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Keric N, Campbell A. Meshing around: high-risk hernias and infected mesh. Trauma Surg Acute Care Open 2024; 9:e001379. [PMID: 38646030 PMCID: PMC11029232 DOI: 10.1136/tsaco-2024-001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Open laparotomy carries a risk up to 20% for an incisional hernia, making repair one of the most common operations performed by general surgeons in the USA. Despite a multitude of mesh appliances and techniques, no size fits all, and there is continued debate on what is the best mesh type, especially in high-risk patients with contaminated hernias. Infected mesh carries a significant burden to the patient, the surgeon and overall healthcare costs with medical legal implications. A stepwise approach that involves optimization of patient comorbidities, patient selective choice of mesh and technique is imperative in mitigating outcomes and recurrence rates. This review will focus on the avoidance of mesh infection and the selection of mesh in patients with contaminated wounds.
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Affiliation(s)
- Natasha Keric
- Surgery, The University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
- Surgery, Banner—University Medical Center Phoenix, Phoenix, Arizona, USA
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2
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Saiding Q, Chen Y, Wang J, Pereira CL, Sarmento B, Cui W, Chen X. Abdominal wall hernia repair: from prosthetic meshes to smart materials. Mater Today Bio 2023; 21:100691. [PMID: 37455815 PMCID: PMC10339210 DOI: 10.1016/j.mtbio.2023.100691] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/15/2023] [Accepted: 06/03/2023] [Indexed: 07/18/2023] Open
Abstract
Hernia reconstruction is one of the most frequently practiced surgical procedures worldwide. Plastic surgery plays a pivotal role in reestablishing desired abdominal wall structure and function without the drawbacks traditionally associated with general surgery as excessive tension, postoperative pain, poor repair outcomes, and frequent recurrence. Surgical meshes have been the preferential choice for abdominal wall hernia repair to achieve the physical integrity and equivalent components of musculofascial layers. Despite the relevant progress in recent years, there are still unsolved challenges in surgical mesh design and complication settlement. This review provides a systemic summary of the hernia surgical mesh development deeply related to abdominal wall hernia pathology and classification. Commercial meshes, the first-generation prosthetic materials, and the most commonly used repair materials in the clinic are described in detail, addressing constrain side effects and rational strategies to establish characteristics of ideal hernia repair meshes. The engineered prosthetics are defined as a transit to the biomimetic smart hernia repair scaffolds with specific advantages and disadvantages, including hydrogel scaffolds, electrospinning membranes, and three-dimensional patches. Lastly, this review critically outlines the future research direction for successful hernia repair solutions by combing state-of-the-art techniques and materials.
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Affiliation(s)
- Qimanguli Saiding
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Yiyao Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
| | - Juan Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Catarina Leite Pereira
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Bruno Sarmento
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
- IUCS – Instituto Universitário de Ciências da Saúde, CESPU, Rua Central de Gandra 1317, 4585-116, Gandra, Portugal
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Xinliang Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
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Mirel S, Pusta A, Moldovan M, Moldovan S. Antimicrobial Meshes for Hernia Repair: Current Progress and Perspectives. J Clin Med 2022; 11:jcm11030883. [PMID: 35160332 PMCID: PMC8836564 DOI: 10.3390/jcm11030883] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
Recent advances in the development of biomaterials have given rise to new options for surgery. New-generation medical devices can control chemical breakdown and resorption, prevent post-operative adhesion, and stimulate tissue regeneration. For the fabrication of medical devices, numerous biomaterials can be employed, including non-degradable biomaterials (silicone, polypropylene, expanded polytetrafluoroethylene) or biodegradable polymers, including implants and three-dimensional scaffolds for tissue engineering, which require particular physicochemical and biological properties. Based on the combination of new generation technologies and cell-based therapies, the biocompatible and bioactive properties of some of these medical products can lead to progress in the repair of injured or harmed tissue and in tissue regeneration. An important aspect in the use of these prosthetic devices is the associated infection risk, due to the medical complications and socio-economic impact. This paper provides the latest achievements in the field of antimicrobial surgical meshes for hernia repair and discusses the perspectives in the development of these innovative biomaterials.
