1
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Tanprasert P, Tepmalai K, Chakrabandhu B, Yodkeeree S, Piyamongkol W, Yamada SL. Collagen Deposition and Inflammatory Response Associated with Macroporous Mesh Shrinkage in Incisional Hernia Repair: A Rat Model. J INVEST SURG 2022; 35:1635-1647. [PMID: 35761473 DOI: 10.1080/08941939.2022.2087240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Mesh repair is the current recommendation for the treatment of incisional hernia; however, the best mesh has yet to be determined. The objective of this study was to compare the inflammatory response and collagen deposition in primary incisional hernia repair (P) and different macroporous mesh materials, including polypropylene with poliglecaprone (PP-PG), polyvinylidene fluoride (PVDF), and polyester (PE), using quantitative methods. Methods: Sixty male rats were divided into four groups. Anterior abdominal wall defects were created and either suture or mesh repair was done. Rats were euthanized on days 14, 90, and 180, and the gross findings were recorded. The inflammatory and collagen levels in the abdominal wall tissues were measured using enzyme-linked immunosorbent assay (ELISA). Results: The PE group demonstrated significant mesh shrinkage at 180 days. The extent of PE mesh shrinkage ranged from 22-42% (mean = 30.49%). At 14 days, the PVDF group had higher interleukin-6 (IL-6) levels than the PP-PG (P = .004) and PE groups (P = .019). At 90 days, the collagen type I (Col I) levels in the PE group were significantly lower than those in the others, and the collagen type I/III (Col I/III) ratios in the PE group were lower than those in the P group (P = .006). Conclusions: The persistently high IL-6 levels until 180 days and the decrease in Col I levels and Col I/III ratio at 90 days seem to predict mesh shrinkage at 180 days. The mesh induces high Col I levels, but those associated with low Col III levels should be preferred.
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Affiliation(s)
- Peticha Tanprasert
- Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Division of Gastrointestinal Surgery and Endoscopy, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokkan Tepmalai
- Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Division of Pediatrics Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Bandhuphat Chakrabandhu
- Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Division of Gastrointestinal Surgery and Endoscopy, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Supachai Yodkeeree
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wirawit Piyamongkol
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirikan Limpakan Yamada
- Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Division of Gastrointestinal Surgery and Endoscopy, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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2
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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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3
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Pérez-Köhler B, Benito-Martínez S, Gómez-Gil V, Rodríguez M, Pascual G, Bellón JM. New Insights into the Application of 3D-Printing Technology in Hernia Repair. MATERIALS 2021; 14:ma14227092. [PMID: 34832493 PMCID: PMC8623842 DOI: 10.3390/ma14227092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/29/2022]
Abstract
Abdominal hernia repair using prosthetic materials is among the surgical interventions most widely performed worldwide. These materials, or meshes, are implanted to close the hernial defect, reinforcing the abdominal muscles and reestablishing mechanical functionality of the wall. Meshes for hernia repair are made of synthetic or biological materials exhibiting multiple shapes and configurations. Despite the myriad of devices currently marketed, the search for the ideal mesh continues as, thus far, no device offers optimal tissue repair and restored mechanical performance while minimizing postoperative complications. Additive manufacturing, or 3D-printing, has great potential for biomedical applications. Over the years, different biomaterials with advanced features have been successfully manufactured via 3D-printing for the repair of hard and soft tissues. This technological improvement is of high clinical relevance and paves the way to produce next-generation devices tailored to suit each individual patient. This review focuses on the state of the art and applications of 3D-printing technology for the manufacture of synthetic meshes. We highlight the latest approaches aimed at developing improved bioactive materials (e.g., optimizing antibacterial performance, drug release, or device opacity for contrast imaging). Challenges, limitations, and future perspectives are discussed, offering a comprehensive scenario for the applicability of 3D-printing in hernia repair.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Selma Benito-Martínez
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Verónica Gómez-Gil
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
- Departamento de Ciencias Biomédicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Marta Rodríguez
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Gemma Pascual
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain; (B.P.-K.); (S.B.-M.)
