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Capella-Monsonís H, Crum RJ, Hussey GS, Badylak SF. Advances, challenges, and future directions in the clinical translation of ECM biomaterials for regenerative medicine applications. Adv Drug Deliv Rev 2024; 211:115347. [PMID: 38844005 DOI: 10.1016/j.addr.2024.115347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Extracellular Matrix (ECM) scaffolds and biomaterials have been widely used for decades across a variety of diverse clinical applications and have been implanted in millions of patients worldwide. ECM-based biomaterials have been especially successful in soft tissue repair applications but their utility in other clinical applications such as for regeneration of bone or neural tissue is less well understood. The beneficial healing outcome with the use of ECM biomaterials is the result of their biocompatibility, their biophysical properties and their ability to modify cell behavior after injury. As a consequence of successful clinical outcomes, there has been motivation for the development of next-generation formulations of ECM materials ranging from hydrogels, bioinks, powders, to whole organ or tissue scaffolds. The continued development of novel ECM formulations as well as active research interest in these materials ensures a wealth of possibilities for future clinical translation and innovation in regenerative medicine. The clinical translation of next generation formulations ECM scaffolds faces predictable challenges such as manufacturing, manageable regulatory pathways, surgical implantation, and the cost required to address these challenges. The current status of ECM-based biomaterials, including clinical translation, novel formulations and therapies currently under development, and the challenges that limit clinical translation of ECM biomaterials are reviewed herein.
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Affiliation(s)
- Héctor Capella-Monsonís
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Surgery, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Viscus Biologics LLC, 2603 Miles Road, Cleveland, OH 44128, USA
| | - Raphael J Crum
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Surgery, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - George S Hussey
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Pathology, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Stephen F Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Surgery, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261, USA.
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Troka M, Szepietowska K, Lubowiecka I. Self-organising maps in the analysis of strains of human abdominal wall to identify areas of similar mechanical behaviour. J Mech Behav Biomed Mater 2024; 156:106578. [PMID: 38781775 DOI: 10.1016/j.jmbbm.2024.106578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/05/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
The study refers to the application of a type of artificial neural network called the Self-Organising Map (SOM) for the identification of areas of the human abdominal wall that behave in a similar mechanical way. The research is based on data acquired during in vivo tests using the digital image correlation technique (DIC). The mechanical behaviour of the human abdominal wall is analysed during changing intra-abdominal pressure. SOM allow to study simultaneously three variables in four time/load steps. The variables refer to the principal strains and their directions. SOM classifies all the abdominal surface data points into clusters that behave similarly in accordance with the 12 variables. The analysis of the clusters provides a better insight into abdominal wall deformation and its evolution under pressure than when observing a single mechanical variable. The presented results may provide a better understanding of the mechanics of the living human abdominal wall. It might be particularly useful when selecting proper implants as well as for the design of surgical meshes for the treatment of abdominal hernias, which would be mechanically compatible with identified regions of the human anterior abdominal wall, and possibly open the way for patient-specific solutions.
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Affiliation(s)
- Mateusz Troka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Izabela Lubowiecka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland.
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Baekelandt J, Vertongen AS, Matak L, Stuart A. No mess with mesh; vaginal natural orifice transluminal endoscopic surgery (vNOTES) autologous posterior rectus fascia mesh for vaginal urinary incontinence procedures. J Gynecol Obstet Hum Reprod 2024; 53:102816. [PMID: 38909957 DOI: 10.1016/j.jogoh.2024.102816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024]
Abstract
Urinary incontinence affects 25-45 % of women with the gold standard surgical approach being placement of mid-urethral synthetic slings; tension-free vaginal tape (TVT) and trans-obturator tape (TOT). Due to the controversies regarding vaginal mesh the last decade, an increasing demand has evolved for incontinence treatment without vaginal synthetic mesh. The short term results of autologous rectus fascia sling for TOT surgery have shown similar success rates compared to those after the use of synthetic mesh, but the harvesting of the mesh is less minimally invasive and is associated with longer surgical time. vNOTES is a combination of a vaginal entrance to the abdomen and endoscopy via the vagina. The aim with the video is to show a new surgical technique with a fully vaginal, scarless vNOTES approach for harvesting the posterior rectus fascia for TVT and TOT procedures.
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Affiliation(s)
- Jan Baekelandt
- Department of Obstetrics and Gynecology, Imelda Hospital, Bonheiden, Belgium; Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | | | - Luka Matak
- Department of Obstetrics and Gynecology, General Hospital Zadar, Croatia
| | - Andrea Stuart
- Department of Obstetrics and Gynecology, Helsingborg, Sweden; Institution of Clinical Sciences, Dept. of Obstetrics and Gynecology, Lund University, Lund, Sweden.
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Berardo A, Bonaldi L, Stecco C, Fontanella CG. Biomechanical properties of the human superficial fascia: Site-specific variability and anisotropy of abdominal and thoracic regions. J Mech Behav Biomed Mater 2024; 157:106637. [PMID: 38914036 DOI: 10.1016/j.jmbbm.2024.106637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/30/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Superficial fascia is a fibrofatty tissue found throughout the body. Initially described in relation to hernias, it has only recently received attention from the scientific community due to new evidence on its role in force transmission and structural integrity of the body. Considering initial difficulties in its anatomical identification, to date, a characterization of the superficial fascia through mechanical tests is still lacking. The mechanical properties of human superficial fasciae of abdominal and thoracic districts (back) of different subjects (n = 4) were then investigated, focusing on anisotropy and viscoelasticity. Experimental tests were performed on samples taken in two perpendicular directions according to body planes (cranio-caudal and latero-medial axes). Data collected from two different uniaxial tensile protocols, failure (i.e., ultimate tensile strength and strain at break, Young's modulus and toughness) and stress-relaxation (i.e., residual stress), were processed and then grouped for statistical analysis. Failure tests confirmed tissue anisotropy, revealing the stiffer nature of the latero-medial direction compared to the cranio-caudal one, for both the districts (with a ratio of the respective Young's moduli close to 2). Furthermore, the thoracic region exhibited significantly greater strength and resultant Young's modulus compared to the abdomen (with greater results along the latero-medial direction, such as 6.13 ± 3.11 MPa versus 0.85 ± 0.39 MPa and 24.87 ± 15.23 MPa versus 3.19 ± 1.62 MPa, respectively). On the contrary, both regions displayed similar strain at break (varying between 38 and 47%), with no clear dependence from the loading directions. Stress-relaxation tests highlighted the viscous behavior of the superficial fascia, with no significant differences in the stress decay between directions and districts (35-38% of residual stress after 300 s). All these collected results represent the starting point for a more in-depth knowledge of the mechanical characterization of the superficial fascia, which can have direct implications in the design, implementation, and effectiveness of site-specific treatments.
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Affiliation(s)
- Alice Berardo
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131, Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy
| | - Lorenza Bonaldi
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131, Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy.
| | - Carla Stecco
- Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy; Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121, Padova, Italy
| | - Chiara Giulia Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy; Department of Industrial Engineering, University of Padova, 35131, Padova, Italy
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Liu Y, Huang J, Li S, Li Z, Chen C, Qu G, Chen K, Teng Y, Ma R, Ren J, Wu X. Recent Advances in Functional Hydrogel for Repair of Abdominal Wall Defects: A Review. Biomater Res 2024; 28:0031. [PMID: 38845842 PMCID: PMC11156463 DOI: 10.34133/bmr.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 06/09/2024] Open
Abstract
The abdominal wall plays a crucial role in safeguarding the internal organs of the body, serving as an essential protective barrier. Defects in the abdominal wall are common due to surgery, infection, or trauma. Complex defects have limited self-healing capacity and require external intervention. Traditional treatments have drawbacks, and biomaterials have not fully achieved the desired outcomes. Hydrogel has emerged as a promising strategy that is extensively studied and applied in promoting tissue regeneration by filling or repairing damaged tissue due to its unique properties. This review summarizes the five prominent properties and advances in using hydrogels to enhance the healing and repair of abdominal wall defects: (a) good biocompatibility with host tissues that reduces adverse reactions and immune responses while supporting cell adhesion migration proliferation; (b) tunable mechanical properties matching those of the abdominal wall that adapt to normal movement deformations while reducing tissue stress, thereby influencing regulating cell behavior tissue regeneration; (c) drug carriers continuously delivering drugs and bioactive molecules to sites optimizing healing processes enhancing tissue regeneration; (d) promotion of cell interactions by simulating hydrated extracellular matrix environments, providing physical support, space, and cues for cell migration, adhesion, and proliferation; (e) easy manipulation and application in surgical procedures, allowing precise placement and close adhesion to the defective abdominal wall, providing mechanical support. Additionally, the advances of hydrogels for repairing defects in the abdominal wall are also mentioned. Finally, an overview is provided on the current obstacles and constraints faced by hydrogels, along with potential prospects in the repair of abdominal wall defects.
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Affiliation(s)
- Ye Liu
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Jinjian Huang
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Sicheng Li
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Ze Li
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Canwen Chen
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Guiwen Qu
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Kang Chen
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Yitian Teng
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Rui Ma
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Jianan Ren
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
| | - Xiuwen Wu
- School of Medicine,
Southeast University, Nanjing 210009, China
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School,
Nanjing University, Nanjing 210002, China
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Liu J, Tang R, Zhu X, Ma Q, Mo X, Wu J, Liu Z. Ibuprofen-loaded bilayer electrospun mesh modulates host response toward promoting full-thickness abdominal wall defect repair. J Biomed Mater Res A 2024; 112:941-955. [PMID: 38230575 DOI: 10.1002/jbm.a.37672] [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: 04/20/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
Pro-inflammatory response impairs the constructive repair of abdominal wall defects after mesh implantation. Electrospinning-aid functionalization has the potential to improve the highly orchestrated response by attenuating the over-activation of foreign body reactions. Herein, we combined poly(L-lactic acid-co-caprolactone) (PLLA-CL) with gelatin proportionally via electrospinning, with Ibuprofen (IBU) incorporation to fabricate a bilayer mesh for the repair improvement. The PLLA-CL/gelatin/IBU (PGI) mesh was characterized in vitro and implanted into the rat model with a full-thickness defect for a comprehensive evaluation in comparison to the PLLA-CL/gelatin (PG) and off-the-shelf small intestinal submucosa (SIS) meshes. The bilayer PGI mesh presented a sustained release of IBU over 21 days with degradation in vitro and developed less-intensive intraperitoneal adhesion along with a histologically weaker inflammatory response than the PG mesh after 28 days. It elicited an M2 macrophage-dominant foreign body reaction within the process, leading to a pro-remodeling response similar to the biological SIS mesh, which was superior to the PG mesh. The PGI mesh provided preponderant mechanical supports over the SIS mesh and the native abdominal wall with similar compliance. Collectively, the newly developed mesh advances the intraperitoneal applicability of electrospun meshes by guiding a pro-remodeling response and offers a feasible functionalization approach upon immunomodulation.
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Affiliation(s)
- Jiajie Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
| | - Rui Tang
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
| | - Xiaoqiang Zhu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
| | - Qiaolin Ma
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, People's Republic of China
| | - Xiumei Mo
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, People's Republic of China
| | - Jinglei Wu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Biological Science and Medical Engineering, Donghua University, Shanghai, People's Republic of China
| | - Zhengni Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, Tongji University, Shanghai, People's Republic of China
- Department of General Surgery, Shanghai East Hospital Ji'an Hospital, Ji'an, Jiangxi Province, People's Republic of China
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Tang F, Miao D, Huang R, Zheng B, Yu Y, Ma P, Peng B, Li Y, Wang H, Wu D. Double-Layer Asymmetric Porous Mesh with Dynamic Mechanical Support Properties Enables Efficient Single-Stage Repair of Contaminated Abdominal Wall Defect. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2307845. [PMID: 38408735 DOI: 10.1002/adma.202307845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/08/2024] [Indexed: 02/28/2024]
Abstract
Contamination tolerance and long-term mechanical support are the two critical properties of meshes for contaminated abdominal wall defect repair. However, biological meshes with excellent pollution tolerance fail to provide bio-adaptive long-term mechanical support due to their rapid degradation. Here, a novel double-layer asymmetric porous mesh (SIS/PVA-EXO) is designed by simple and efficient in situ freeze-thaw of sticky polyvinyl alcohol (PVA) solution on the loosely porous surface of small intestinal submucosal decellularized matrix (SIS), which can successfully repair the contaminated abdominal wall defect with bio-adaptive dynamic mechanical support through only single-stage surgery. The exosome-loaded degradable loosely porous SIS layer accelerates the tissue healing; meanwhile, the exosome-loaded densely porous PVA layer can maintain long-term mechanical support without any abdominal adhesion. In addition, the tensile strength and strain at break of SIS/PVA-EXO mesh change gradually from 0.37 MPa and 210% to 0.10 MPa and 385% with the degradation of SIS layer. This unique performance can dynamically adapt to the variable mechanical demands during different periods of contaminated abdominal wall reconstruction. As a result, this SIS/PVA-EXO mesh shows an attractive prospect in the treatment of contaminated abdominal wall defect without recurrence by integrating local immune regulation, tissue remodeling, and dynamic mechanical supporting.