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Affiliation(s)
- Simona Mirel
- Department of Medical Devices, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Alexandra Pusta
- Department of Medical Devices, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
- Correspondence:
| | - Mihaela Moldovan
- Pediatric Surgery Department, Emergency Clinical Children’s Hospital, 400370 Cluj-Napoca, Romania;
| | - Septimiu Moldovan
- Surgery Department, Prof. Dr. O. Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
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Simić D, Zarić M, Nikolić I, Živković-Zarić R, Čanović P, Kočović A, Radojević I, Raković I, Jovičić Milić S, Petrović Đ, Stojković D, Vuković N, Kačániová M, Vukić M, Jevtić V. Newly synthesized palladium(II) complexes with aminothiazole derivatives: in vitro study of antimicrobial activity and antitumor activity on the human prostate cancer cell line. Dalton Trans 2021; 51:1191-1205. [PMID: 34951416 DOI: 10.1039/d1dt03364f] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Five new complexes of the palladium(II) ion (C1-C5) having the general formula [(PdL2)]Cl2 with some 2-aminothiazoles (L1-L5), where L1 = 2-amino-4-(3,4-difluorophenyl)thiazole, L2 = 2-amino-5-methyl-4-phenylthiazole, L3 = 2-amino-4-phenylthiazole, L4 = 2-amino-4-(4-chlorophenyl)thiazole, and L5 = 2-amino-4-(2,4-difluorophenyl)thiazole, have been synthesized and characterized by elemental microanalysis and infrared, 1H NMR and 13C NMR spectroscopy. The in vitro antimicrobial activity of the five ligands and the corresponding Pd(II) complexes is investigated. Testing is performed by the microdilution method and the minimum inhibitory concentration (MIC) and minimum microbicidal concentration (MMC) have been determined. Testing is conducted against 11 microorganisms (nine strains of pathogenic bacteria and two yeast species). The tested ligands and palladium(II) complexes show selective, high and moderate activity. There is a difference in antimicrobial activity between the ligands and the corresponding palladium(II) complexes. The complexes have significant anti-staphylococcal activity and activity on Pseudomonas aeruginosa which is better than the positive control. The interactions of newly synthesized palladium(II) complexes with calf thymus DNA (CT-DNA) were investigated using UV-Vis absorption and fluorescence spectroscopy. Analysis of UV-absorption and fluorescence spectra indicates the formation of a complex between the palladium(II) complexes and DNA. The high values of intrinsic binding constants, Kb, of the order 104 M-1 and Stern-Volmer quenching constants, KSV, of the order 105 M-1 indicated very good binding of all complexes to CT-DNA. Also, the new Pd(II) complexes show high cytotoxic activity towards the human prostate cancer cell line and insignificant activity towards non-cancerous human fibroblasts. Future research could additionally explore the biological activity of Pd(II) complexes presented in this paper and investigate the possibility of their implementation in clinical practice.
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Affiliation(s)
- Dejan Simić
- University of Defence, Belgrade, Serbia, Military Medical Academy, Department of Urology, Crnotravska 17, 11040 Belgrade, Serbia
| | - Milan Zarić
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Biochemistry, Svetozara Markovica 69, 34000 Kragujevac, Serbia.
| | - Ivana Nikolić
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Biochemistry, Svetozara Markovica 69, 34000 Kragujevac, Serbia.
| | - Radica Živković-Zarić
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Pharmacology and Toxicology, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Petar Čanović
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Biochemistry, Svetozara Markovica 69, 34000 Kragujevac, Serbia.
