Early tissue incorporation and collagen deposition in lightweight polypropylene meshes: bioassay in an experimental model of ventral hernia

doi:10.1016/j.surg.2008.04.005

Surgery

Volume 144, Issue 3, September 2008, Pages 427-435

https://doi.org/10.1016/j.surg.2008.04.005 Get rights and content

Background

This study was designed to assess the early host tissue incorporation of several polypropylene lightweight (PP-LW) meshes used to repair abdominal wall defects and to correlate collagen deposition with the biomechanical response shown by PP-LW versus polypropylene heavyweight (PP-HW) meshes.

Methods

Ventral hernial defects (7 × 5 cm) were created in the anterior abdominal wall of New Zealand rabbits and repaired by fixing PP-LW mesh of different pore sizes or a low porosity HW mesh to the edges of the defect. Rabbits were killed 14 days after implant, and specimens were taken from the central mesh area to examine collagen deposition by light microscopy, real time reverse transcription polymerase chain reaction, immunohistochemistry, and Western blotting. The biomechanical resistance of the biomaterials was also assessed.

Results

All the materials showed excellent incorporation in host tissue. Relative amounts of collagen III mRNA were considerably higher than collagen I mRNA. Higher collagen I and III mRNA levels were noted for pore sizes equal to or greater than 3.45 ± 0.19 mm² (Ultrapro®/Optilene Elastic®). These two meshes showed significantly higher levels of collagen III than Parietene® and Surgipro® with smaller pores. Biomechanical resistance values for Optilene® were significantly higher than those recorded for Surgipro® and Parietene®.

Conclusions

(a) LW meshes of pore size larger than 3 mm² induced the genetic overexpression of collagen types I and III; (b) the larger pore-sized LW meshes induced more collagen type III deposition and its faster conversion to collagen I; (c) Optilene®, the most porous LW mesh examined, showed the greatest tensile strength 14 days after implant.

Section snippets

Experimental animals

The experimental animals were 24 male New Zealand White rabbits, weighing approximately 2500 g, caged under conditions of constant light and temperature according to European Union animal care guidelines (EEC 2871-22 A9).

Prosthetic materials

The biomaterials used were (Fig 1):

Surgipro® (Tyco Healthcare, Mansfield, MA) HW polypropylene (85 g/m²) with a pore surface area of 0.26±0.03 mm² (Fig 1, A).
Parietene® (Tyco Healthcare, Mansfield, MA): LW polypropylene (38 g/m²) with a pore surface area of 1.15±0.05 mm² (Fig 1

Light microscopy

On light microscopy, all of the prosthetic materials showed excellent incorporation in host tissue (Fig 2). All of the meshes, regardless of pore size, induced complete tissue colonization of the zones limited by the filaments comprising the implants. In these areas, we could observe neoformed tissue such that the implant surface overlaying the visceral peritoneum appeared completely mesothelialized.

Real time RT-PCR

Generally speaking, in each of the study groups, the relative amounts of mRNA corresponding to

Discussion

The increased use of biomaterials for the first-line surgical treatment of abdominal wall hernia has prompted several modifications in their structure aimed at finding the ideal prosthesis. These changes have had a special impact on the reticular mesh type prostheses mainly composed of polypropylene, which have essentially varied in terms of their pore size. The final goal of these developments has always been to try to improve their tissue incorporation and to leave a minimal quantity of

References (22)

A. Kingsnorth et al.
Hernias: inguinal and incisional
Lancet
(2003)
J.M. Bellón et al.
Integrations of biomaterials implanted into abdominal wall: process of scar formation and macrophage response
Biomaterials
(1995)
W.S. Cobb et al.
Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model
J Surg Res
(2006)
J.M. Bellón et al.
Partially absorbable meshes for hernia repair offer advantages over nonabsorbable meshes
Am J Surg
(2007)
U. Klinge et al.
Impact of polymer pore size on the interface scar formation in a rat model
J Surg Res
(2002)
J.M. Bellón et al.
Tissue response to polypropylene meshes used in the repair of abdominal wall defects
Biomaterials
(1998)
Mesh compared with non-mesh methods of open groin hernia repair: Systematic Review of randomized controlled trials
Br J Surg
(2000)
V. Schumpelick et al.
Incisional abdominal hernia: the open mesh repair
Langenbecks Arch Surg
(2004)
W.S. Cobb et al.
The argument for lightweight polypropylene mesh in hernia repair
Surg Innov
(2005)
K. Junge et al.
Functional and morphologic properties of a modified mesh for inguinal hernia repair
World J Surg
(2002)