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Affiliation(s)
- Fuxin Tang
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Dongtian Miao
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Rongkang Huang
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Bingna Zheng
- The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, P.R. China
| | - Yang Yu
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Pengwei Ma
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Binying Peng
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Yong Li
- Department of General Surgery (Gastrointestinal Surgery), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China
| | - Hui Wang
- Department of General Surgery (Colorectal Surgery), Guangdong Institute of Gastroenterology, Biomedical Innovation Center, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Dingcai Wu
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
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Nessel R, Löffler T, Rinn J, Kallinowski F. Three-year follow-up of the grip concept: an open, prospective, observational registry study on biomechanically calculated abdominal wall repair for complex incisional hernias. Hernia 2024; 28:913-924. [PMID: 38761301 PMCID: PMC11249466 DOI: 10.1007/s10029-024-03064-2] [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: 01/14/2024] [Accepted: 04/28/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE We studied the effectiveness of biomechanically calculated abdominal wall reconstructions for incisional hernias of varying complexity in an open, prospective observational registry trial. METHODS From July 1st, 2017 to December 31st, 2020, four hospitals affiliated with the University of Heidelberg recruited 198 patients with complex incisional hernias. Hernias were repaired using biomechanically calculated reconstructions and materials classified on their gripping force towards cyclic load. This approach determines the required strength preoperatively based on the hernia size, using the Critical Resistance to Impacts related to Pressure. The surgeon is supported in reliably determining the Gained Resistance, which is based on the mesh-defect-area-ratio, as well as other mesh and suture factors, and the tissue stability. Tissue stability is defined as a maximum distension of 1.5 cm upon a Valsalva maneuver. In complex cases, a CT scan of the abdomen can be used to assess unstable tissue areas both at rest and during Valsalva's maneuver. RESULTS Larger and stronger gripping meshes were required for more complex cases to achieve a durable repair, especially for larger hernia sizes. To achieve durable repairs, the number of fixation points increased while the mesh-defect area ratio decreased. Performing these repairs required more operating room time. The complication rate remained low. Less than 1% of recurrences and low pain levels were observed after 3 years. CONCLUSIONS Biomechanical stability, defined as the resistance to cyclic load, is crucial in preventing postoperative complications, including recurrences and chronic pain.
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Affiliation(s)
- R Nessel
- General, Visceral and Pediatric Surgery, Klinikum Am Gesundbrunnen, Am Gesundbrunnen 20‑26, 74078, Heilbronn, Germany
| | - T Löffler
- General and Visceral Surgery, GRN Hospital Eberbach, Scheuerbergstrasse 3, 69412, Eberbach, Germany
| | - J Rinn
- General and Visceral Surgery, KKB Hospital Bergstrasse, Viernheimer Strasse 2, 64646, Heppenheim, Germany
| | - F Kallinowski
- Hernia Center, General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Remus R, Sure C, Selkmann S, Uttich E, Bender B. Soft tissue material properties based on human abdominal in vivo macro-indenter measurements. Front Bioeng Biotechnol 2024; 12:1384062. [PMID: 38854855 PMCID: PMC11157078 DOI: 10.3389/fbioe.2024.1384062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/22/2024] [Indexed: 06/11/2024] Open
Abstract
Simulations of human-technology interaction in the context of product development require comprehensive knowledge of biomechanical in vivo behavior. To obtain this knowledge for the abdomen, we measured the continuous mechanical responses of the abdominal soft tissue of ten healthy participants in different lying positions anteriorly, laterally, and posteriorly under local compression depths of up to 30 mm. An experimental setup consisting of a mechatronic indenter with hemispherical tip and two time-of-flight (ToF) sensors for optical 3D displacement measurement of the surface was developed for this purpose. To account for the impact of muscle tone, experiments were conducted with both controlled activation and relaxation of the trunk muscles. Surface electromyography (sEMG) was used to monitor muscle activation levels. The obtained data sets comprise the continuous force-displacement data of six abdominal measurement regions, each synchronized with the local surface displacements resulting from the macro-indentation, and the bipolar sEMG signals at three key trunk muscles. We used inverse finite element analysis (FEA), to derive sets of nonlinear material parameters that numerically approximate the experimentally determined soft tissue behaviors. The physiological standard values obtained for all participants after data processing served as reference data. The mean stiffness of the abdomen was significantly different when the trunk muscles were activated or relaxed. No significant differences were found between the anterior-lateral measurement regions, with exception of those centered on the linea alba and centered on the muscle belly of the rectus abdominis below the intertubercular plane. The shapes and areas of deformation of the skin depended on the region and muscle activity. Using the hyperelastic Ogden model, we identified unique material parameter sets for all regions. Our findings confirmed that, in addition to the indenter force-displacement data, knowledge about tissue deformation is necessary to reliably determine unique material parameter sets using inverse FEA. The presented results can be used for finite element (FE) models of the abdomen, for example, in the context of orthopedic or biomedical product developments.
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Affiliation(s)
- Robin Remus
- Chair of Product Development, Department of Mechanical Engineering, Ruhr-University Bochum, Bochum, Germany
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Hendrawan S, Lheman J, Weber U, Oberkofler CE, Eryani A, Vonlanthen R, Baer HU. Fibroblast matrix implants-a better alternative for incisional hernia repair? Biomed Mater 2024; 19:035033. [PMID: 38604155 DOI: 10.1088/1748-605x/ad3da4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/11/2024] [Indexed: 04/13/2024]
Abstract
The standard surgical procedure for abdominal hernia repair with conventional prosthetic mesh still results in a high recurrence rate. In the present study, we propose a fibroblast matrix implant (FMI), which is a three-dimensional (3D) poly-L-lactic acid scaffold coated with collagen (matrix) and seeded with fibroblasts, as an alternative mesh for hernia repair. The matrix was seeded with fibroblasts (cellularized) and treated with a conditioned medium (CM) of human Umbilical Cord Mesenchymal Stem Cells (hUC-MSC). Fibroblast proliferation and function were assessed and compared between treated with CM hUC-MSC and untreated group, 24 h after seeding onto the matrix (n= 3). To study the matricesin vivo,the hernia was surgically created on male Sprague Dawley rats and repaired with four different grafts (n= 3), including a commercial mesh (mesh group), a matrix without cells (cell-free group), a matrix seeded with fibroblasts (FMI group), and a matrix seeded with fibroblasts and cultured in medium treated with 1% CM hUC-MSC (FMI-CM group).In vitroexamination showed that the fibroblasts' proliferation on the matrices (treated group) did not differ significantly compared to the untreated group. CM hUC-MSC was able to promote the collagen synthesis of the fibroblasts, resulting in a higher collagen concentration compared to the untreated group. Furthermore, thein vivostudy showed that the matrices allowed fibroblast growth and supported cell functionality for at least 1 month after implantation. The highest number of fibroblasts was observed in the FMI group at the 14 d endpoint, but at the 28 d endpoint, the FMI-CM group had the highest. Collagen deposition area and neovascularization at the implantation site were observed in all groups without any significant difference between the groups. FMI combined with CM hUC-MSC may serve as a better option for hernia repair, providing additional reinforcement which in turn should reduce hernia recurrence.
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Affiliation(s)
- Siufui Hendrawan
- Tarumanagara Human Cell Technology Laboratory, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
| | - Jennifer Lheman
- Tarumanagara Human Cell Technology Laboratory, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
| | - Ursula Weber
- Tarumanagara Human Cell Technology Laboratory, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
- Baermed, Centre of Abdominal Surgery, Hirslanden Clinic, 8032 Zürich, Switzerland
| | | | - Astheria Eryani
- Department of Histology, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
| | - René Vonlanthen
- Vivévis AG, Viszeral-, Tumor- und Roboterchirurgie, Kappelistrasse 7, 8002 Zürich, Switzerland
| | - Hans Ulrich Baer
- Tarumanagara Human Cell Technology Laboratory, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
- Baermed, Centre of Abdominal Surgery, Hirslanden Clinic, 8032 Zürich, Switzerland
- Department of Visceral and Transplantation Surgery, University of Bern, 3012 Bern, Switzerland
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Allaeys M, Visscher L, den Hartog FPJ, Dries P, Tanis PJ, Theeuwes HP, Berrevoet F, Eker HH. Strength of small-bites abdominal wall closure using different suturing methods and materials in an experimental animal model. Hernia 2024; 28:527-535. [PMID: 38212505 DOI: 10.1007/s10029-023-02945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/08/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Using small instead of large bites for laparotomy closure results in lower incidence of incisional hernia, but no consensus exists on which suture material to use. This study aimed to compare five different closure strategies in a standardized experimental setting. METHODS Fifty porcine abdominal walls were arranged into 5 groups: (A) running 2/0 polydioxanone; (B) interlocking 2/0 polydioxanone; (C) running size 0 barbed polydioxanone; (D) running size 0 barbed glycolic acid and trimethylene carbonate; (E) running size 0 suturable polypropylene mesh. The small-bites technique was used for linea alba closure in all. The abdominal walls were divided into a supra- and infra-umbilical half, resulting in 20 specimens per group that were pulled apart in a tensile testing machine. Maximum tensile force and types of suture failure were registered. RESULTS The highest tensile force was measured when using barbed polydioxanone (334.8 N ± 157.0), but differences did not reach statistical significance. Infra-umbilical abdominal walls endured a significantly higher maximum tensile force compared to supra-umbilical (397 N vs 271 N, p < 0.001). Barbed glycolic acid and trimethylene carbonate failed significantly more often (25% vs 0%, p = 0.008). CONCLUSION Based on tensile force, both interlocking and running suture techniques using polydioxanone, and running sutures using barbed polydioxanone or suturable mesh, seem to be suitable for abdominal wall closure. Tensile strength was significantly higher in infra-umbilical abdominal walls compared to supra-umbilical. Barbed glycolic acid and trimethylene carbonate should probably be discouraged for fascial closure, because of increased risk of suture failure.
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Affiliation(s)
- M Allaeys
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium.
| | - L Visscher
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Surgical SkillsLab, Department of Neuroscience and Anatomy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F P J den Hartog
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P Dries
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - P J Tanis
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H P Theeuwes
- Surgical SkillsLab, Department of Neuroscience and Anatomy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - H H Eker
- Department of General and HPB Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
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12
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Liang K, Ding C, Li J, Yao X, Yu J, Wu H, Chen L, Zhang M. A Review of Advanced Abdominal Wall Hernia Patch Materials. Adv Healthc Mater 2024; 13:e2303506. [PMID: 38055999 DOI: 10.1002/adhm.202303506] [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: 10/12/2023] [Revised: 12/05/2023] [Indexed: 12/08/2023]
Abstract
Tension-free abdominal wall hernia patch materials (AWHPMs) play an important role in the repair of abdominal wall defects (AWDs), which have a recurrence rate of <1%. Nevertheless, there are still significant challenges in the development of tailored, biomimetic, and extracellular matrix (ECM)-like AWHPMs that satisfy the clinical demands of abdominal wall repair (AWR) while effectively handling post-operative complications associated with abdominal hernias, such as intra-abdominal visceral adhesion and abnormal healing. This extensive review presents a comprehensive guide to the high-end fabrication and the precise selection of these advanced AWHPMs. The review begins by briefly introducing the structures, sources, and properties of AWHPMs, and critically evaluates the advantages and disadvantages of different types of AWHPMs for AWR applications. The review subsequently summarizes and elaborates upon state-of-the-art AWHPM fabrication methods and their key characteristics (e.g., mechanical, physicochemical, and biological properties in vitro/vivo). This review uses compelling examples to demonstrate that advanced AWHPMs with multiple functionalities (e.g., anti-deformation, anti-inflammation, anti-adhesion, pro-healing properties, etc.) can meet the fundamental clinical demands required to successfully repair AWDs. In particular, there have been several developments in the enhancement of biomimetic AWHPMs with multiple properties, and additional breakthroughs are expected in the near future.
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Affiliation(s)
- Kaiwen Liang
- College of Material Engineering, Fujian Agriculture and Forestry University, Fuzhou, Fujian, 350002, P. R. China
| | - Cuicui Ding
- College of Ecological Environment and Urban Construction, Fujian University of Technology, Fuzhou, Fujian, 350118, P. R. China
| | - Jingyi Li
- School of Basic Medicine, Fujian Medical University, Fuzhou, Fujian, 350122, P. R. China
| | - Xiao Yao
- College of Ecological Environment and Urban Construction, Fujian University of Technology, Fuzhou, Fujian, 350118, P. R. China
| | - Jingjing Yu
- College of Ecological Environment and Urban Construction, Fujian University of Technology, Fuzhou, Fujian, 350118, P. R. China
| | - Hui Wu
- College of Material Engineering, Fujian Agriculture and Forestry University, Fuzhou, Fujian, 350002, P. R. China
| | - Lihui Chen
- College of Material Engineering, Fujian Agriculture and Forestry University, Fuzhou, Fujian, 350002, P. R. China
| | - Min Zhang
- College of Material Engineering, Fujian Agriculture and Forestry University, Fuzhou, Fujian, 350002, P. R. China
- National Forestry & Grassland Administration Key Laboratory for Plant Fiber Functional Materials, Fuzhou, Fujian, 350000, P. R. China
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13
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Tran DH, Rubarth C, Leeds SG, Fair L, McGowan T, Ramakrishnan S, Shabbir R, Ogola G, Ward MA, Aladegbami B. The use of poly-4-hydroxybutyrate (P4HB, Phasix™) mesh in ventral hernia repair: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-02996-z. [PMID: 38512507 DOI: 10.1007/s10029-024-02996-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/18/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE/BACKGROUND Despite the growing use of bioabsorbable mesh in ventral hernia repairs (VHR), the evidence of its impact on patient outcomes remains limited. This study aims to investigate the efficacy and safety profile of poly-4-hydroxybutyrate (P4HB) mesh for ventral hernia repair through a systematic review and meta-analysis. METHODS A literature search of five databases (PubMed, Embase, Ovid, Medline, and Google Scholar) produced a list of publications that analyzed the use of P4HB mesh in ventral hernia repair in both clean and contaminated cases. The primary postoperative outcomes of hernia recurrence, surgical site infections (SSI), and any complications were analyzed through a pooled meta-analysis. RESULTS In our systematic review, 21 studies met the inclusion criteria with a total of 1858 patients (933 males and 925 females) and an average age of 56.8 years. The median follow-up ranged from 1.6 to 62.3 months. In our meta-analysis, the use of P4HB mesh in VHR in proportion of events demonstrated a recurrence rate of 9% [6%; 15%], SSI of 10% [6%; 16%] and 35% [9%; 42%] for rate of any complications. Sub-meta-analysis restricted to studies with follow up > 18 months continues to show low rates of recurrence of 9% (95%CI, 4-17%), SSI of 9% (95%CI, 4-16%), and 31% (95%CI, 23-41%) for any complications. CONCLUSION Our study demonstrates that the use of P4HB mesh is both safe and effective in ventral hernia repairs. When further analyzed past 18 months, the time where P4HB mesh fully resorbs, the rates of hernia recurrence, SSI, and any complications remain low of upwards of 5 years and comparable to the rates seen in synthetic and biologics in similar patient populations.