| | - Aleksandar Kočović
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Pharmacy, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Ivana Radojević
- University of Kragujevac, Serbia, Faculty of Science, Department of Biology, Radoja Domanovica 12, 34000 Kragujevac, Serbia
| | - Ivana Raković
- University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Infectious diseases, Svetozara Markovica 69, 34000 Kragujevac, Serbia
| | - Sandra Jovičić Milić
- University of Kragujevac, Serbia, Faculty of Science, Department of Chemistry, Radoja Domanovica 12, 34000 Kragujevac, Serbia
| | - Đorđe Petrović
- University of Kragujevac, Serbia, Faculty of Science, Department of Chemistry, Radoja Domanovica 12, 34000 Kragujevac, Serbia
| | - Danijela Stojković
- University of Kragujevac, Serbia, Institute for Information Technologies, Jovana Cvijica bb, 34000 Kragujevac, Serbia
| | - Nenad Vuković
- University of Kragujevac, Serbia, Faculty of Science, Department of Chemistry, Radoja Domanovica 12, 34000 Kragujevac, Serbia
| | - Miroslava Kačániová
- Slovak University of Agriculture, Faculty of Horticulture and Landscape Engineering, Department of Fruit sciences, Viticulture and Enology, Trieda Andreja Hlinku 2, 949 76 Nitra-Chrenová, Slovakia
| | - Milena Vukić
- University of Kragujevac, Serbia, Faculty of Science, Department of Chemistry, Radoja Domanovica 12, 34000 Kragujevac, Serbia
| | - Verica Jevtić
- University of Kragujevac, Serbia, Faculty of Science, Department of Chemistry, Radoja Domanovica 12, 34000 Kragujevac, Serbia
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A critical review of the in vitro and in vivo models for the evaluation of anti-infective meshes. Hernia 2018; 22:961-974. [PMID: 30168006 DOI: 10.1007/s10029-018-1807-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/18/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Infectious complications following mesh implantation for abdominal wall repair appear in 0.7 up to 26.6% of hernia repairs and can have a detrimental impact for the patient. To prevent or to treat mesh-related infection, the scientific community is currently developing a veritable arsenal of antibacterial meshes. The numerous and increasing reports published every year describing new technologies indicate a clear clinical need, and an academic interest in solving this problem. Nevertheless, to really appreciate, to challenge, to compare and to optimize the antibacterial properties of next generation meshes, it is important to know which models are available and to understand them. PURPOSE We proposed for the first time, a complete overview focusing only on the in vitro and in vivo models which have been employed specifically in the field of antibacterial meshes for hernia repair. RESULTS AND CONCLUSION From this investigation, it is clear that there has been vast progress and breadth in new technologies and models to test them. However, it also shows that standardization or adoption of a more restricted number of models would improve comparability and be a benefit to the field of study.
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Guillaume O, Pérez-Tanoira R, Fortelny R, Redl H, Moriarty TF, Richards RG, Eglin D, Petter Puchner A. Infections associated with mesh repairs of abdominal wall hernias: Are antimicrobial biomaterials the longed-for solution? Biomaterials 2018; 167:15-31. [PMID: 29554478 DOI: 10.1016/j.biomaterials.2018.03.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/30/2022]
Abstract
The incidence of mesh-related infection after abdominal wall hernia repair is low, generally between 1 and 4%; however, worldwide, this corresponds to tens of thousands of difficult cases to treat annually. Adopting best practices in prevention is one of the keys to reduce the incidence of mesh-related infection. Once the infection is established, however, only a limited number of options are available that provides an efficient and successful treatment outcome. Over the past few years, there has been a tremendous amount of research dedicated to the functionalization of prosthetic meshes with antimicrobial properties, with some receiving regulatory approval and are currently available for clinical use. In this context, it is important to review the clinical importance of mesh infection, its risk factors, prophylaxis and pathogenicity. In addition, we give an overview of the main functionalization approaches that have been applied on meshes to confer anti-bacterial protection, the respective benefits and limitations, and finally some relevant future directions.
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Affiliation(s)
- O Guillaume
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland.