U. Klinge et al.

Functional and morphological evaluation of a low-weight monofilament polypropylene mesh for hernia repair

J Biomed Mater Res

(2002)

Cited by (64)

Abdominal wall hernia repair: from prosthetic meshes to smart materials
2023, Materials Today Bio
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.
Cellular response to synthetic polymers
2020, Handbook of Biomaterials Biocompatibility
A great number of currently available synthetic polymers makes the selection of a suitable polymer for a particular biomedical application a difficult task. However, among all properties required for an application, the biocompatibility of the polymer with tissues and biological fluids is always the foremost consideration for all candidate materials. Here, cellular response of the synthetic polymers has been discussed in direct correlation with their biomedical applications, such as implants (joints, sutures, bone plates), and medical devices such as blood tubes, artificial heart, pacemakers, etc. They are classified in inert and degradable ones and in each class the factors related to polymer characteristics and biological media determining biocompatibility and cellular response have been evidenced.
An experimental research in mice on the “soft tissue reaction to 3 different mesh implants: Titanium silk, Parietene Progrip and Prolene”
2018, JPRAS Open
Citation Excerpt :
Mesh characteristics such as pore size, chemical composition, filament structure, amount of implanted material, and biodegradability affect the processes of inflammation, angiogenesis, and tissue formation which consequently may alter wound healing11–17. Theoretically, the increased diameter of the pores and the reduction in the density of meshes could minimize inflammation and, consequently reduce the complications related to these implants18–21. According to data from current randomized controlled trials and retrospective studies, light meshes seem to have some advantages with respect to postoperative pain and foreign body sensation.
To analyze the soft tissue reaction of ‘Titanium Silk’ mesh implant in comparison with ‘Parietene Progrip’ and ‘Prolene’ mesh implants for the reinforcement and augmentation of soft tissues to improve the results of static correction in Facial Paralysis and other defects of Maxillofacial region.
Under standard laboratory conditions, 89 mice were divided into 4 groups: a control group of 5 mice; first group of 28 mice with Titanium mesh implant, second group of 28 mice with semi-resorbable ‘Parietene Progrip’ implant and third group of 28 mice with ‘Prolene’ implant. Under inhalational anesthesia with ethyl ether at days 7, 14, 30 and 60, seven mice from each experimental group underwent Gross and histological analysis of the mesh structures for the following characteristics: Macrophage Infiltration, Multinucleated Macrophages, Meshwork around the implant fibers, Connective tissue proliferation, Angiogenesis and Fibroblasts.
Histological analysis revealed a significantly less pronounced inflammatory response to Titanium mesh implant resulting in the formation of a more delicate connective tissue network around the mesh elements.
The experiment clearly demonstrated the cellular and tissue responses to different implantable mesh materials at various times of its integration. It revealed that the titanium mesh is the most bio-inert alloplastic material suitable for reinforcement of soft tissue augmentation and to prioritize it's use in static correction of facial paralysis and other defects of the maxillofacial region. A postoperative timeframe of 30 days is considered appropriate for the adequate formation of connective tissue around the mesh elements.
Mechanical properties of the abdominal wall and biomaterials utilized for hernia repair
2017, Journal of the Mechanical Behavior of Biomedical Materials
Abdominal wall hernias are one of the most common and long-standing surgical applications for biomaterials engineering. Yet, despite over 50 years of standard use of hernia repair materials, revision surgery is still required in nearly one third of patients due to hernia recurrence. To date, hernia mesh designs have focused on maximizing tensile strength to prevent structural failure of the implant. However, most recurrences occur at the biomaterial-tissue interface. There is a fundamental gap in understanding the degree to which a mechanical mismatch between hernia repair materials and host tissue contributes to failure at this interface. This review summarizes the current literature related to the anatomy and mechanics of both human and animal abdominal wall tissues, as well as the mechanical properties of many commonly-utilized hernia repair materials. The studies reviewed here reported greater compliance of the linea alba, larger strains for the intact abdominal wall, and greater stiffness for the rectus sheath and umbilical fascia when the tissues were loaded in the longitudinal direction compared to transverse. Additionally, greater stresses were observed in the linea alba when loaded in the transverse direction compared to longitudinal. Given these trends, a few recommendations can be made regarding orientation of mesh. The most