The darn technique for small (< 2 cm diameter) midline hernias

Bioinspired Janus Mesh with Mechanical Support and Side-specific Biofunctions for Hernia Repair

Postoperative adhesion (PA) caused by the combination of proteins, inflammatory response and bacterial infection poses substantial challenges for polypropylene meshes (PPMs) based hernioplasty. Herein, inspired by the peritoneum, a Janus PPMs with side-specific functions was developed via a surface-initiated photoiniferter-mediated polymerization technology. A physical barrier composed of zwitterionic polymer brushes (PS) was firstly constructed on the one side of the PPMs, while the polymethacrylic acid (PMAA) brushes acting as the linker for bioactive nanoparticles (HAP) were precisely situated on the opposite surface subsequently. Our findings reveal that the mesh surface modified with PS demonstrated significant antifouling property that more than 99% of protein adhesion could be inhibited even after the co-incubation for 72 h in the crucial test. Meanwhile, on the other surface of the PPMs modified with HAP achieved satisfactory ROS-scavenging, inflammation-inhibiting and cell adhesion-promoting properties as well as good bactericidal performance (killing rate > 99.9%). Furthermore, the Janus PPMs could maintain comparable mechanical property with pristine meshes. Equipped with the above multiple merits and asymmetric property, the constructed Janus PPMs demonstrated effective treatment for abdominal hernia defects in vivo without any PA formation. Overall, this study duplicates the unique characteristics of peritoneum onto PPMs to successfully address postoperative complications of the hernioplasty and also offers a versatile and innovative idea to construct asymmetrical functions on the one implant. STATEMENT OF SIGNIFICANCE: The implantation of surgical meshes in the hernia defect provides additional firm support to reinforce the abdomen fascia in tension-free way. However, multiple post-surgery complications induced tissue adhesions is of great challenges for commercial mesh-based hernioplasty. Although material designing and surface modification might circumvent these limitations partly, the construction of side-specific biofunctions on the commercial mesh surfaces is very challenging because of its porous structure. Herein, we demonstrate a feasible and promising approach to construct asymmetric biofunctions on the opposite sides of network structured polypropylene mesh, which is rarely achieved previously. The fabricated Janus PPMs maintains the inherent long-term mechanical support; meanwhile, the opposite sides of PPMs could perform multiple biofunctions independently.