| | - R Pérez-Tanoira
- Division of Infectious Diseases, IIS-Fundación Jiménez Díaz, Madrid, Spain; Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - R Fortelny
- Department of General, Visceral and Oncologic Surgery, Wilhelminen Hospital, Montleartstrasse 37, 1160, Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria; Sigmund Freud University, Medical Faculty, Kelsenstraße 2, A-1030, Vienna, Austria
| | - H Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Donaueschingenstrasse 13, A-1200, Vienna, Austria
| | - T F Moriarty
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - R G Richards
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - D Eglin
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - A Petter Puchner
- Department of General, Visceral and Oncologic Surgery, Wilhelminen Hospital, Montleartstrasse 37, 1160, Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria
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7
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Vaidya MY, McBain AJ, Butler JA, Banks CE, Whitehead KA. Antimicrobial Efficacy and Synergy of Metal Ions against Enterococcus faecium, Klebsiella pneumoniae and Acinetobacter baumannii in Planktonic and Biofilm Phenotypes. Sci Rep 2017; 7:5911. [PMID: 28724953 PMCID: PMC5517536 DOI: 10.1038/s41598-017-05976-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/06/2017] [Indexed: 12/17/2022] Open
Abstract
The effects of metal ion solutions (silver, copper, platinum, gold and palladium) were determined individually and in combination against Enterococcus faecium, Acinetobacter baumannii and Klebsiella pneumoniae. Platinum, gold and palladium showed the greatest antimicrobial efficacy in zone of inhibition (ZoI) assays. When tested in combinations using ZoI assays, gold/platinum, gold/palladium and platinum/palladium were indicative of synergy. Microbial inhibitory concentration demonstrated platinum and gold against Enterococcus faecium, platinum against Klebsiella pneumoniae and platinum and silver against Acinetobacter baumannii were optimal. Minimal bactericidal concentrations determined the greatest bactericidal activity was again platinum gold and palladium against all three bacteria. Fractional Inhibitory Concentration (FIC) studies demonstrated that the silver/platinum combination against Enterococcus faecium, and silver/copper combination against Acinetobacter baumannii demonstrated antimicrobial synergy. Following crystal violet biofilm assays for single metal ion solutions, antimicrobial efficacies were demonstrated for all the metals against all the bacteria Synergistic assays against biofilms demonstrated gold/palladium, gold/platinumand platinum/palladium resulted in the greatest antimicrobial efficacy. Overall, platinum, palladium and gold metal ion solutions in individual use or combination demonstrated the greatest antimicrobial efficacies against planktonic or biofilm bacteria. This work demonstrates the potential for using a range of metal ions, as biocidal formulations against both planktonic or biofilm bacteria.
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Affiliation(s)
- Misha Y Vaidya
- School of Healthcare Science, Manchester Metropolitan University, Chester St, Manchester, M1 5GD, UK
| | - Andrew J McBain
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK
| | - Jonathan A Butler
- School of Healthcare Science, Manchester Metropolitan University, Chester St, Manchester, M1 5GD, UK
| | - Craig E Banks
- School of Healthcare Science, Manchester Metropolitan University, Chester St, Manchester, M1 5GD, UK
| | - Kathryn A Whitehead
- School of Healthcare Science, Manchester Metropolitan University, Chester St, Manchester, M1 5GD, UK.
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Evaluation of the role of substrate and albumin on Pseudomonas aeruginosa biofilm morphology through FESEM and FTIR studies on polymeric biomaterials. Prog Biomater 2017; 6:27-38. [PMID: 28155216 PMCID: PMC5433955 DOI: 10.1007/s40204-017-0061-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/05/2017] [Indexed: 12/15/2022] Open
Abstract
Bacterial biofilms pose the greatest challenge to implant surgeries leading to device-related infections and implant failure. Our present study aims at monitoring the variation in the biofilm architecture of a clinically isolated strain and ATCC 27853 strain of Pseudomonas aeruginosa on two polymeric biomaterials, used in implants. The perspective of our study is to recognize the potential of these two biomaterials to create biofilm infections and develop the understanding regarding their limitations of use and handle patients with this deeper insight. The final goal, however, is an accurate interpretation of substrate-microbe interactions in the two biomaterials, which will provide us the knowledge of possible surface modifications to develop of an efficacious anti-biofilm therapy for deterring implant infections. The reference strain ATCC 27853 and a clinical isolate of P. aeruginosa collected from urinary catheters of patients suffering from urinary tract infections, have been used as microbes while clinical grades of polypropylene and high density polyethylene, have been used as 'substrates' for biofilm growth. The variation in the nature of the 'substrate' and 'conditioning layer' of BSA have been found to affect the biofilm architecture as well as the physiology of the biofilm-forming bacteria, accompanied by an alteration in the nature and volume of EPS (extracellular polysaccharide) matrices.