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Correspondence:
| | - Juan Manuel Bellón
- Biomedical Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (V.G.-G.); (M.R.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
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4
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García-García C, Carrascal-Morillo MT, Castell Gómez JT, Bernal Guerrero C, García Prada JC. An approach to evaluating and benchmarking the mechanical behavior of a surgical mesh prototype designed for the repair of abdominal wall defects. J Mech Behav Biomed Mater 2021; 125:104909. [PMID: 34736025 DOI: 10.1016/j.jmbbm.2021.104909] [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: 07/30/2021] [Revised: 09/16/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
Ventral hernia repair is a common surgical procedure in abdominal surgery in which surgical mesh has become an essential tool to improve outcomes. To avoid recurrences the mesh needs to mimic the mechanical behavior of the abdominal wall. In this scenario the mechanical properties at the interface between the mesh and its surrounding tissue is critical for the performance of the device and, therefore, the success after surgery. We aimed to characterize and compare the mechanical behavior of the patented prototype mesh Spider and four commercial meshes at the mesh-tissue interface. The prototype mesh was designed based on the hypothesis that the best performance for a large-sized defect in a ventral hernia is obtained when the mesh presents an isotropic behavior. In contrast, commercial meshes presented significant anisotropic behavior. Mechanical properties of the meshes were characterized through uniaxial tensile tests. Longitudinal and transverse axes were defined for each mesh, and samples were cut in each axis orientation. Samples underwent uniaxial tensile testing, from which the elastic modulus in each axis was determined. The degree of anisotropy was calculated as the ratio between the elastic modulus in each axis. An in silico model of the ventral hernia defect was designed to simulate the mesh-tissue interface behavior via finite element method. Meshes were modeled by an hyperelastic orthotropic constitutive model, which allowed isotropic symmetry as particular case for the prototype mesh. Abdominal wall was modeled using a Neo-Hookean model. Once the simulations were launched, mesh-tissue interface behavior was evaluated through the difference between Von Mises stress values on either size of the interface, both on the external and the internal face of the mesh and abdominal wall. Mechanical response was anisotropic for all commercial meshes and isotropic for the Spider prototype. Among commercial, Ultrapro® was highly anisotropic. Tests revealed Gore-Tex® to be the stiffest, followed by Repol Angimesh®, Spider and Ultrapro®; Duramesh™ was found to be the most compliant. Concerning mesh-tissue behavior, simulation results revealed the Spider prototype and Duramesh™ to be the best; Spider due to its uniformity and lower stress difference thanks to its nearly isotropic behavior, and Duramesh™ due to its compliant behavior. Our results suggest that the compromise between stiffness and anisotropy must be considered in order to improve the mechanical performance of the meshes, bearing in mind that for large-sized ventral defects, nearly isotropic mesh ensures better performance.
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Affiliation(s)
- C García-García
- PhD Programme in Industrial Engineering Technologies, International PhD School (EIDUNED), The National Distance Education University (UNED), Madrid, Spain.
| | - M T Carrascal-Morillo
- Department of Mechanics, ETSI Industriales, The National Distance Education University (UNED), Madrid, Spain
| | | | - C Bernal Guerrero
- Department of Construction and Manufacturing Engineering , ETSI Industriales, The National Distance Education University (UNED), Madrid, Spain
| | - J C García Prada
- Department of Mechanics, ETSI Industriales, The National Distance Education University (UNED), Madrid, Spain
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5
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Morch A, Doucède G, Lecomte-Grosbras P, Brieu M, Rubod C, Cosson M. Pelvic organ prolapse meshes: Can they preserve the physiological behavior? J Mech Behav Biomed Mater 2021; 120:104569. [PMID: 34058600 DOI: 10.1016/j.jmbbm.2021.104569] [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: 06/19/2020] [Revised: 11/24/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Implants for the cure of female genital prolapse still show numerous complications cases that sometimes have dramatic consequences. These implants must be improved to provide physiological support and restore the normal functionalities of the pelvic area. Besides the trend towards lighter meshes, a better understanding of the in vivo role and impact of the mesh implantation is required. This work investigates the mechanical impact of meshes after implantation with regards to the behavior of the native tissues. Three meshes were studied to assess their mechanical and biological impact on the native tissues. An animal study was conducted on rats. Four groups (n = 17/group) underwent surgery. Rats were implanted on the abdominal wall with one of the three polypropylene knitted mesh (one mesh/group). The last group served as control and underwent the same surgery without any mesh implantation. Post-operative complications, contraction, mechanical rigidities, and residual deformation after cyclic loading were collected. Non-parametric statistical comparisons were performed (Kruskal-Wallis) to observe potential differences between implanted and control groups. Mechanical characterization showed that one of the three meshes did not alter the mechanical behavior of the native tissues. On the contrary, the two others drastically increased the rigidities and were also associated with clinical complications. All of the meshes seem to reduce the geometrical lengthening of the biological tissues that comes with repetitive loads. Mechanical aspects might play a key role in the compatibility of the mesh in vivo. One of the three materials that were implanted during an animal study seems to provide better support and adapt more properly to the physiological behavior of the native tissues.
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Affiliation(s)
- Annie Morch
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France
| | - Guillaume Doucède
- Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France
| | - Pauline Lecomte-Grosbras
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France
| | - Mathias Brieu
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; California State University - Los Angeles, College Engineering - Computer Science, and Technology, Dept. Mechanical Engineering, United States
| | - Chrystèle Rubod
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France
| | - Michel Cosson
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France.