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Affiliation(s)
- Daniel H Tran
- Texas A&M College of Medicine, Bryan, TX, USA
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Charles Rubarth
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Steven G Leeds
- Texas A&M College of Medicine, Bryan, TX, USA
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Luke Fair
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Titus McGowan
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | | | - Rehma Shabbir
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Gerald Ogola
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Marc A Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Bola Aladegbami
- Texas A&M College of Medicine, Bryan, TX, USA.
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
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Tuset L, López-Cano M, Fortuny G, López JM, Herrero J, Puigjaner D. A virtual simulation approach to assess the effect of trocar-site placement and scar characteristics on the abdominal wall biomechanics. Sci Rep 2024; 14:3583. [PMID: 38351278 PMCID: PMC10864383 DOI: 10.1038/s41598-024-54119-4] [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: 05/15/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
Analyses of registries and medical imaging suggest that laparoscopic surgery may be penalized with a high incidence of trocar-site hernias (TSH). In addition to trocar diameter, the location of the surgical wound (SW) may affect TSH incidence. The intra-abdominal pressure (IAP) exerted on the abdominal wall (AW) might also influence the appearance of TSH. In the present study, we used finite element (FE) simulations to predict the influence of trocar location and SW characteristics (stiffness) on the mechanical behavior of the AW subject to an IAP. Two models of laparoscopy patterns on the AW, with trocars in the 5-12 mm range, were generated. FE simulations for IAP values within the 4 kPa-20 kPa range were carried out using the Code Aster open-source software. Different stiffness levels of the SW tissue were considered. We found that midline-located surgical wounds barely deformed, even though they moved outwards along with the regular LA tissue. Laterally located SWs hardly changed their location but they experienced significant variations in their volume and shape. The amount of deformation of lateral SWs was found to strongly depend on their stiffness. Trocar incisions placed in a LA with non-diastatic dimensions do not compromise its mechanical integrity. The more lateral the trocars are placed, the greater is their deformation, regardless of their size. Thus, to prevent TSH it might be advisable to close lateral trocars with a suture, or even use a prosthetic reinforcement depending on the patient's risk factors (e.g., obesity).
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Affiliation(s)
- Lluís Tuset
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain
| | - Manuel López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gerard Fortuny
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain
| | - Josep M López
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain
| | - Joan Herrero
- Departament d'Enginyeria Química, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain
| | - Dolors Puigjaner
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain.
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15
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Jiao Y, Yang X, Li Y, Wang F, Wang L, Li C. Spider-Silk-like Fiber Mat-Covered Polypropylene Warp-Knitted Hernia Mesh for Inhibition of Fibrosis under Dynamic Environment. Biomacromolecules 2024; 25:1214-1227. [PMID: 38295271 DOI: 10.1021/acs.biomac.3c01181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Hernia surgery is a widely performed procedure, and the use of a polypropylene mesh is considered the standard approach. However, the mesh often leads to complications, including the development of scar tissue that wraps around the mesh and causes it to shrink. Consequently, there is a need to investigate the relationship between the mesh and scar formation as well as to develop a hernia mesh that can prevent fibrosis. In this study, three different commercial polypropylene hernia meshes were examined to explore the connection between the fabric structure and mechanical properties. In vitro dynamic culture was used to investigate the mechanism by which the mechanical properties of the mesh in a dynamic environment affect cell differentiation. Additionally, electrospinning was employed to create polycaprolactone spider-silk-like fiber mats to achieve mechanical energy dissipation in dynamic conditions. These fiber mats were then combined with the preferred hernia mesh. The results demonstrated that the composite mesh could reduce the activation of fibroblast mechanical signaling pathways and inhibit its differentiation into myofibroblasts in dynamic environments.
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Affiliation(s)
- Yongjie Jiao
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Xiaowei Yang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Yan Li
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Fujun Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Chaojing Li
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
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16
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Pushpa NB, Patra A, Ravi KS, Viveka S, Pushpalatha K, Smitha MC. Reappraisal of the anatomical diversities of the pyramidalis muscle with their potential clinical applicability: cadaveric analysis. Surg Radiol Anat 2024; 46:203-210. [PMID: 38182780 DOI: 10.1007/s00276-023-03278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/30/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION The present study examined the morphology and morphometric parameters of the pyramidalis muscle (PM) in detail with their potential applicability in making midline infra-umbilical incisions and biomechanics of the linea alba. METHODS PM was examined in 51 formalin-fixed cadavers (36 males and 15 females), and based on the mode of insertion or the level of apex, the formation or shape of the muscle was classified into nine types (Mori's classification). RESULTS Bilateral PM was more prevalent (39.21%) than unilateral (1.96%) (p = 0.001). All the cases showed side symmetry except one. Mori's type 7 (right PM is higher apex and the left PM with elongated origin) was the most common form. The mean length of PM in males and females was 4.51 ± 0.14 and 3.33 ± 0.12 cm on the right and 4.51 ± 0.11 and 3.26 ± 0.16 cm on the left side. The mean width of right-sided PMs in males and females was 1.90 ± 0.17 and 1.58 ± 0.13 cm and left-sided 1.88 ± 0.14 and 1.55 ± 0.38 cm. The mean of pyramidalis-pubo-umbilical index (PPI) in males and females was 32.82 ± 1.65 and 27.50 ± 1.08, respectively. The mean insertion angle was 24.56 ± 3.07 on right side and 23 ± 2.03 on the left side (p = 0.03). Male predominance existed on right- and left-sided PM length (p < 0.001 and p < 0.001), width (p = 0.001) and PPI (p = 0.001). The strong positive correlation (r = 0.83) between length and width indicates a symmetrical muscle augmentation in the two dimensions. CONCLUSION PM is an inconsistent anatomical structure with persistent morphology. The level and angle of insertion into the linea are crucial in the biomechanics of linea alba. PPI, determining the termination level would be useful to surgeons making midline infra-umbilical incisions.
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Affiliation(s)
- N B Pushpa
- JSS Medical College, JAASHER, Mysore, India
| | - Apurba Patra
- All India Institute of Medical Sciences, Bathinda, India.
| | - K S Ravi
- All India Institute of Medical Sciences, Gorakhpur, India
| | - S Viveka
- Healiosomed Academy, Bangalore, India
| | | | - M C Smitha
- JSS Medical College, JAASHER, Mysore, India
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17
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Waller J, Gowans P, Lord S, McGill K. Impact of Stoma Baseplate Convexity on Tension and Compression Around the Stoma Site: A Finite Element Analysis. Cureus 2024; 16:e52112. [PMID: 38213939 PMCID: PMC10783598 DOI: 10.7759/cureus.52112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Abstract
For patients living with intestinal or urinary stomas, skin barriers play an essential role in protecting the peristomal skin and preventing peristomal complications. Convex baseplates press into the peristomal skin and are suitable for retracted stomas that do not protrude, peristomal skin with creases, folds, or dips, and stomas where frequent leaking can occur with flat pouching systems. However, there is a lack of data on the magnitude and location of tension applied to the abdomen by convex baseplates. We evaluated the impact of a range of convex baseplates applied to a simulated stoma site. A comparative finite element analysis investigation was conducted to evaluate the impact of eight different convex stoma system baseplates applied to an idealised flat abdomen, representing skin, subcutaneous tissue, and musculature layers. The baseplates considered had varying convexity with depths of 3.5 mm and 7 mm and internal structural diameters between ~30 mm and ~60 mm. The convex product range provided tension in the skin (maximum principal strain) and compression through the fat layer (minimum principal strain). Large differences in the locations and magnitudes of skin tension and fat layer compression were seen between the baseplates under analysis, with both the depth and diameter of convexity influencing the strain experienced across the abdominal topography. The results generated highlight the importance of having an appropriate range of convexity products available and selecting an appropriate option for use based on the stoma type and condition of the peristomal skin.
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Affiliation(s)
| | | | | | - Katie McGill
- Engineering, Kinneir Dufort Design Ltd., Bristol, GBR
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18
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Grillo A, Hyder Z, Mudera V, Kureshi A. Evaluation of hernia surgical meshes sterilised with ethylene oxide for adoption under UK regulations. Surg Endosc 2023; 37:9556-9562. [PMID: 37730855 PMCID: PMC10709235 DOI: 10.1007/s00464-023-10460-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Low-cost meshes (LCM) have been successfully used in low-income countries (LIC) over the past decades, demonstrating comparable surgical outcomes to commercial meshes at a fraction of the cost. However, LIC sterilisation standards (autoclave sterilisation at 121 °C) do not meet UK regulations for medical devices, which require either ethylene oxide (EO) sterilisation or steam sterilisation at 134 °C. Therefore, the aim of this study was to sterilise UK LCM and characterise their mechanical properties and in vitro biocompatibility to verify whether EO sterilisation causes changes in the mechanical properties and biocompatibility of LCM. METHODS EO sterilised LCM were used. Uniaxial tensile tests were performed to measure mechanical properties. Biocompatibility was measured through viability and morphology of Human Dermal Fibroblasts (HDFs) cultured in mesh-conditioned media, and by calculating the metabolic activity and proliferation of HDFs attached on the meshes, with alamarBlue assay. RESULTS Break stress of LCM1 was significantly higher than LCM2 (p < 0.0001), while Young's modulus of LCM1 was significantly lower than LCM2 (p < 0.05) and there was no significant difference in break strain. Viability and morphology showed no significant difference between LCM and control. Attachment and proliferation of HDFs on LCM showed a better proliferation on LCM2 than LCM1, with values similar to the control at the final time point. CONCLUSIONS We demonstrated that EO sterilisation affects LCM mechanical properties, but they still have values closer to the native tissues than the commercially available ones. We also showed that in vitro biocompatibility of LCM2 is not affected by EO sterilisation, as HDFs attached and proliferated on the mesh, while EO affected attachment on LCM1. A more detailed cost analysis of the potential savings for healthcare systems around the world needs to be performed to strengthen the cost-effectiveness of this frugal innovation.
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Affiliation(s)
- Alessandra Grillo
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, UCL, London, UK.
| | - Zargham Hyder
- Hydermed Limited, Woodford Green, UK
- Homerton University Hospital, NHS Trust, London, UK
| | - Vivek Mudera
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, UCL, London, UK
| | - Alvena Kureshi
- Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, UCL, London, UK
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19
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Vergari C, Persohn S, Rohan PY. The effect of breathing on the in vivo mechanical characterization of linea alba by ultrasound shearwave elastography. Comput Biol Med 2023; 167:107637. [PMID: 37897961 DOI: 10.1016/j.compbiomed.2023.107637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023]
Abstract
The most common surgical repair of abdominal wall hernia consists in implanting a mesh to reinforce hernia defects during the healing phase. Ultrasound shearwave elastography (SWE) is a promising non-invasive method to estimate soft tissue mechanical properties at bedside through shear wave speed (SWS) measurement. Combined with conventional ultrasonography, it could help the clinician plan surgery. In this work, a novel protocol is proposed to reliably assess the stiffness of the linea alba, and to evaluate the effect of breathing and of inflating the abdomen on SWS. Fifteen healthy adults were included. SWS was measured in the linea alba, in the longitudinal and transverse direction, during several breathing cycle and during active abdominal inflation. SWS during normal breathing was 2.3 [2.0; 2.5] m/s in longitudinal direction and 2.2 [1.9; 2.7] m/s in the transversal. Inflating the abdomen increased SWS both in longitudinal and transversal direction (3.5 [2.8; 5.8] m/s and 5.2 [3.0; 6.0] m/s, respectively). The novel protocol significantly improved the reproducibility relative to the literature (8% in the longitudinal direction and 14% in the transverse one). Breathing had a mild effect on SWS, and accounting for it only marginally improved the reproducibility. This study proved the feasibility of the method, and its potential clinical interest. Further studies on larger cohort should focus on improving our understanding of the relationship between abdominal wall properties and clinical outcomes, but also provide a cartography of the abdominal wall, beyond the linea alba.