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Badrossamay M, Sun G. Enhancing hygiene/antimicrobial properties of polyolefins. POLYOLEFIN FIBRES 2017. [PMCID: PMC7151946 DOI: 10.1016/b978-0-08-101132-4.00008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Pérez-Köhler B, Bayon Y, Bellón JM. Mesh Infection and Hernia Repair: A Review. Surg Infect (Larchmt) 2015; 17:124-37. [PMID: 26654576 DOI: 10.1089/sur.2015.078] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The use of a prosthetic mesh to repair a tissue defect may produce a series of post-operative complications, among which infection is the most feared and one of the most devastating. When occurring, bacterial adherence and biofilm formation on the mesh surface affect the implant's tissue integration and host tissue regeneration, making preventive measures to control prosthetic infection a major goal of prosthetic mesh improvement. METHODS This article reviews the literature on the infection of prosthetic meshes used in hernia repair to describe the in vitro and in vivo models used to examine bacterial adherence and biofilm formation on the surface of different biomaterials. Also discussed are the prophylactic measures used to control implant infection ranging from meshes soaked in antibiotics to mesh coatings that release antimicrobial agents in a controlled manner. RESULTS Prosthetic architecture has a direct effect on bacterial adherence and biofilm formation. Absorbable synthetic materials are more prone to bacterial colonization than non-absorbable materials. The reported behavior of collagen biomeshes, also called xenografts, in a contaminated environment has been contradictory, and their use in this setting needs further clinical investigation. New prophylactic mesh designs include surface modifications with an anti-adhesive substance or pre-treatment with antibacterial agents or metal coatings. CONCLUSIONS The use of polymer coatings that slowly release non-antibiotic drugs seems to be a good strategy to prevent implant contamination and reduce the onset of resistant bacterial strains. Even though the prophylactic designs described in this review are mainly focused on hernia repair meshes, these strategies can be extrapolated to other implantable devices, regardless of their design, shape or dimension.
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Affiliation(s)
- Bárbara Pérez-Köhler
- 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .,2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Yves Bayon
- 3 Covidien - Sofradim Production , Trévoux, France
| | - Juan Manuel Bellón
- 1 Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá . Madrid, Spain .,2 Networking Research Center on Bioengineering , Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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Guillaume O, Teuschl AH, Gruber-Blum S, Fortelny RH, Redl H, Petter-Puchner A. Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio-Functionality to Meshes. Adv Healthc Mater 2015; 4:1763-89. [PMID: 26111309 DOI: 10.1002/adhm.201500201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Indexed: 12/19/2022]
Abstract
Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.
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Affiliation(s)
- Olivier Guillaume
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Andreas Herbert Teuschl
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- University of Applied Sciences Technikum Wien; Department of Biochemical Engineering; Höchstädtplatz 5 1200 Vienna Austria
| | - Simone Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - René Hartmann Fortelny
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Alexander Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
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12
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Tatara AM, Shah SR, Livingston CE, Mikos AG. Infected animal models for tissue engineering. Methods 2015; 84:17-24. [PMID: 25843609 PMCID: PMC4526327 DOI: 10.1016/j.ymeth.2015.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/26/2015] [Indexed: 01/15/2023] Open
Abstract
Infection is one of the most common complications associated with medical interventions and implants. As tissue engineering strategies to replace missing or damaged tissue advance, the focus on prevention and treatment of concomitant infection has also begun to emerge as an important area of research. Because the in vivo environment is a complex interaction between host tissue, implanted materials, and native immune system that cannot be replicated in vitro, animal models of infection are integral in evaluating the safety and efficacy of experimental treatments for infection. In this review, considerations for selecting an animal model, established models of infection, and areas that require further model development are discussed with regard to cutaneous, fascial, and orthopedic infections.
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Affiliation(s)
- Alexander M Tatara
- Department of Bioengineering, Rice University, Houston, TX 77030, United States
| | - Sarita R Shah
- Department of Bioengineering, Rice University, Houston, TX 77030, United States
| | | | - Antonios G Mikos
- Department of Bioengineering, Rice University, Houston, TX 77030, United States; Department of Chemical and Biomolecular Engineering, Rice University, Houston, TX 77005, United States.