compliant axis of the biomaterial should be oriented in the cranio-caudal (longitudinal) direction, and the strongest axis of the biomaterial should be oriented in the medial-lateral (transverse) direction. The human abdominal wall is also anisotropic, with anisotropy ratios as high as 8–9 reported for the human linea alba. Current biomaterial designs exhibit anisotropy ratios in the range of 1–3, and it is unclear whether an ideal ratio exists for optimal match between mesh and tissue. This is likely dependent on implantation location as the linea alba, rectus sheath, and other tissues of the abdominal wall exhibit different characteristics. Given the number of unknowns yet to be addressed by studies of the human abdominal wall, it is unlikely that any single biomaterial design currently encompasses all of the ideal features identified. More data on the mechanical properties of the abdominal wall will be needed to establish a full set of guidelines for ideal mesh mechanics including strength, compliance, anisotropy, nonlinearity and hysteresis.
The effect of fabric structure on the mechanical properties of warp knitted surgical mesh for hernia repair
2017, Journal of the Mechanical Behavior of Biomedical Materials
Citation Excerpt :
Pore size is the determinant factor in tissue reaction and biocompatibility of mesh structure (Klinge et al., 2002). Mesh with larger pores induce more collagen deposition, and tissue ingrowth, and better incorporation of the mesh to the tissue (Pascual et al., 2008). The election of surgical mesh is a reconciliation between its biocompatibility and mechanical behavior.
Surgical mesh is being used for healing hernia, pelvic organ prolapse, skull injuries and urinary incontinence. In this research the effect of fabric structure on the mechanical properties of warp knitted surgical meshes in comparison to abdominal fascia has been investigated. For this purpose, warp knitted surgical mesh with five different structures (Tricot, Pin-hole-net, quasi-Sandfly, Sandfly and quasi-Marquissite) were produced using polypropylene monofilament. Thereafter, their mechanical properties such as uniaxial tensile behavior in various directions (wale-wise (90°), course-wise (0°) and diagonal (45°)), bending resistance and crease recovery were analyzed. The meshes demonstrated different elastic modulus in various directions, which can be attributed to the pore shape (pore angle) and underlap angle in the structure of mesh. Except Pin-hole-net mesh, other produced meshes exhibited better level of orthotropy in comparison to abdominal fascia. The most flexible mesh in both wale-wise and course-wise directions was quasi-Sandfly and thereafter quasi-Marquissite. Tricot and Pin-hole-net manifested the highest crease recovery in wale-wise and coursewise directions respectively. The most desirable mesh in terms of porosity was quasi-Marquissite mesh. Overall, the quasi-Marquissite mesh was selected as the most suitable surgical mesh considering all advantages and disadvantages of each produced mesh in this study.
Design strategies and applications of biomaterials and devices for Hernia repair
2016, Bioactive Materials
Hernia repair is one of the most commonly performed surgical procedures worldwide, with a multi-billion dollar global market. Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias, and despite significant progress, there is no ideal mesh for every surgery. This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias. Next, the major milestones in implant design are discussed. Commonly encountered complications and strategies to minimize these adverse effects are described, followed by a thorough description of the implant characteristics necessary for successful repair. Finally, available implants are categorized and their advantages and limitations are elucidated, including non-absorbable and absorbable (synthetic and biologically derived) prostheses, composite prostheses, and coated prostheses. This review not only summarizes the state of the art in hernia repair, but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.

View all citing articles on Scopus

View full text

Original CommunicationEarly tissue incorporation and collagen deposition in lightweight polypropylene meshes: bioassay in an experimental model of ventral hernia

Background

Methods

Results

Conclusions

Section snippets

Experimental animals

Prosthetic materials

Light microscopy

Real time RT-PCR

Discussion

Lancet

Biomaterials

J Surg Res

Am J Surg

J Surg Res

Biomaterials

Mesh compared with non-mesh methods of open groin hernia repair: Systematic Review of randomized controlled trials

Br J Surg

Incisional abdominal hernia: the open mesh repair

Langenbecks Arch Surg

The argument for lightweight polypropylene mesh in hernia repair

Surg Innov

Functional and morphologic properties of a modified mesh for inguinal hernia repair

World J Surg

Functional and morphological evaluation of a low-weight monofilament polypropylene mesh for hernia repair

J Biomed Mater Res

Original Communication
Early tissue incorporation and collagen deposition in lightweight polypropylene meshes: bioassay in an experimental model of ventral hernia