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Affiliation(s)
- Claudio Vergari
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France.
| | - Sylvain Persohn
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
| | - Pierre-Yves Rohan
- Arts et Métiers Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, Université Sorbonne Paris Nord, Paris, France
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20
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Jiao Y, Li X, Liu X, Li C, Yang X, Sun X, Wang F, Wang L. Cobweb-Inspired Micro/Nanostructured Scaffolds for Soft Tissue Regeneration with Inhibition Effect of Fibrosis under Dynamic Environment. Adv Healthc Mater 2023; 12:e2300997. [PMID: 37713107 DOI: 10.1002/adhm.202300997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/08/2023] [Indexed: 09/16/2023]
Abstract
In soft tissue repair, fibrosis can lead to repair failure and long-term chronic pain in patients. Excessive mechanical stimulation of fibroblasts is one of the causes of fibrosis during abdominal wall regeneration. Inspired by the cobweb, a polycaprolactone beaded fiber is prepared by electrospinning. The cobweb-inspired structure attenuates the mechanical stimulation of cells under a dynamic environment. Nano-protrusions are introduced into the scaffold for further inhibition of fibrosis by self-induced crystallization. A machine is built for in vitro dynamic culture and rat abdominal subcutaneous embedding experiments are performed to verify the inhibiting effect of fibrosis in a dynamic environment in vivo. Results show that the expression of integrin β1 and α-smooth muscle actin is inhibited by the cobweb-inspired structure under dynamic culture. The results of hematoxylin and eosin and Masson's trichrome indicate that the cobweb-inspired structure has a good inhibitory effect on fibrosis in a dynamic environment in vivo. In general, the cobweb-inspired scaffold with nano-protrusions has a good ability to inhibit fibrosis under both static and dynamic environments. It is believed that the scaffold has promising applications in the field of inhibiting fibrosis caused by mechanical stimulation.
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Affiliation(s)
- Yongjie Jiao
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| | - Xiaojing Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Xingxing Liu
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| | - Chaojing Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| | - Xiao Yang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Xuwei Sun
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Fujun Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
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Najm A, Niculescu AG, Gaspar BS, Grumezescu AM, Beuran M. A Review of Abdominal Meshes for Hernia Repair-Current Status and Emerging Solutions. MATERIALS (BASEL, SWITZERLAND) 2023; 16:7124. [PMID: 38005054 PMCID: PMC10672379 DOI: 10.3390/ma16227124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Abdominal hernias are common issues in the clinical setting, burdening millions of patients worldwide. Associated with pain, decreased quality of life, and severe potential complications, abdominal wall hernias should be treated as soon as possible. Whether an open repair or laparoscopic surgical approach is tackled, mesh reinforcement is generally required to ensure a durable hernia repair. Over the years, numerous mesh products have been made available on the market and in clinical settings, yet each of the currently used meshes presents certain limitations that reflect on treatment outcomes. Thus, mesh development is still ongoing, and emerging solutions have reached various testing stages. In this regard, this paper aims to establish an up-to-date framework on abdominal meshes, briefly overviewing currently available solutions for hernia repair and discussing in detail the most recent advances in the field. Particularly, there are presented the developments in lightweight materials, meshes with improved attachment, antimicrobial fabrics, composite and hybrid textiles, and performant mesh designs, followed by a systematic review of recently completed clinical trials.
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Affiliation(s)
- Alfred Najm
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 8 Calea Floresca, Sector 1, 014461 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Bogdan Severus Gaspar
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 8 Calea Floresca, Sector 1, 014461 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania
| | - Mircea Beuran
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari, Sector 5, 050474 Bucharest, Romania; (A.N.); (B.S.G.); (M.B.)
- Emergency Hospital Floreasca Bucharest, 8 Calea Floresca, Sector 1, 014461 Bucharest, Romania
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22
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Szepietowska K, Troka M, Lichodziejewska-Niemierko M, Chmielewski M, Lubowiecka I. Full-field in vivo experimental study of the strains of a breathing human abdominal wall with intra-abdominal pressure variation. J Mech Behav Biomed Mater 2023; 147:106148. [PMID: 37797556 DOI: 10.1016/j.jmbbm.2023.106148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023]
Abstract
The presented study aims to assess the mechanical behaviour of the anterior abdominal wall based on an in vivo experiment on humans. Full-field measurement of abdominal wall displacement during changes of intra-abdominal pressure is performed using a digital image correlation (DIC) system. Continuous measurement in time enables the observation of changes in the strain field during breathing. The understanding of the mechanical behaviour of a living human abdominal wall is important for the proper design of surgical meshes used for ventral hernia repair, which was also a motivation for the research presented below. The research refers to the strain field of a loaded abdominal wall and presents the evolution of principal strains and their directions in the case of 12 subjects, 8 male and 4 female. Peritoneal dialysis procedure allows for the measurement of intra-abdominal pressure after fluid introduction. High variability among patients is observed, also in terms of principal strain direction. Subjects exhibit intra-abdominal pressure of values from 11 to 21 cmH2O. However, the strain values are not strongly correlated with the pressure value, indicating variability of material properties.
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Affiliation(s)
- Katarzyna Szepietowska
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Mateusz Troka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | | | - Michał Chmielewski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Izabela Lubowiecka
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland.
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23
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Russo Serafini M, Mowat A, Mustafa S, Saifzadeh S, Shabab T, Bas O, O’Rourke N, W. Hutmacher D, Medeiros Savi F. 3D-Printed Medical-Grade Polycaprolactone (mPCL) Scaffold for the Surgical Treatment of Vaginal Prolapse and Abdominal Hernias. Bioengineering (Basel) 2023; 10:1242. [PMID: 38002366 PMCID: PMC10669821 DOI: 10.3390/bioengineering10111242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/26/2023] Open
Abstract
The expected outcome after a scaffold augmented hernia repair is the regeneration of a tissue composition strong enough to sustain biomechanical function over long periods. It is hypothesised that melt electrowriting (MEW) medical-grade polycaprolactone (mPCL) scaffolds loaded with platelet-rich plasma (PRP) will enhance soft tissue regeneration in fascial defects in abdominal and vaginal sheep models. A pre-clinical evaluation of vaginal and abdominal hernia reconstruction using mPCL mesh scaffolds and polypropylene (PP) meshes was undertaken using an ovine model. Each sheep was implanted with both a PP mesh (control group), and a mPCL mesh loaded with PRP (experimental group) in both abdominal and vaginal sites. Mechanical properties of the tissue-mesh complexes were assessed with plunger tests. Tissue responses to the implanted meshes were evaluated via histology, immunohistochemistry and histomorphometry. At 6 months post-surgery, the mPCL mesh was less stiff than the PP mesh, but stiffer than the native tissue, while showing equitable collagen and vascular ingrowth when compared to PP mesh. The results of this pilot study were supportive of mPCL as a safe and effective biodegradable scaffold for hernia and vaginal prolapse repair, hence a full-scale long-term study (over 24-36 months) with an adequate sample size is recommended.
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Affiliation(s)
- Mairim Russo Serafini
- Department of Pharmacy, Universidade Federal de Sergipe, São Cristóvão 49100-000, Brazil;
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
| | - Alexandra Mowat
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
- Queen Elisabeth II Jubilee Hospital, Brisbane, QLD 4108, Australia;
| | - Susanah Mustafa
- Queen Elisabeth II Jubilee Hospital, Brisbane, QLD 4108, Australia;
| | - Siamak Saifzadeh
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Medical Engineering Research Facility, Queensland University of Technology, Brisbane, QLD 4032, Australia
| | - Tara Shabab
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Onur Bas
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Nicholas O’Rourke
- Department of Hepato-Pancreato-Biliary Surgery, Royal Brisbane and Women’s Hospital, University of Queensland, Brisbane, QLD 4029, Australia;
| | - Dietmar W. Hutmacher
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Brisbane, QLD 4059, Australia
| | - Flavia Medeiros Savi
- Centre in Regenerative Medicine, Faculty of Engineering, Queensland University of Technology, Brisbane, QLD 4059, Australia; (S.S.); (T.S.); (O.B.); (D.W.H.)
- Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology, Brisbane, QLD 4059, Australia
- ARC Training Centre for Multiscale 3D Imaging, Modelling and Manufacturing, Brisbane, QLD 4059, Australia
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24
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Zamkowski M, Tomaszewska A, Lubowiecka I, Śmietański M. Biomechanical causes for failure of the Physiomesh/Securestrap system. Sci Rep 2023; 13:17504. [PMID: 37845369 PMCID: PMC10579252 DOI: 10.1038/s41598-023-44940-8] [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: 07/29/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023] Open
Abstract
This study investigates the mechanical behavior of the Physiomesh/Securestrap system, a hernia repair system used for IPOM procedures associated with high failure rates. The study involved conducting mechanical experiments and numerical simulations to investigate the mechanical behavior of the Physiomesh/Securestrap system under pressure load. Uniaxial tension tests were conducted to determine the elasticity modulus of the Physiomesh in various directions and the strength of the mesh-tissue-staple junction. Ex-vivo experiments on porcine abdominal wall models were performed to observe the system's behavior under simulated intra-abdominal pressure load. Numerical simulations using finite element analysis were employed to support the experimental findings. The results reveal nonlinearity, anisotropy, and non-homogeneity in the mechanical properties of the Physiomesh, with stress concentration observed in the polydioxanone (PDO) stripe. The mesh-tissue junction exhibited inadequate fixation strength, leading to staple pull-out or breakage. The ex-vivo models demonstrated failure under higher pressure loads. Numerical simulations supported these findings, revealing the reaction forces exceeding the experimentally determined strength of the mesh-tissue-staple junction. The implications of this study extend beyond the specific case of the Physiomesh/Securestrap system, providing insights into the mechanics of implant-tissue systems. By considering biomechanical factors, researchers and clinicians can make informed decisions to develop improved implants that mimic the mechanics of a healthy abdominal wall. This knowledge can contribute to better surgical outcomes and reduce complications in abdominal hernia repair and to avoid similar failures in future.
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Affiliation(s)
- Mateusz Zamkowski
- Department of General Surgery and Hernia Center, Swissmed Hospital, Wileńska 44, 80-215, Gdańsk, Poland.
| | - Agnieszka Tomaszewska
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Izabela Lubowiecka
- Department of Structural Mechanics, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Maciej Śmietański
- Department of General Surgery and Hernia Center, Swissmed Hospital, Wileńska 44, 80-215, Gdańsk, Poland
- II Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Sun X, Chen Q, Guan AA, Yuan S, Li Z. Multifunctional Fluorinated Lubricant-Infused Poly(4-Hydroxybutyrate) (P4HB) Membranes for Full-Thickness Abdominal Wall Defect Repair. Macromol Biosci 2023; 23:e2300146. [PMID: 37243394 DOI: 10.1002/mabi.202300146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/23/2023] [Indexed: 05/28/2023]
Abstract
Abdominal wall defect caused by surgical trauma, congenital rupture, or tumor resection may result in hernia formation or even death. Tension-free abdominal wall defect repair by using patches is the gold standard to solve such problems. However, adhesions following patch implantation remain one of the most challenging issues in surgical practice. The development of new kinds of barriers is key to addressing peritoneal adhesions and repairing abdominal wall defects. It is already well recognized that ideal barrier materials need to have good resistance to nonspecific protein adsorption, cell adhesion, and bacterial colonization for preventing the initial development of adhesion. Herein, electrospun poly(4-hydroxybutyrate) (P4HB) membranes infused with perfluorocarbon oil are used as physical barriers. The oil-infused P4HB membranes can greatly prevent protein attachment and reduce blood cell adhesion in vitro. It is further shown that the perfluorocarbon oil-infused P4HB membranes can reduce bacterial colonization. The in vivo study reveals that perfluoro(decahydronaphthalene)-infused P4HB membranes can significantly prevent peritoneal adhesions in the classic abdominal wall defects' model and accelerate defect repair, as evidenced by gross examination and histological evaluation. This work provides a safe fluorinated lubricant-impregnated P4HB physical barrier to inhibit the formation of postoperative peritoneal adhesions and efficiently repair soft-tissue defects.
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Affiliation(s)
- Xiuxia Sun
- College of Chemical Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
| | - Qi Chen
- Key Lab of Biobased Polymer Materials of Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
| | - Angelique A Guan
- Key Lab of Biobased Polymer Materials of Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
| | - Shuaishuai Yuan
- Key Lab of Biobased Polymer Materials of Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
- National Engineering Laboratory of Medical Implantable Devices & Key Laboratory for Medical Implantable Devices of Shandong Province, WEGO Holding Company Limited, Weihai, 264210, P. R. China
| | - Zhibo Li
- College of Chemical Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
- Key Lab of Biobased Polymer Materials of Shandong Provincial Education Department, College of Polymer Science and Engineering, Qingdao University of Science and Technology, Qingdao, 266042, P. R. China
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26
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Qafiti FN, Buicko JL. Not deep enough: Modeling the effect of shallow placement of the DaVinci Xi "bariatric" long trocar on the muscular abdominal wall. Surg Endosc 2023; 37:7264-7270. [PMID: 37415018 DOI: 10.1007/s00464-023-10207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION The DaVinci Xi Robotic Surgical System (Xi) long cannula (Intuitive Surgical Company, Sunnyvale, CA) provides five additional centimeters of distal length compared to the standard Xi trocar. The extra length allows the cannula to traverse prohibitively thick body wall tissue. Our aims are to quantitatively model the consequences of not preserving the rotational centerpoint of motion (RCM) at the muscular abdominal wall. This is an essential tenet in robotic surgery; it is violated with shallow placement of the long trocar. This leads to unchecked, unnoticed blunt widening of port sites by the robotic arm, increasing hernia risk. METHODS We begin with an exploration of the schematic of the Xi robotic arm as patented by Intuitive (U.S. Patent #5931832). We trigonometrically model the lateral displacement of the abdominal wall at the trocar site with respect to vertical trocar shallowness, instrument tip depth, and instrument tip lateral motion from neutral midline. RESULTS The rigid parallelogram movement structure of the Xi preserves the RCM at the thick black marker printed on every Xi cannula. By limitation of design, both long and standard trocars must have this marker at the exact same distance from their proximal end. The value ranges of our model parameters (presuming a reasonable maximum orientation angle of 45° from midline) are: trocar shallowness [1 cm, 7 cm]; instrument tip depth [0 cm, 20 cm]; instrument tip lateral movement [0.0 cm, 14.1 cm]. Abdominal wall displacement increased proportionally as each instrument tip parameter reached its maximum deviation from the orthogonal midline as described in the plot figure. Maximal wall displacement at maximal shallowness was approximately 7.0 cm. CONCLUSION Robotic surgery revolutionizes modern operation, particularly within bariatrics. However, the current Xi arm design disallows a true long trocar to be used safely without compromising the RCM, thereby risking hernia development.