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13
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Pérez-Köhler B, García-Moreno F, Bayon Y, Pascual G, Bellón JM. Inhibition of Staphylococcus aureus Adhesion to the Surface of a Reticular Heavyweight Polypropylene Mesh Soaked in a Combination of Chlorhexidine and Allicin: An In vitro Study. PLoS One 2015; 10:e0126711. [PMID: 25962163 PMCID: PMC4427482 DOI: 10.1371/journal.pone.0126711] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/07/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Presoaking meshes for hernia repair with antiseptics prior to implantation could decrease the adhesion of microorganisms to the material surface and reduce the risk of antibiotic resistances. In this work, we evaluate chlorhexidine and allicin (natural antiseptic not yet tested for these purposes) against vancomycin as antiseptics to be used in the pretreatment of a heavyweight polypropylene mesh using an in vitro model of bacterial contamination. METHODS Solutions of saline, vancomycin (40 µg/mL), allicin (1,000 µg/mL), chlorhexidine (2%-0.05%) and the combination allicin-chlorhexidine (900 µg/mL-0.05%) were analyzed with agar diffusion tests in the presence of 106 CFU Staphylococcus aureus ATCC25923. Additionally, sterile fragments of Surgipro (1 cm2) were soaked with the solutions and cultured onto contaminated agar plates for 24/48/72 h. The antimicrobial material DualMesh Plus was utilized as positive control. At every time, the inhibition zones were measured and the bacterial adhesion to the mesh surface quantified (sonication, scanning electron microscopy). Cytotoxicity of the treatments was examined (alamarBlue) using rabbit skin fibroblasts. RESULTS The largest zones of inhibition were created by allicin-chlorhexidine. Chlorhexidine was more effective than vancomycin, and allicin lost its effectiveness after 24 h. No bacteria adhered to the surface of the DualMesh Plus or the meshes soaked with vancomycin, chlorhexidine and allicin-chlorhexidine. On the contrary, saline and allicin allowed adherence of high loads of bacteria. Vancomycin had no toxic effects on fibroblasts, while allicin and chlorhexidine exerted high toxicity. Cytotoxicity was significantly reduced with the allicin-chlorhexidine combination. CONCLUSIONS The use of antiseptics such as chlorhexidine, alone or combined with others like allicin, could represent an adequate prophylactic strategy to be used for hernia repair materials because soaking with these agents provides the mesh with similar antibacterial properties to those observed after soaking with vancomycin, similar to the effect of DualMesh Plus.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Madrid, Spain
| | - Francisca García-Moreno
- Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Madrid, Spain
| | - Yves Bayon
- Covidien—Sofradim Production, Trévoux, France
| | - Gemma Pascual
- Department of Medicine and Medical Specialties. Faculty of Medicine and Health Sciences. University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Madrid, Spain
| | - Juan Manuel Bellón
- Department of Surgery, Medical and Social Sciences. Faculty of Medicine and Health Sciences. University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Madrid, Spain
- * E-mail:
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Reśliński A, Dąbrowiecki S, Głowacka K. The impact of diclofenac and ibuprofen on biofilm formation on the surface of polypropylene mesh. Hernia 2013; 19:179-85. [PMID: 24366755 PMCID: PMC4372680 DOI: 10.1007/s10029-013-1200-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 12/03/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE The difficulties related to treatment of deep surgical site infection involve formation of biofilm on the surface of synthetic material. It is considered that in treatment of infections involving formation of biofilm, concomitant therapy shall be applied covering anti-inflammatory drugs. The purpose of the work was to assess the impact of diclofenac and ibuprofen on bacterial biofilm formation on the surface of monofilament polypropylene mesh. MATERIALS AND METHODS The study involved 70 strains of Staphylococcus aureus and 70 strains of Escherichia coli isolated from different patients and those which differ with chromosomal DNA pattern within the species. The assessment of the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on biofilm formation was carried out with the use of qualitative method (TTC reduction), quantitative (tenfold serial dilution) and with the use of scanning electron microscope (SEM). RESULTS In the qualitative assessment, after incubation in the medium containing NSAIDs statistically significant growth of S. aureus strain amount and E. coli which poorly make up biofilm was stated. Quantitative examination indicated characteristic decrease of the number of colony forming units in 1 ml of the suspension isolated from bacterial biofilm formed as a result of incubation of isolates in the medium with the addition of examined NSAIDs in comparison to biofilm from control regimen. In the examination with the use of SEM it was stated that the effect of isolates incubation in the medium with NSAIDs was decrease of the number of bacteria adjacent to the biomaterial surface. CONCLUSIONS Diclofenac and ibuprofen in the concentration obtained in the serum limit the formation of biofilm by S. aureus and E. coli.
