TY - JOUR
T1 - Bioprosthetic versus synthetic mesh
T2 - Analysis of tissue adherence and revascularization in an experimental animal model
AU - Adelman, David M.
AU - Cornwell, Kevin G.
N1 - Funding Information:
Dr. Adelman is a consultant and received research funding from Integra LifeSciences. Dr. Cornwell is an employee of Integra LifeSciences. The Article Processing Charge was paid for by the Integra LifeSciences. The authors thank Lara Reyelt for her assistance in conducting the surgical procedures.
Publisher Copyright:
Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
PY - 2018
Y1 - 2018
N2 - Background: Both synthetic and bioprosthetic meshes play important roles in urgical procedures such as ventral hernia repair. Although sometimes used inerchangeably, these devices have inherently different properties. We therefore ought to better understand how these materials interact with the host environment to optimize surgical techniques and to improve outcomes. Methods: Synthetic mesh (polypropylene, Prolene) or bioprosthetic mesh (acellular etal/neonatal bovine dermis, SurgiMend) was implanted intraperitoneally into rats ateral to a ventral incision in a novel intra-abdominal implant model. Two variables were modified with each material: (1) tight or loose tissue apposition, altered by modfying suture placement; and (2) abdominal wall injury, altered by selective abrasion of the peritoneal lining. After 5 weeks, the meshes and abdominal wall were evaluted grossly and histologically. The analysis focused on the degree of inflammatory esponse, neovascularization, and mesh adherence to the surrounding tissues. Results: Synthetic mesh adhered to the abdominal wall and visceral organs, regardless of he degree of apposition or tissue injury, due to a foreign body–mediated inflammatory eaction. In areas of noninjured peritoneal lining, SurgiMend was adherent peri-suture. Neovascularization entered the mesh from these apposition points and spread outward. n areas of denuded peritoneal lining, the adherent and vascularized areas were signifiantly greater and not merely coincident with suture placement. Conclusions: The inflammatory and wound healing responses with bioprosthetic mesh seem fundamentally different from synthetic mesh. Understanding these differences may lead to varied outcomes in adherence and vascularization of the materials, and ultimately the efficacy of hernia repair. Additionally, these differnces highlight the need for further basic research to optimize mesh selection for surgical technique.
AB - Background: Both synthetic and bioprosthetic meshes play important roles in urgical procedures such as ventral hernia repair. Although sometimes used inerchangeably, these devices have inherently different properties. We therefore ought to better understand how these materials interact with the host environment to optimize surgical techniques and to improve outcomes. Methods: Synthetic mesh (polypropylene, Prolene) or bioprosthetic mesh (acellular etal/neonatal bovine dermis, SurgiMend) was implanted intraperitoneally into rats ateral to a ventral incision in a novel intra-abdominal implant model. Two variables were modified with each material: (1) tight or loose tissue apposition, altered by modfying suture placement; and (2) abdominal wall injury, altered by selective abrasion of the peritoneal lining. After 5 weeks, the meshes and abdominal wall were evaluted grossly and histologically. The analysis focused on the degree of inflammatory esponse, neovascularization, and mesh adherence to the surrounding tissues. Results: Synthetic mesh adhered to the abdominal wall and visceral organs, regardless of he degree of apposition or tissue injury, due to a foreign body–mediated inflammatory eaction. In areas of noninjured peritoneal lining, SurgiMend was adherent peri-suture. Neovascularization entered the mesh from these apposition points and spread outward. n areas of denuded peritoneal lining, the adherent and vascularized areas were signifiantly greater and not merely coincident with suture placement. Conclusions: The inflammatory and wound healing responses with bioprosthetic mesh seem fundamentally different from synthetic mesh. Understanding these differences may lead to varied outcomes in adherence and vascularization of the materials, and ultimately the efficacy of hernia repair. Additionally, these differnces highlight the need for further basic research to optimize mesh selection for surgical technique.
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U2 - 10.1097/GOX.0000000000001713
DO - 10.1097/GOX.0000000000001713
M3 - Article
C2 - 29922542
AN - SCOPUS:85065078176
SN - 2169-7574
VL - 6
JO - Plastic and Reconstructive Surgery - Global Open
JF - Plastic and Reconstructive Surgery - Global Open
IS - 5
M1 - e1713
ER -