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Affiliation(s)
- Fred N Qafiti
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University Medicine, 777 Glades Road, Boca Raton, FL, 33431, USA.
| | - Jessica L Buicko
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University Medicine, 777 Glades Road, Boca Raton, FL, 33431, USA
- Bethesda Health System, Baptist Health South Florida, Boynton Beach, FL, USA
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Civilini V, Giacalone V, Audenino AL, Terzini M. A reliable and replicable test protocol for the mechanical evaluation of synthetic meshes. J Mech Behav Biomed Mater 2023; 144:105987. [PMID: 37413894 DOI: 10.1016/j.jmbbm.2023.105987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
Despite the worldwide spread of surgical meshes in abdominal and inguinal surgery repair, the lack of specific standards for mechanical characterization of synthetic meshes, used in hernia repair and urogynecologic surgery, makes performance comparison between prostheses undoubtedly difficult. This consequently leads to the absence of acknowledged specifications about the mechanical requirements that synthetic meshes should achieve in order to avoid patient discomfort or hernia recurrences. The aim of this study is to provide a rigorous test protocol for the mechanical comparison between surgical meshes having the same intended use. The test protocol is composed of three quasi-static test methods: (1) ball burst test, (2) uniaxial tensile test, and (3) suture retention test. For each test, post-processing procedures are proposed to compute relevant mechanical parameters from the raw data. Some of the computed parameters, indeed, could be more suitable for comparison with physiological conditions (e.g., membrane strain and anisotropy), while others (e.g., uniaxial tension at rupture and suture retention strength) are reported as they provide useful mechanical information and could be convenient for comparisons between devices. The proposed test protocol was applied on 14 polypropylene meshes, 3 composite meshes, and 6 urogynecologic devices to verify its universal applicability towards meshes of different types and produced by various manufacturers, and its repeatability in terms of coefficient of variation. The test protocol resulted easily applicable to all the tested surgical meshes with intra-subject variability characterized by coefficient of variations settled around 0.05. Its use within other laboratories could allow the determination of the inter-subject variability assessing its repeatability among users of alternative universal testing machines.
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Affiliation(s)
- Vittoria Civilini
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy; Polito(BIO)Med Lab, Politecnico di Torino, 10129, Turin, Italy.
| | - Vincenzo Giacalone
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy; Polito(BIO)Med Lab, Politecnico di Torino, 10129, Turin, Italy
| | - Alberto L Audenino
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy; Polito(BIO)Med Lab, Politecnico di Torino, 10129, Turin, Italy
| | - Mara Terzini
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy; Polito(BIO)Med Lab, Politecnico di Torino, 10129, Turin, Italy
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28
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Skepastianos G, Mallis P, Kostopoulos E, Michalopoulos E, Skepastianos V, Palazi C, Pannuto L, Tsourouflis G. Efficient Decellularization of the Full-Thickness Rat-Derived Abdominal Wall to Produce Acellular Biologic Scaffolds for Tissue Reconstruction: Promising Evidence Acquired from In Vitro Results. Bioengineering (Basel) 2023; 10:913. [PMID: 37627798 PMCID: PMC10451677 DOI: 10.3390/bioengineering10080913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/26/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Functional restoration of abdominal wall defects represents one of the fundamental challenges of reconstructive surgery. Synthetic grafts or crosslinked animal-derived biological grafts are characterized by significant adverse reactions, which are mostly observed after their implantation. The aim of this study was to evaluate the efficacy of the decellularization protocol to produce a completely acellular full-thickness abdominal wall scaffold. METHODS Full-thickness abdominal wall samples were harvested from Wistar rats and submitted to a three-cycle decellularization process. Histological, biochemical, and DNA quantification analyses were applied to evaluate the effect of the decellularization protocol. Mechanical testing and immunogenicity assessment were also performed. RESULTS Histological, biochemical, and DNA analysis results showed efficient decellularization of the abdominal wall samples after the third cycle. Decellularized abdominal wall scaffolds were characterized by good biochemical and mechanical properties. CONCLUSION The data presented herein confirm the effective production of a rat-derived full-thickness abdominal wall scaffold. Expanding this approach will allow the exploitation of the capacity of the proposed decellularization protocol in producing acellular abdominal wall scaffolds from larger animal models or human cadaveric donors. In this way, the utility of biological scaffolds with preserved in vivo remodeling properties may be one step closer to its application in clinical studies.
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Affiliation(s)
- George Skepastianos
- Plastic Surgery Department, EANP Metaxa, National Hospital of Athens, 51 Botatsi Street, 185 37 Pireus, Greece; (G.S.); (E.K.); (V.S.); (C.P.)
- Center of Experimental Surgery, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece
| | - Panagiotis Mallis
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece;
| | - Epameinondas Kostopoulos
- Plastic Surgery Department, EANP Metaxa, National Hospital of Athens, 51 Botatsi Street, 185 37 Pireus, Greece; (G.S.); (E.K.); (V.S.); (C.P.)
| | - Efstathios Michalopoulos
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece;
| | - Vasileios Skepastianos
- Plastic Surgery Department, EANP Metaxa, National Hospital of Athens, 51 Botatsi Street, 185 37 Pireus, Greece; (G.S.); (E.K.); (V.S.); (C.P.)
| | - Chrysoula Palazi
- Plastic Surgery Department, EANP Metaxa, National Hospital of Athens, 51 Botatsi Street, 185 37 Pireus, Greece; (G.S.); (E.K.); (V.S.); (C.P.)
| | - Lucia Pannuto
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead RH19 3DZ, UK;
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 115 27 Athens, Greece;
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29
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Kenawy DM, Underhill JM, Jacobs AG, Olson MA, Renshaw SM, Gabanic BT, Garcia-Neuer MI, Kanga P, Gunacar A, Poulose BK. Ten-year outcomes following ventral hernia repair: making the case for better post-market surveillance in the USA. Surg Endosc 2023; 37:5612-5622. [PMID: 36348168 PMCID: PMC10164834 DOI: 10.1007/s00464-022-09725-6] [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: 03/30/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND We sought to identify the 10-year complication and recurrence rates and associated sociodemographic and operative characteristics associated with non-mesh versus mesh-based ventral hernia repairs (VHRs). METHODS This was an IRB-approved (2020H0317) retrospective longitudinal study of patients undergoing mesh or non-mesh VHR from 2009-2019 at a single tertiary-care institution. The electronic medical record was used to collect sociodemographic, clinical, and intraoperative details, and early (≤ 30 days) and long-term (> 30-day) postoperative complications. Up to ten-year follow-up was obtained for long-term complications, categorized as: hernia recurrence reoperation (HRR), major complications requiring emergency surgery (MCES) (defined as non-elective operations related to the abdominal wall), and non-recurrence procedural intervention (NRPI) (defined as any procedures related to the abdominal wall, bowel, or mesh). Kaplan-Meier survival curves were obtained for each long-term complication. RESULTS Of the 645 patients identified, the mean age at index operation was 52.51 ± 13.57 years with 50.70% female. Of the index operations, 21.24% were for a recurrence. Procedure categories included: 57.36% incisional, 37.21% non-incisional umbilical, 8.22% non-incisional epigastric, 3.88% parastomal, 0.93% diastasis recti, and 0.47% Spigelian hernias. Operative approaches included open (n = 383), laparoscopic (n = 267), and robotic (n = 21). Fascial closure (81.55%) and mesh use (66.2%) were performed in the majority of cases. Median follow-up time was 2098 days (interquartile range 1320-2806). The rate of short-term complications was 4.81% for surgical site infections, 15.04% for surgical site occurrences, and 13.64% for other complications. At 10 years, the HRR-free survival probability was 85.26%, MCES-free survival probability was 94.44%, and NRPI-free survival probability was 78.11%. CONCLUSIONS A high proportion of patients experienced long-term recurrence and complications requiring intervention after index VHR. For many patients, a ventral hernia develops into a chronic medical condition. Improved efforts at post-market surveillance of operative approaches and mesh location and type should be undertaken to help optimize outcomes.
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Affiliation(s)
- Dahlia M Kenawy
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA.
| | - Jennifer M Underhill
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA
| | - Ayanna G Jacobs
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA
| | - Molly A Olson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Savannah M Renshaw
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA
| | - Benjamin T Gabanic
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA
| | - Marlene I Garcia-Neuer
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA
| | - Parviz Kanga
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA
| | - Aysenur Gunacar
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA
| | - Benjamin K Poulose
- Center for Abdominal Core Health, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, #670, Columbus, OH, 43210, USA
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30
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Pawelec KM, Tu E, Chakravarty S, Hix JML, Buchanan L, Kenney L, Buchanan F, Chatterjee N, Das S, Alessio A, Shapiro EM. Incorporating Tantalum Oxide Nanoparticles into Implantable Polymeric Biomedical Devices for Radiological Monitoring. Adv Healthc Mater 2023; 12:e2203167. [PMID: 36848875 PMCID: PMC10460461 DOI: 10.1002/adhm.202203167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/19/2023] [Indexed: 03/01/2023]
Abstract
Longitudinal radiological monitoring of biomedical devices is increasingly important, driven by the risk of device failure following implantation. Polymeric devices are poorly visualized with clinical imaging, hampering efforts to use diagnostic imaging to predict failure and enable intervention. Introducing nanoparticle contrast agents into polymers is a potential method for creating radiopaque materials that can be monitored via computed tomography. However, the properties of composites may be altered with nanoparticle addition, jeopardizing device functionality. Thus, the material and biomechanical responses of model nanoparticle-doped biomedical devices (phantoms), created from 0-40 wt% tantalum oxide (TaOx ) nanoparticles in polycaprolactone and poly(lactide-co-glycolide) 85:15 and 50:50, representing non, slow, and fast degrading systems, respectively, are investigated. Phantoms degrade over 20 weeks in vitro in simulated physiological environments: healthy tissue (pH 7.4), inflammation (pH 6.5), and lysosomal conditions (pH 5.5), while radiopacity, structural stability, mechanical strength, and mass loss are monitored. The polymer matrix determines overall degradation kinetics, which increases with lower pH and higher TaOx content. Importantly, all radiopaque phantoms could be monitored for a full 20 weeks. Phantoms implanted in vivo and serially imaged demonstrate similar results. An optimal range of 5-20 wt% TaOx nanoparticles balances radiopacity requirements with implant properties, facilitating next-generation biomedical devices.
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Affiliation(s)
- Kendell M Pawelec
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, MI, 48824, USA
| | - Ethan Tu
- Department of Biomedical Engineering, Michigan State University, 775 Woodlot Dr, East Lansing, MI, 48824, USA
| | - Shatadru Chakravarty
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, MI, 48824, USA
| | - Jeremy M L Hix
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, MI, 48824, USA
- Institute for Quantitative Health Science and Engineering (IQ), Michigan State University, 775 Woodlot Dr, East Lansing, MI, 48824, USA
| | - Lane Buchanan
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, MI, 48824, USA
| | - Legend Kenney
- Department of Biomedical Engineering, Michigan State University, 775 Woodlot Dr, East Lansing, MI, 48824, USA
| | - Foster Buchanan
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, MI, 48824, USA
| | - Nandini Chatterjee
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, MI, 48824, USA
| | - Subhashri Das
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, MI, 48824, USA
| | - Adam Alessio
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, MI, 48824, USA
- Department of Biomedical Engineering, Michigan State University, 775 Woodlot Dr, East Lansing, MI, 48824, USA
- Department of Computational Mathematics Science Engineering, Michigan State University, 428 S. Shaw Ln, East Lansing, MI, 48824, USA
| | - Erik M Shapiro
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, MI, 48824, USA
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Lanzalaco S, Weis C, Traeger KA, Turon P, Alemán C, Armelin E. Mechanical Properties of Smart Polypropylene Meshes: Effects of Mesh Architecture, Plasma Treatment, Thermosensitive Coating, and Sterilization Process. ACS Biomater Sci Eng 2023; 9:3699-3711. [PMID: 37232093 PMCID: PMC10889589 DOI: 10.1021/acsbiomaterials.3c00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Smart polypropylene (PP) hernia meshes were proposed to detect surgical infections and to regulate cell attachment-modulated properties. For this purpose, lightweight and midweight meshes were modified by applying a plasma treatment for subsequent grafting of a thermosensitive hydrogel, poly(N-isopropylacrylamide) (PNIPAAm). However, both the physical treatment with plasma and the chemical processes required for the covalent incorporation of PNIPAAm can modify the mechanical properties of the mesh and thus have an influence in hernia repair procedures. In this work, the mechanical performance of plasma-treated and hydrogel-grafted meshes preheated at 37 °C has been compared with standard meshes using bursting and the suture pull out tests. Furthermore, the influence of the mesh architecture, the amount of grafted hydrogel, and the sterilization process on such properties have been examined. Results reveal that although the plasma treatment reduces the bursting and suture pull out forces, the thermosensitive hydrogel improves the mechanical resistance of the meshes. Moreover, the mechanical performance of the meshes coated with the PNIPAAm hydrogel is not influenced by ethylene oxide gas sterilization. Micrographs of the broken meshes evidence the role of the hydrogel as reinforcing coating for the PP filaments. Overall, results confirm that the modification of PP medical textiles with a biocompatible thermosensitive hydrogel do not affect, and even improve, the mechanical requirements necessary for the implantation of these prostheses in vivo.