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Affiliation(s)
- A Reśliński
- Department of General Surgery and Transplantology, Ludwik Rydygier College of Medicine in Bydgoszcz, Nicolaus Copernicus University in Toruń, M. Skłodowskiej-Curie 9 Str., 85-094, Bydgoszcz, Poland,
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Soyer T, Bostanoğlu E, Aslan MK, Boybeyi Ö, Demirbilek M, Göçmen JS. In vitro evaluation of E. coli and S. epidermidis adhesion on dressing materials used in hypospadias repair. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-013-0909-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fernandez-Gutierrez M, Olivares E, Pascual G, Bellon JM, Román JS. Low-density polypropylene meshes coated with resorbable and biocompatible hydrophilic polymers as controlled release agents of antibiotics. Acta Biomater 2013; 9:6006-18. [PMID: 23261925 DOI: 10.1016/j.actbio.2012.12.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 12/03/2012] [Accepted: 12/07/2012] [Indexed: 11/25/2022]
Abstract
The application of bioactive meshes in abdominal surgery for the repair of hernias is an increasing clinical activity in a wide sector of the population. The main secondary effect is the appearance of infections from bacteria, specifically Staphylococcus aureus and S. epidermidis. This paper describes the development and application of low-density polypropylene meshes coated with a biocompatible and resorbable polymer as a controlled release system of the antibiotic vancomycin. The polymeric coating (a non-cross-linked copolymer of 2-hydroxyethyl methacrylate and 2-acrylamido-2-methylpropanesulfonic acid) has a thickness of 14-15μm and contains 0.32mgcm(-2) of the antibiotic vancomycin. The in vitro experiments demonstrate the excellent inhibitory character of the coated meshes loaded with the antibiotic, following the standard protocol of inhibition of halo in agar diffusion test. This inhibitory effect is maintained for a relatively long period (at least 14days) with a low concentration of antibiotic. The acrylic polymer system regulates the release of the antibiotic with a rate of 24μgh(-1), due to its slow dissolution in the medium. Experiments in vivo, based on the implantation of coated meshes, demonstrate that the system controls the infection in the animal (rabbits) for at least 30days. The concentration of antibiotic in the blood stream of the rabbits was below the detection limit of the analytical technique (<1-2μgml(-1)), which demonstrates that the antibiotic is released in the local area of the implant and remains concentrated at the implantation site, without diffusion to the blood stream. The systems can be applied to other medical devices and implants for the application of new-generation antibiotics in a controlled release and targeted applications.
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Collage RD, Rosengart MR. Abdominal wall infections with in situ mesh. Surg Infect (Larchmt) 2010; 11:311-8. [PMID: 20583867 DOI: 10.1089/sur.2010.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Synthetic mesh is used commonly in the repair of abdominal wall hernias. Infection at the surgical site where mesh is present poses a formidable clinical problem. METHODS The current surgical literature was reviewed to formulate accepted approaches to the management of hernia repairs with infected mesh. RESULTS Prevention of mesh infection is best achieved by judicious use of systemic antibiotics. Topical antibiotics often are used without convincing evidence to support their value. Laparoscopic repairs have lower infection rates than open repairs. Evidence is lacking to support lower rates of infection with mesh of specific composition or with antibacterial agents that coat the mesh. The diagnosis of mesh infection is principally a clinical one. Repairs of infected mesh usually necessitate antibiotics and removal of the foreign material. Clinical judgment is required for attempts at salvaging portions of the mesh. Component separation or biological materials may be used in those circumstances for hernia repair in which large defects are created by removal of the infected synthetic material. CONCLUSIONS Prevention of mesh infections remains the best strategy. Clinical judgment is essential in determining the degree of mesh removal. Continued clinical studies are necessary to improve the outcomes of established mesh infection in hernia repairs.
