen , Aachen , Germany
| | - Bernd Klosterhalfen
- b Department of Pathology , Institute for Pathology at the Düren Hospital , Düren , Germany
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