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Affiliation(s)
- Sonia Lanzalaco
- IMEM-BRT Group, Departament d'Enginyeria Química, EEBE, Universitat Politècnica de Catalunya, C/Eduard Maristany, 10-14, 08019 Barcelona, Spain
- Barcelona Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, 08930 Barcelona, Spain
| | - Christine Weis
- Research and Development Centre, B. Braun Surgical, S.A.U., Carretera de Terrassa 121, Rubí, Barcelona 08191, Spain
| | - Kamelia A Traeger
- Research and Development Centre, B. Braun Surgical, S.A.U., Carretera de Terrassa 121, Rubí, Barcelona 08191, Spain
| | - Pau Turon
- Research and Development Centre, B. Braun Surgical, S.A.U., Carretera de Terrassa 121, Rubí, Barcelona 08191, Spain
| | - Carlos Alemán
- IMEM-BRT Group, Departament d'Enginyeria Química, EEBE, Universitat Politècnica de Catalunya, C/Eduard Maristany, 10-14, 08019 Barcelona, Spain
- Barcelona Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, 08930 Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Baldiri Reixac 10-12, 08028 Barcelona, Spain
| | - Elaine Armelin
- IMEM-BRT Group, Departament d'Enginyeria Química, EEBE, Universitat Politècnica de Catalunya, C/Eduard Maristany, 10-14, 08019 Barcelona, Spain
- Barcelona Research Center in Multiscale Science and Engineering, Universitat Politècnica de Catalunya, 08930 Barcelona, Spain
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32
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Whitehead-Clarke T, Brown C, Ail G, Mudera V, Smith C, Kureshi A. Characterisation of human posterior rectus sheath reveals mechanical and structural anisotropy. Clin Biomech (Bristol, Avon) 2023; 106:105989. [PMID: 37244136 DOI: 10.1016/j.clinbiomech.2023.105989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Our work aims to investigate the mechanical properties of the human posterior rectus sheath in terms of its ultimate tensile stress, stiffness, thickness and anisotropy. It also aims to assess the collagen fibre organisation of the posterior rectus sheath using Second-Harmonic Generation microscopy. METHODS For mechanical analysis, twenty-five fresh-frozen samples of posterior rectus sheath were taken from six different cadaveric donors. They underwent uniaxial tensile stress testing until rupture either in the transverse (n = 15) or longitudinal (n = 10) plane. The thickness of each sample was also recorded using digital callipers. On a separate occasion, ten posterior rectus sheath samples and three anterior rectus sheath samples underwent microscopy and photography to assess collagen fibre organisation. FINDINGS samples had a mean ultimate tensile stress of 7.7 MPa (SD 4.9) in the transverse plane and 1.2 MPa (SD 0.8) in the longitudinal plane (P < 0.01). The same samples had a mean Youngs modulus of 11.1 MPa (SD 5.0) in the transverse plane and 1.7 MPa (SD 1.3) in the longitudinal plane (P < 0.01). The mean thickness of the posterior rectus sheath was 0.51 mm (SD 0.13). Transversely aligned collagen fibres could be identified within the posterior sheath tissue using Second-Harmonic Generation microscopy. INTERPRETATION The posterior rectus sheath displays mechanical and structural anisotropy with greater tensile stress and stiffness in the transverse plane compared to the longitudinal plane. The mean thickness of this layer is around 0.51 mm - consistent with other studies. The tissue is constructed of transversely aligned collagen fibres that are visible using Second-Harmonic Generation microscopy.
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Affiliation(s)
- Thomas Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery and Interventional Science, University College London, UK.
| | | | - Geetika Ail
- Department of Anatomy, Brighton and Sussex Medical School, UK
| | - Vivek Mudera
- Division of Surgery and Interventional Science, University College London, UK
| | - Claire Smith
- Department of Anatomy, Brighton and Sussex Medical School, UK
| | - Alvena Kureshi
- Division of Surgery and Interventional Science, University College London, UK
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Guo R, Zhang Q, Wu Y, Chen H, Liu Y, Wang J, Duan X, Chen Q, Ge Z, Zhang Y. Extremely Strong and Tough Biodegradable Poly(urethane) Elastomers with Unprecedented Crack Tolerance via Hierarchical Hydrogen-Bonding Interactions. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2212130. [PMID: 36822221 DOI: 10.1002/adma.202212130] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/13/2023] [Indexed: 05/26/2023]
Abstract
The elastomers with the combination of high strength and high toughness have always been intensively pursued due to their diverse applications. Biomedical applications frequently require elastomers with biodegradability and biocompatibility properties. It remains a great challenge to prepare the biodegradable elastomers with extremely robust mechanical properties for in vivo use. In this report, we present a polyurethane elastomer with unprecedented mechanical properties for the in vivo application as hernia patches, which was obtained by the solvent-free reaction of polycaprolactone (PCL) and isophorone diisocyanate (IPDI) with N,N-bis(2-hydroxyethyl)oxamide (BHO) as the chain extender. Abundant and hierarchical hydrogen-bonding interactions inside the elastomers hinder the crystallization of PCL segments and facilitate the formation of uniformly distributed hard phase microdomains, which miraculously realize the extremely high strength and toughness with the fracture strength of 92.2 MPa and true stress of 1.9 GPa, while maintaining the elongation-at-break of ≈1900% and ultrahigh toughness of 480.2 MJ m-3 with the unprecedented fracture energy of 322.2 kJ m-2 . Hernia patches made from the elastomer via 3D printing technology exhibit outstanding mechanical properties, biocompatibility, and biodegradability. The robust and biodegradable elastomers demonstrate considerable potentials for in vivo applications.
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Affiliation(s)
- Rui Guo
- Engineering Research Center of Energy Storage Materials and Devices, Ministry of Education, School of Chemistry, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Qiang Zhang
- Engineering Research Center of Energy Storage Materials and Devices, Ministry of Education, School of Chemistry, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Youshen Wu
- Engineering Research Center of Energy Storage Materials and Devices, Ministry of Education, School of Chemistry, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Hongbing Chen
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - Yanghe Liu
- Key Laboratory for Non-equilibrium Synthesis and Modulation of Condensed Matter, School of Chemistry, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Jingjing Wang
- School of Pharmacy Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xianglong Duan
- Second Department of General Surgery, Shaanxi Provincial People's Hospital and Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710068, China
| | - Quan Chen
- State Key Laboratory of Polymer Physics and Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, China
| | - Zhishen Ge
- Engineering Research Center of Energy Storage Materials and Devices, Ministry of Education, School of Chemistry, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Yanfeng Zhang
- Engineering Research Center of Energy Storage Materials and Devices, Ministry of Education, School of Chemistry, Xi'an Jiaotong University, Xi'an, 710049, China
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34
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Castells-Sala C, Pérez ML, López-Chicón P, Lopez-Puerto L, Martinez JIR, Ruiz-Ponsell L, Sastre S, Madariaga SE, Aiti A, Fariñas O, Vilarrodona A. Development of a full-thickness acellular dermal graft from human skin: Case report of first patient rotator cuff patch augmentation repair. Transpl Immunol 2023; 78:101825. [PMID: 36934900 DOI: 10.1016/j.trim.2023.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
The processing and initial testing of a new human tissue preparation is described. Full-thickness Acellular Dermal Matrix (ftADM) is the extracellular matrix (ECM) obtained by decellularization of full-thickness human skin from cadaveric donors. The safety, stability and usability of the graft are discussed with respect to the results of the residual cellular content, maintenance of ECM components, and biomechanical properties. Quantitative and qualitative analysis of the ECM demonstrated the absence of cell debris, while the native structure of human dermis was maintained. Biomechanical testing showed stiffness values comparable to other commercial products used for tendon reinforcement, suggesting that our ftADM could be successfully used not only in soft tissue regeneration surgeries, but also in tendon reinforcement. First case of ftADM in rotator cuff augmentation is described. Technical management of the patch during surgery and clinical outcomes are discussed.
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Affiliation(s)
- C Castells-Sala
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain.
| | - M L Pérez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.
| | - P López-Chicón
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - L Lopez-Puerto
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - J I Rodríguez Martinez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - L Ruiz-Ponsell
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - S Sastre
- Arthroscopy Unit, Department of Orthopaedics, Hospital Clinic de Barcelona, Barcelona, Spain
| | - S E Madariaga
- Arthroscopy Unit, Department of Orthopaedics, Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Aiti
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain
| | - O Fariñas
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - A Vilarrodona
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
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35
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Williams DF. The plasticity of biocompatibility. Biomaterials 2023; 296:122077. [PMID: 36907003 DOI: 10.1016/j.biomaterials.2023.122077] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Biocompatibility concerns the phenomena that occur within the interactions between biomaterials and human patients, which ultimately control the performance of many facets of medical technology. It involves aspects of materials science, many different forms of engineering and nanotechnology, chemistry, biophysics, molecular and cellular biology, immunology, pathology and a myriad of clinical applications. It is not surprising that an overarching framework of mechanisms of biocompatibility has been difficult to elucidate and validate. This essay discusses one fundamental reason for this; we have tended to consider biocompatibility pathways as essentially linear sequences of events which follow well-understood processes of materials science and biology. The reality, however, is that the pathways may involve a great deal of plasticity, in which many additional idiosyncratic factors, including those of genetic, epigenetic and viral origin, exert influence, as do complex mechanical, physical and pharmacological variables. Plasticity is an inherent core feature of the performance of synthetic materials; here we follow the more recent biological applications of plasticity concepts into the sphere of biocompatibility pathways. A straightforward linear pathway may result in successful outcomes for many patients; we may describe this in terms of classic biocompatibility pathways. In other situations, which usually command much more attention because of their unsuccessful outcomes, these plasticity-driven processes follow alternative biocompatibility pathways; often, the variability in outcomes with identical technologies is due to biological plasticity rather than material or device deficiency.
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Affiliation(s)
- David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, North Carolina, USA.
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36
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Nishiguchi A, Ito S, Nagasaka K, Taguchi T. Tissue-Adhesive Decellularized Extracellular Matrix Patches Reinforced by a Supramolecular Gelator to Repair Abdominal Wall Defects. Biomacromolecules 2023; 24:1545-1554. [PMID: 36880637 DOI: 10.1021/acs.biomac.2c01210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Implantation of surgical meshes composed of synthetic and biological materials has been applied for abdominal wall defect repair. Despite many efforts, there are no reliable meshes that fully satisfy clinical requirements because of their lack of biodegradability, mechanical strength, and tissue-adhesive properties. Here, we report biodegradable, decellularized extracellular matrix (dECM)-based biological patches to treat abdominal wall defects. By incorporating a water-insoluble supramolecular gelator that forms physical cross-linking networks through intermolecular hydrogen bonding, dECM patches were reinforced to improve mechanical strength. Reinforced dECM patches possessed higher tissue adhesion strength and underwater stability compared with the original dECM because of enhanced interfacial adhesion strength. In vivo experiments using an abdominal wall defect rat model showed that reinforced dECM patches induced collagen deposition and the formation of blood vessels during material degradation, and the accumulation of CD68-positive macrophages was suppressed compared to nonbiodegradable synthetic meshes. Tissue-adhesive and biodegradable dECM patches with improved mechanical strength by a supramolecular gelator have enormous potential for use in the repair of abdominal wall defects.
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Affiliation(s)
- Akihiro Nishiguchi
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Shima Ito
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Kazuhiro Nagasaka
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Tetsushi Taguchi
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
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37
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He W, Shen F, Xu Z, Pei B, Xie H, Li X. The effect of mesh orientation, defect location and size on the biomechanical compatibility of hernia mesh. Ing Rech Biomed 2023. [DOI: 10.1016/j.irbm.2023.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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38
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Pawelec KM, Tu E, Chakravarty S, Hix JM, Buchanan L, Kenney L, Buchanan F, Chatterjee N, Das S, Alessio A, Shapiro EM. Incorporating Radiopacity into Implantable Polymeric Biomedical Devices for Clinical Radiological Monitoring. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.06.523025. [PMID: 36711467 PMCID: PMC9881976 DOI: 10.1101/2023.01.06.523025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Longitudinal radiological monitoring of biomedical devices is increasingly important, driven by risk of device failure following implantation. Polymeric devices are poorly visualized with clinical imaging, hampering efforts to use diagnostic imaging to predict failure and enable intervention. Introducing nanoparticle contrast agents into polymers is a potential method for creating radiopaque materials that can be monitored via computed tomography. However, properties of composites may be altered with nanoparticle addition, jeopardizing device functionality. This, we investigated material and biomechanical response of model nanoparticle-doped biomedical devices (phantoms), created from 0-40wt% TaO x nanoparticles in polycaprolactone, poly(lactide-co-glycolide) 85:15 and 50:50, representing non-, slow and fast degrading systems, respectively. Phantoms degraded over 20 weeks in vitro, in simulated physiological environments: healthy tissue (pH 7.4), inflammation (pH 6.5), and lysosomal conditions (pH 5.5), while radiopacity, structural stability, mechanical strength and mass loss were monitored. The polymer matrix determined overall degradation kinetics, which increased with lower pH and higher TaO x content. Importantly, all radiopaque phantoms could be monitored for a full 20-weeks. Phantoms implanted in vivo and serially imaged, demonstrated similar results. An optimal range of 5-20wt% TaO x nanoparticles balanced radiopacity requirements with implant properties, facilitating next-generation biomedical devices.