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Affiliation(s)
- Richard D Collage
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Suska F, Svensson S, Johansson A, Emanuelsson L, Karlholm H, Ohrlander M, Thomsen P. In vivoevaluation of noble metal coatings. J Biomed Mater Res B Appl Biomater 2010; 92:86-94. [DOI: 10.1002/jbm.b.31492] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aydinuraz K, Ağalar C, Ağalar F, Çeken S, Duruyürek N, Vural T. In Vitro S. epidermidis and S. aureus Adherence to Composite and Lightweight Polypropylene Grafts. J Surg Res 2009; 157:e79-86. [DOI: 10.1016/j.jss.2009.04.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 02/20/2009] [Accepted: 04/01/2009] [Indexed: 11/16/2022]
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Lichter JA, Thompson MT, Delgadillo M, Nishikawa T, Rubner MF, Van Vliet KJ. Substrata mechanical stiffness can regulate adhesion of viable bacteria. Biomacromolecules 2008; 9:1571-8. [PMID: 18452330 DOI: 10.1021/bm701430y] [Citation(s) in RCA: 183] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The competing mechanisms that regulate adhesion of bacteria to surfaces and subsequent biofilm formation remain unclear, though nearly all studies have focused on the role of physical and chemical properties of the material surface. Given the large monetary and health costs of medical-device colonization and hospital-acquired infections due to bacteria, there is considerable interest in better understanding of material properties that can limit bacterial adhesion and viability. Here we employ weak polyelectrolyte multilayer (PEM) thin films comprised of poly(allylamine) hydrochloride (PAH) and poly(acrylic acid) (PAA), assembled over a range of conditions, to explore the physicochemical and mechanical characteristics of material surfaces controlling adhesion of Staphylococcus epidermidis bacteria and subsequent colony growth. Although it is increasingly appreciated that eukaryotic cells possess subcellular structures and biomolecular pathways to sense and respond to local chemomechanical environments, much less is known about mechanoselective adhesion of prokaryotes such as these bacteria. We find that adhesion of viable S. epidermidis correlates positively with the stiffness of these polymeric substrata, independently of the roughness, interaction energy, and charge density of these materials. Quantitatively similar trends observed for wild-type and actin analogue mutant Escherichia coli suggest that these results are not confined to only specific bacterial strains, shapes, or cell envelope types. These results indicate the plausibility of mechanoselective adhesion mechanisms in prokaryotes and suggest that mechanical stiffness of substrata materials represents an additional parameter that can regulate adhesion of and subsequent colonization by viable bacteria.
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Affiliation(s)
- Jenny A Lichter
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Abed A, Deval B, Assoul N, Bataille I, Portes P, Louedec L, Henin D, Letourneur D, Meddahi-Pellé A. A Biocompatible Polysaccharide Hydrogel–Embedded Polypropylene Mesh for Enhanced Tissue Integration in Rats. Tissue Eng Part A 2008; 14:519-27. [DOI: 10.1089/tea.2007.0134] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aicha Abed
- INSERM U 698, CHU Xavier Bichat, Bât. Inserm, Paris, France
| | | | - Nabila Assoul
- INSERM U 698, CHU Xavier Bichat, Bât. Inserm, Paris, France
| | - Isabelle Bataille
- INSERM U 698, CHU Xavier Bichat, Bât. Inserm, Paris, France
- Institut Galilée, Université Paris 13, Villetaneuse, France
| | - Patrick Portes
- LIMHP-CNRS UPR 1311, Université Paris 13, Villetaneuse, France
| | | | - Dominique Henin
- Service d’Anatomo-Pathologie, CHU Xavier Bichat, Paris, France
| | - Didier Letourneur
- INSERM U 698, CHU Xavier Bichat, Bât. Inserm, Paris, France
- Institut Galilée, Université Paris 13, Villetaneuse, France
| | - Anne Meddahi-Pellé
- INSERM U 698, CHU Xavier Bichat, Bât. Inserm, Paris, France
- Université d’Orléans, UFR STAPS, Orléans, France
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