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Affiliation(s)
| | - Ethan Tu
- Michigan State University, Dept Biomedical Engineering, East Lansing, MI 48823
| | | | - Jeremy Ml Hix
- Michigan State University, Dept Radiology, East Lansing, MI 48823
- Michigan State University, Institute for Quantitative Health Science and Engineering (IQ), East Lansing, MI 48823
| | - Lane Buchanan
- Michigan State University, Dept Radiology, East Lansing, MI 48823
| | - Legend Kenney
- Michigan State University, Dept Biomedical Engineering, East Lansing, MI 48823
| | - Foster Buchanan
- Michigan State University, Dept Radiology, East Lansing, MI 48823
| | | | - Subhashri Das
- Michigan State University, Dept Radiology, East Lansing, MI 48823
| | - Adam Alessio
- Michigan State University, Dept Radiology, East Lansing, MI 48823
- Michigan State University, Dept Biomedical Engineering, East Lansing, MI 48823
- Michigan State University, Dept of Computational Mathematics Science Engineering, East Lansing, MI 48823
| | - Erik M Shapiro
- Michigan State University, Dept Radiology, East Lansing, MI 48823
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39
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Ye Z, Zhang L, Liu T, Xuan W, He X, Hou C, Han D, Yu B, Shi J, Kang J, Chen J. The effect of surface nucleation modulation on the mechanical and biocompatibility of metal-polymer biomaterials. Front Bioeng Biotechnol 2023; 11:1160351. [PMID: 37091349 PMCID: PMC10117951 DOI: 10.3389/fbioe.2023.1160351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
The deployment of hernia repair patches in laparoscopic procedures is gradually increasing. In this technology, however, understanding the new phases of titanium from the parent phase on polymer substrates is essential to control the microstructural transition and material properties. It remains a challenging area of condensed matter physics to predict the kinetic and thermodynamic properties of metals on polymer substrates from the molecular scale due to the lack of understanding of the properties of the metal-polymer interface. However, this paper revealed the mechanism of nucleation on polymer substrates and proposed for the first record a time-dependent regulatory mechanism for the polymer-titanium interface. The interconnection between polymer surface chain entanglement, nucleation and growth patterns, crystal structure and surface roughness were effectively unified. The secondary regulation of mechanical properties was accomplished simultaneously to satisfy the requirement of biocompatibility. Titaniumized polypropylene patches prepared by time-dependent magnetron sputtering technology demonstrated excellent interfacial mechanical properties and biocompatibility. In addition, modulation by low-temperature plasma metal deposition opened a new pathway for biomaterials. This paper provides a solid theoretical basis for the research of titanium nanofilms on medical polypropylene substrates and the medical industry of implantable biomaterials, which will be of great value in the future.
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Affiliation(s)
- Zhenhong Ye
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai High Efficiency Cooling System Research Center, Shanghai, China
| | - Le Zhang
- State Key Laboratory for Oncogenes and Bio-ID Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Taiwei Liu
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Weicheng Xuan
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaodong He
- Department of Engineering Mechanics and Innovation Center for Advanced Ship and Deep-Sea Exploration, School of Naval Architecture, Ocean and Civil Engineering Shanghai Jiao Tong University, Shanghai, China
| | - Changhao Hou
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Donglin Han
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Binbin Yu
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junye Shi
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Kang
- Department of General Surgery, Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Jie Kang, ; Jiangping Chen,
| | - Jiangping Chen
- Institute of Refrigeration and Cryogenics, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shanghai High Efficiency Cooling System Research Center, Shanghai, China
- *Correspondence: Jie Kang, ; Jiangping Chen,
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40
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Lauro E, Corridori I, Luciani L, Di Leo A, Sartori A, Andreuccetti J, Trojan D, Scudo G, Motta A, Pugno NM. Stapled fascial suture: ex vivo modeling and clinical implications. Surg Endosc 2022; 36:8797-8806. [PMID: 35578046 DOI: 10.1007/s00464-022-09304-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recently, in the field of abdominal wall repair surgery, some minimally invasive procedures introduced the use of staplers to provide a retromuscular prosthetic repair. However, to the knowledge of the authors, there are little data in the literature about the outcomes of stapled sutures adoption for midline reconstruction. This study aims to investigate the biomechanics of stapled sutures, simple (stapled), or oversewn (hybrid), in comparison with handsewn suture. From the results obtained, we tried to draw indications for their use in a clinical context. METHODS Human cadaver fascia lata specimens, sutured (handsewn, stapled, or hybrid) or not, underwent tensile tests. The data on strength (maximal stress), ultimate strain (deformability), Young's modulus (rigidity), and dissipated specific energy (ability to absorb mechanical energy up to the breaking point) were recorded for each type of specimens and analyzed. RESULTS Stapled and hybrid suture showed a significantly higher strength (handsewn 0.83 MPa, stapled 2.10 MPa, hybrid 2.68 MPa) and a trend toward a lower ultimate strain as compared to manual sutures (handsewn 344%, stapled 249%, hybrid 280%). Stapled and hybrid sutures had fourfold higher Young's modulus as compared to handsewn sutures (handsewn 1.779 MPa, stapled 7.374 MPa, hybrid 6.964 MPa). Handsewn and hybrid sutures showed significantly higher dissipated specific energy (handsewn 0.99 mJ-mm3, stapled 0.73 mJ-mm3, hybrid 1.35 mJ-mm3). CONCLUSION Stapled sutures can resist high loads, but are less deformable and rigid than handsewn suture. This suggests a safer employment in case of small defects or diastasis (< W1 in accord to EHS classification), where the presumed tissutal displacement is minimal. Oversewing a stapled suture improves its efficiency, becoming crucial in case of larger defects (> W1 in accord to EHS classification) where the expected tissutal displacement is maximal. Hybrid sutures seem to be a good compromise.
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Affiliation(s)
- Enrico Lauro
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy.
| | - Ilaria Corridori
- Laboratory for Bioinspired, Bionic, Nano, Meta Materials and Mechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy
- BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Lorenzo Luciani
- Robotic Unit and Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - Alberto Di Leo
- Department of General Surgery, San Camillo Hospital, Trento, Italy
| | - Alberto Sartori
- Department of General Surgery, Montebelluna-Castelfranco Veneto Hospital, Treviso, Italy
| | - Jacopo Andreuccetti
- Department of General Surgery 2^, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Diletta Trojan
- Fondazione Banca dei Tessuti Treviso FBTV, Treviso, Italy
| | - Giovanni Scudo
- Department of General Surgery, St. Maria Del Carmine Hospital, Rovereto, Italy
| | - Antonella Motta
- BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, University of Trento, Trento, Italy
| | - Nicola M Pugno
- Laboratory for Bioinspired, Bionic, Nano, Meta Materials and Mechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Trento, Italy.
- School of Engineering and Material Science, Queen Mary University of London, London, UK.
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Morales-Conde S, Hernández-Granados P, Tallón-Aguilar L, Verdaguer-Tremolosa M, López-Cano M. Ventral hernia repair in high-risk patients and contaminated fields using a single mesh: proportional meta-analysis. Hernia 2022; 26:1459-1471. [PMID: 36098869 PMCID: PMC9684228 DOI: 10.1007/s10029-022-02668-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The use of mesh is a common practice in ventral hernia repair (VHR). Lack of consensus on which prosthetic material works better in different settings remains. This meta-analysis aims to summarize the available evidence on hernia recurrence and complications after repair with synthetic, biologic, or biosynthetic/bioabsorbable meshes in hernias grade 2-3 of the Ventral Hernia Working Group modified classification. METHODS A literature search was conducted in January 2021 using Web of Science (WoS), Scopus, and MEDLINE (via PubMed) databases. Randomized Controlled Trials (RCTs) and observational studies with adult patients undergoing VHR with either synthetic, biologic, or biosynthetic/bioabsorbable mesh were included. Outcomes were hernia recurrence, Surgical Site Occurrence (SSO), Surgical Site Infection (SSI), 30 days re-intervention, and infected mesh removal. Random-effects meta-analyses of pooled proportions were performed. Quality of the studies was assessed, and heterogeneity was explored through sensitivity analyses. RESULTS 25 articles were eligible for inclusion. Mean age ranged from 47 to 64 years and participants' follow-up ranged from 1 to 36 months. Biosynthetic/bioabsorbable mesh reported a 9% (95% CI 2-19%) rate of hernia recurrence, lower than synthetic and biologic meshes. Biosynthetic/bioabsorbable mesh repair also showed a lower incidence of SSI, with a 14% (95% CI 6-24%) rate, and there was no evidence of infected mesh removal. Rates of seroma were similar for the different materials. CONCLUSIONS This meta-analysis did not show meaningful differences among materials. However, the best proportions towards lower recurrence and complication rates after grade 2-3 VHR were after using biosynthetic/slowly absorbable mesh reinforcement. These results should be taken with caution, as head-to-head comparative studies between biosynthetic and synthetic/biologic meshes are lacking. Although, biosynthetic/bioabsorbable materials could be considered an alternative to synthetic and biologic mesh reinforcement in these settings.
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Affiliation(s)
- S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - P Hernández-Granados
- General Surgery Unit, Fundación Alcorcón University Hospital, Rey Juan Carlos University, Alcorcón, Spain
| | - L Tallón-Aguilar
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitario Virgen del Rocío, c/ Asuncion 26, 2ºA, 41011, Seville, Spain.
| | - M Verdaguer-Tremolosa
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - M López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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42
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Addressing parastomal herniation through biomechanical simulation. Hernia 2022; 27:565-573. [DOI: 10.1007/s10029-022-02704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
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43
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Tobias K, Mulon PY, Daniels A, Sun X. Does quality of novice hand-tied square knots improve with repetition during a single training session? PeerJ 2022; 10:e14106. [PMID: 36187746 PMCID: PMC9521345 DOI: 10.7717/peerj.14106] [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: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 01/21/2023] Open
Abstract
Background Knot tying is a key surgical skill for novices, and repetition over several training sessions improves knot tying. This study examined the effects of repetition within a single training session on quality of knotted loops and compared results of novice trainees and experienced surgeons. Methods Using 0.55 mm nylon monofilament fishing line, novices and surgeons each hand-tied 20 knotted loops, using a 2=1=1=1 configuration (surgeon's throw and three square throws). Loops were mechanically tested with a single load to failure. Results All loops tolerated five newtons (N) preload. More than 70% of novice and surgeon knots failed by slipping or untying, and 8.8% of novice knots and 2.5% of surgeon's knots were considered dangerous. Surgeons' loops had less extension at preload, indicating better loop security. However, during single test to failure, there was no difference in mean extension or maximum load between surgeons and novices. There was no significant difference in results of mechanical testing or modes of failure for the first and last ten knotted loops, or the first, second, third, and fourth sets of knotted loops. Discussion With appropriate training, novices can construct knots as strong and secure as experienced surgeons. A large percentage of knotted loops are insecure under testing conditions; extra throws may be required when using large diameter monofilament nylon. Novices may require extra training in maintenance of loop security when constructing square knots. Tying more than five or 10 knotted loops within a single training session does not provide added benefits for novices.
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Affiliation(s)
- Karen Tobias
- Small Animal Clinical Sciences, University of Tennessee, Knoxville, Knoxville, TN, United States of America
| | - Pierre-Yves Mulon
- Department of Large Animal Clinical Sciences, University of Tennessee, Knoxville, Knoxville, TN, United States of America
| | - Alec Daniels
- Small Animal Clinical Sciences, University of Tennessee, Knoxville, Knoxville, TN, United States of America
| | - Xiaocun Sun
- Office of Information Technology, University of Tennessee Knoxville, Knoxville, TN, United States of America
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Zhang Z, Zhu L, Hu W, Dai J, Ren P, Shao X, Xiong B, Zhang T, Ji Z. Polypropylene mesh combined with electrospun poly (L-lactic acid) membrane in situ releasing sirolimus and its anti-adhesion efficiency in rat hernia repair. Colloids Surf B Biointerfaces 2022; 218:112772. [PMID: 35985128 DOI: 10.1016/j.colsurfb.2022.112772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/23/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
This study developed, a novel polypropylene (PP) mesh combined with poly (L-lactic acid) (PLA) electrospun nanofibers loaded sirolimus (SRL). The PP mesh was combined with PLA/SRL (1/0, 1/0.01, 1/0.02; mass ratios) composed electrospun membrane characterized by FTIR spectroscopy, XPS and SEM, and evaluated for cytocompatibility in vitro. In an in vivo study, a total of 84 Sprague-Dawley rats were employed to evaluate the efficacy of the novel composite PP mesh anti-adhesion, mechanical properties and inflammation. As a results, the PLA/SRL membrane could compound with PP mesh stably and load SRL. Although tensile testing showed that the mechanical properties of composite mesh decreased in vivo, the integration strength between the tissue and mesh was still able to counteract intra-abdominal pressure. Compared with the native PP mesh group, the novel PP mesh group showed a lower score for abdominal adhesion and inflammation. More importantly, the novel PP mesh completely integrated with the abdominal wall and had sufficient mechanical strength to repair abdominal wall defects.
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Affiliation(s)
- Zhigang Zhang
- Department of General Surgery, Affiliated ZhongDa Hospital, Southeast University, Dingjiaqiao 87, Nanjing 210009, China; Medical School of Southeast University, Dingjiaqiao 87, Nanjing 210009, China
| | - Long Zhu
- Medical School of Southeast University, Dingjiaqiao 87, Nanjing 210009, China
| | - Wanjun Hu
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China; Department of light industry and materials science, Chengdu Textile College, Chengdu 611731, China.
| | - Jidong Dai
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Pengfei Ren
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Xiangyu Shao
- Department of General Surgery, Affiliated ZhongDa Hospital, Southeast University, Dingjiaqiao 87, Nanjing 210009, China
| | - Bo Xiong
- Department of General Surgery, Affiliated Zhong Da Hospital (Li Shui branch), Southeast University, China
| | - Tianzhu Zhang
- State Key Lab of Bioelectronics, National Demonstration Center for Experimental Biomedical Engineering Education, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Zhenling Ji
- Department of General Surgery, Affiliated ZhongDa Hospital, Southeast University, Dingjiaqiao 87, Nanjing 210009, China; Department of General Surgery, Affiliated Zhong Da Hospital (Li Shui branch), Southeast University, China.
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45
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El Bojairami I, Jacobson N, Driscoll M. Development and evaluation of a numerical spine model comprising intra-abdominal pressure for use in assessing physiological changes on abdominal compliance and spinal stability. Clin Biomech (Bristol, Avon) 2022; 97:105689. [PMID: 35717701 DOI: 10.1016/j.clinbiomech.2022.105689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abdominal compliance is the "measure of ease of abdominal expansion" and determines whether a patient can withstand high intra-abdominal pressures. Thus, high compliance indicates that the abdomen can expand relatively freely, while low compliance restricts abdominal expansion. The global objective of the present work is to evaluate the effect of physiological changes on abdominal compliance using a comprehensive spine finite element model inclusive of intra-abdominal pressure. METHODS The effect of changing Young's modulus, abdominal wall thickness, and abdominal radii on abdominal compliance were evaluated. Intra-abdominal pressure and thoracolumbar fascia forces were also evaluated to assess abdominal physiological changes effects on overall static spinal stability. FINDINGS Results showed that as wall thickness increased, compliance decreased. Similar findings were made with an increase in abdominal radius and Young's modulus. Furthermore, the active reduction in compliance, caused by increased elasticity and abdominal radius, resulted in an increase in spinal supportive forces originating from the thoracolumbar fascia and intra-abdominal pressurization, along with an increase in spine displacement from its original stable position. There was no clear stability trend for the case of changing abdominal wall thickness as fluctuations were present. INTERPRETATION Investigated mechanics and data trends suggested that dangerously low compliance levels might result from poor abdominal elasticity and thickening fat layers. This led to a direct discussion and recommendations for obesity conditions and laparoscopy applications. Lastly, static spinal stability showed to improve through increasing active abdominal compliance by means of actively engaging abdominal pressure, hence augmenting abdominal active elasticity.
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Affiliation(s)
- Ibrahim El Bojairami
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montréal, Quebec, Canada; Orthopaedic Research Laboratory, Department of Surgery, McGill University, Montréal, Quebec, Canada.
| | - Natasha Jacobson
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montréal, Quebec, Canada; Orthopaedic Research Laboratory, Department of Surgery, McGill University, Montréal, Quebec, Canada.
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montréal, Quebec, Canada; Orthopaedic Research Laboratory, Department of Surgery, McGill University, Montréal, Quebec, Canada.
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46
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Olmos-Juste R, Olza S, Gabilondo N, Eceiza A. Tailor-Made 3D Printed Meshes of Alginate-Waterborne Polyurethane as Suitable Implants for Hernia Repair. Macromol Biosci 2022; 22:e2200124. [PMID: 35766012 DOI: 10.1002/mabi.202200124] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/18/2022] [Indexed: 11/10/2022]
Abstract
Hernia injuries are the main condition where mesh implants are needed to provide a suitable reinforcement of the damaged tissue. Mesh implants made of polypropylene (PP) are widely used for this application, however complications related to lack of flexibility, elasticity, and mesh infection have been reported. The development of mesh implants from safer materials adaptable to patient necessities can suppose an alternative for conventional PP meshes. In this work, personalized mesh implants made of alginate and waterborne-polyurethane (A-WBPU) are developed using 3D printing technology. For that purpose, five waterborne polyurethane ink formulations with different amounts of alginate are developed and rheologically characterized. All ink formulations are 3D printed showing good printability, manufacturing surgical mesh implants with suitable morphological characteristics customizable to patient injury through computer-aided design (CAD) mesh model adaptation. A calcium chloride (CaCl2 ) coating is applied after 3D printing as mesh reinforcement. Mechanical analysis revealed that CaCl2 coated meshes containing 6 wt % of alginate in their formulation are the most suitable to be used as implants for small and groin hernias under physiological tensile strength value of 16 N cm-1 , and presenting proper elasticity to cover physiological corporal movements (42.57 %). Moreover, an antibiotic-loaded A-WBPU formulation suitable for 3D printing of meshes are developed as strategy to avoid possible mesh infection.
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Affiliation(s)
- Raquel Olmos-Juste
- 'Materials + Technologies' Research Group (GMT), Department of Chemical and Environmental Engineering, Faculty of Engineering of Gipuzkoa, University of the Basque Country, Plaza Europa 1, Donostia-San Sebastian, 20018, Spain
| | - Sheila Olza
- Department of Cell Biology and Histology, Faculty of Medicine and Dentistry, University of the Basque Country, Barrio Sarriena s/n, Leioa, 48940, Spain
| | - Nagore Gabilondo
- 'Materials + Technologies' Research Group (GMT), Department of Chemical and Environmental Engineering, Faculty of Engineering of Gipuzkoa, University of the Basque Country, Plaza Europa 1, Donostia-San Sebastian, 20018, Spain
| | - Arantxa Eceiza
- 'Materials + Technologies' Research Group (GMT), Department of Chemical and Environmental Engineering, Faculty of Engineering of Gipuzkoa, University of the Basque Country, Plaza Europa 1, Donostia-San Sebastian, 20018, Spain
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Wang S, Yan H, Fang B, Gu C, Guo J, Qiu P, Song N, Xu W, Zhang J, Lin X, Fang X. A myogenic niche with a proper mechanical stress environment improves abdominal wall muscle repair by modulating immunity and preventing fibrosis. Biomaterials 2022; 285:121519. [PMID: 35552116 DOI: 10.1016/j.biomaterials.2022.121519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/05/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022]
Abstract
Volumetric muscle loss (VML) healing is often complicated by fibrosis, which impairs muscle regeneration and function. Adjusting mechanical stress in the repair environment may modulate immunity and reduce fibrosis. In this study, we aimed to create a biomaterial with suitable tension conditions and bidirectional tissue-inducing abilities to prevent fibrosis thus promote muscle regeneration and induce aponeurosis-like structures to restore muscle force transmission. A protocol was developed to manufacture decellularized muscle aponeurosis (D-MA) patches with an intact extracellular matrix (ECM) and low cytotoxicity. D-MA optimized the mechanical stress distribution in muscle injury sites and decreased the number of proinflammatory macrophages and myofibroblasts, thereby attenuating muscle fibrosis. Muscle and aponeurosis ECM environments had different microstructures and mechanical properties, which specifically enhanced stem cell differentiation into muscle-like cells on muscle ECM and tenocyte-like cells on aponeurosis ECM in vitro. Four weeks after orthotopic implantation, the biphasic muscle-aponeurosis-like tissue was successfully regenerated by the D-MA scaffold. The regenerated muscle fibers in D-MA were more abundant than those in the fibrotic decellularized muscle (D-M) scaffold. D-MA can be used to repair abdominal defects, which significantly improves the repair outcomes. Our results suggest D-MA as a promising material for VML repair.
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Affiliation(s)
- Shengyu Wang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Huige Yan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Bin Fang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Chenhui Gu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Jiandong Guo
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Pengchen Qiu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Nan Song
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenbing Xu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Jianfeng Zhang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China.
| | - Xianfeng Lin
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China; Zhejiang Decell Biotechnology Co. LTD, Hangzhou, China.
| | - Xiangqian Fang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China.
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Hu Q, Wu J, Zhang H, Dong W, Gu Y, Liu S. Designing Double-Layer Multi-Material Composite Patch Scaffold with Adhesion Resistance for Hernia Repair. Macromol Biosci 2022; 22:e2100510. [PMID: 35471592 DOI: 10.1002/mabi.202100510] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/12/2022] [Indexed: 11/10/2022]
Abstract
Hernia repair mesh is associated with a number of complications, including adhesions and limited mobility, due to insufficient mechanical strength and non-resorbability. Among them, visceral adhesions are one of the most serious complications of patch repair. In this study, a degradable patch with an anti-adhesive layer was prepared for hernia repair by 3D printing and electrospinning techniques using polycaprolactone (PCL), polyvinyl alcohol (PVA), and soybean peptide (SP). The study into the physicochemical properties of the patch was found that it had adequate mechanical strength requirements (16 N cm-1 ) and large elongation at break, which were superior than commercial polypropylene (PP) patches. In vivo and in vitro experiments showed that human umbilical vein endothelial cells (HUVECs) proliferated well on composite patches, and showed excellent biocompatibility with the host and little adhesion through a rat abdominal wall defect model. In conclusion, the results of this study show that composite patch can effectively reduce the occurrence of adhesions, while the addition of SP in the patch further enhances its biocompatibility. We believe that a regenerative biological patch with great potential in hernia repair provides a new strategy for the development of new biomimetic biodegradable patches. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Qingxi Hu
- Rapid Manufacturing Engineering Center, School of Mechatronical Engineering and Automation, Shanghai University, Shanghai, 200444, China.,Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai, 200072, China.,National Demonstration Center for Experimental Engineering Training Education, Shanghai University, Shanghai, 200444, China
| | - Junjie Wu
- Rapid Manufacturing Engineering Center, School of Mechatronical Engineering and Automation, Shanghai University, Shanghai, 200444, China
| | - Haiguang Zhang
- Rapid Manufacturing Engineering Center, School of Mechatronical Engineering and Automation, Shanghai University, Shanghai, 200444, China.,Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai, 200072, China.,National Demonstration Center for Experimental Engineering Training Education, Shanghai University, Shanghai, 200444, China
| | - Wenpei Dong
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Yan Gu
- Department of General Surgery, Huadong Hospital, Fudan University, Shanghai, 200040, China
| | - Suihong Liu
- Rapid Manufacturing Engineering Center, School of Mechatronical Engineering and Automation, Shanghai University, Shanghai, 200444, China
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Franklyn J, Ramesh S, Madhuri V, Patel B, Dhivya A, Nair PD, Kumar A, Chacko G, Samarasam I. Abdominal Wall Reconstruction with Tissue-Engineered Mesh Using Muscle-Derived Stem Cells in an Animal Model. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2022. [DOI: 10.1007/s40883-022-00253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Liang W, He W, Huang R, Tang Y, Li S, Zheng B, Lin Y, Lu Y, Wang H, Wu D. Peritoneum-Inspired Janus Porous Hydrogel with Anti-Deformation, Anti-Adhesion, and Pro-Healing Characteristics for Abdominal Wall Defect Treatment. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2108992. [PMID: 34981867 DOI: 10.1002/adma.202108992] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/10/2021] [Indexed: 06/14/2023]
Abstract
Implantable meshes used in tension-free repair operations facilitate treatment of internal soft-tissue defects. However, clinical meshes fail to achieve anti-deformation, anti-adhesion, and pro-healing properties simultaneously, leading to undesirable surgery outcomes. Herein, inspired by the peritoneum, a novel biocompatible Janus porous poly(vinyl alcohol) hydrogel (JPVA hydrogel) is developed to achieve efficient repair of internal soft-tissue defects by a facile yet efficient strategy based on top-down solvent exchange. The densely porous and smooth bottom-surface of JPVA hydrogel minimizes adhesion of fibroblasts and does not trigger any visceral adhesion, and its loose extracellular-matrix-like porous and rough top-surface can significantly improve fibroblast adhesion and tissue growth, leading to superior abdominal wall defect treatment to commercially available PP and PCO meshes. With unique anti-swelling property (maximum swelling ratio: 6.4%), JPVA hydrogel has long-lasting anti-deformation performance and maintains high mechanical strength after immersion in phosphate-buffered saline (PBS) for 14 days, enabling tolerance to the maximum abdominal pressure in an internal wet environment. By integrating visceral anti-adhesion and defect pro-healing with anti-deformation, the JPVA hydrogel patch shows great prospects for efficient internal soft-tissue defect repair.
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Affiliation(s)
- Weiwen Liang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Wenyi He
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Rongkang Huang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Youchen Tang
- Center of Accurate Diagnosis, Treatment and Transformation of Bone and Joint Diseases, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, P. R. China
| | - Shimei Li
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Bingna Zheng
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
- Center of Accurate Diagnosis, Treatment and Transformation of Bone and Joint Diseases, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, P. R. China
| | - Yayu Lin
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Yuheng Lu
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
| | - Hui Wang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, P. R. China
| | - Dingcai Wu
- PCFM Lab, School of Chemistry, Sun Yat-sen University, Guangzhou, 510006, P. R. China
- Center of Accurate Diagnosis, Treatment and Transformation of Bone and Joint Diseases, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518000, P. R. China
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