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6
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Hu Q, Zhang R, Zhang H, Yang D, Liu S, Song Z, Gu Y, Ramalingam M. Topological Structure Design and Fabrication of Biocompatible PLA/TPU/ADM Mesh with Appropriate Elasticity for Hernia Repair. Macromol Biosci 2021; 21:e2000423. [PMID: 33870647 DOI: 10.1002/mabi.202000423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/21/2021] [Indexed: 11/06/2022]
Abstract
The meshes for hernia repair result in many problems that are related to complications including chronic pain and limited movement due to inadequate mechanical strength, non-absorbability, or low elasticity. In this study, degradable polylactic acid (PLA), synthetic thermoplastic polyurethane (TPU), and acellular dermal matrix (ADM) powders are combined to prepare a novel PLA/TPU/ADM mesh with three different topological structures (square, circular, and diamond) by 3D printing. The physicochemical properties and structural characteristics of mesh are studied, the results show that the diamond structure mesh with the pore size of 3 mm has sufficient elasticity and tensile strength, which provides the efficient mechanical strength required for hernia repair (16 N cm-1 ) and the value more than polypropylene(PP) mesh. Besides, in vitro and in vivo experiments demonstrate human umbilical vein endothelial cells could successfully proliferate on the PLA/TPU/ADM mesh whose biocompatibility with the host is shown using a rat model of abdominal wall defect. In conclusion, the results of this study demonstrate that the PLA/TPU/ADM mesh may be considered a good choice for hernia repair as its potential to overcome the elastic and strength challenges associated with a highly flexible abdominal wall, as well as its good biocompatibility.
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Affiliation(s)
- Qingxi Hu
- Rapid Manufacturing Engineering Center, Shanghai University, Shanghai, 200444, China.,Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai, 200072, China
| | - Rennan Zhang
- Rapid Manufacturing Engineering Center, Shanghai University, Shanghai, 200444, China
| | - Haiguang Zhang
- Rapid Manufacturing Engineering Center, Shanghai University, Shanghai, 200444, China.,Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, Shanghai University, Shanghai, 200072, China
| | - Dongchao Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Suihong Liu
- Rapid Manufacturing Engineering Center, Shanghai University, Shanghai, 200444, China
| | - Zhicheng Song
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Yan Gu
- Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Murugan Ramalingam
- Biomaterials and Organ Engineering Group, Centre for Biomaterials, Cellular and Molecular Theranostics, School of Mechanical Engineering, Vellore Institute of Technology, Vellore, 632014, India
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7
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Morch A, Astruc L, Mayeur O, Witz JF, Lecomte-Grosbras P, Brieu M. Is there any objective and independent characterization and modeling of soft biological tissues? J Mech Behav Biomed Mater 2020; 110:103915. [PMID: 32771881 DOI: 10.1016/j.jmbbm.2020.103915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/28/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
The characterization of soft tissue raises several difficulties. Indeed, soft biological tissues usually shrink when dissected from their in vivo location. This shrinkage is characteristic of the release of residual stresses, since soft tissues are indeed often pre-stressed in their physiological configuration. During experimental loading, large extension at very low level of force are expected and assumed to be related to the progressive recruitment and stretching of fibers. However, the first phase of the mechanical test is also aiming at recovering the pre-stressed in vivo behavior. As a consequence, the initial phase, corresponding to the recovering of prestress and/or recruitment of fiberes, is questionable and frequently removed. One of the preferred methods to erase it consists in applying a preforce or prestress to the sample: this allows to easily get rid of the sample retensioning range. However this operation can impact the interpretation of the identified mechanical parameters. This study presents an evaluation of the impact of the data processing on the mechanical properties of a numerically defined material. For this purpose, a finite element simulation was performed to replicate a uniaxial tensile test on a biological soft tissue sample. The influence of different pre-stretches on the mechanical parameters of a second order Yeoh model was investigated. The Yeoh mechanical parameters, or any other strain energy density, depend strongly on any pre- and post-processing choices: they adapt to compensate the error made when choosing an arbitrary level of prestretch or prestress. This observation spreads to any modeling approach used in soft tissues. Mechanical parameters are indeed naturally bound to the choice of the pre-stretch (or pre-stress) through the elongation and the constitutive law. Regardless of the model, it would therefore be pointless to compare mechanical parameters if the conditions for the processing of experimental raw data are not fully documented.
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Affiliation(s)
- A Morch
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube Laboratoire de mécanique multiphysique et multiéchelle, F-59000, Lille, France
| | - L Astruc
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube Laboratoire de mécanique multiphysique et multiéchelle, F-59000, Lille, France
| | - O Mayeur
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube Laboratoire de mécanique multiphysique et multiéchelle, F-59000, Lille, France
| | - J-F Witz
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube Laboratoire de mécanique multiphysique et multiéchelle, F-59000, Lille, France
| | - P Lecomte-Grosbras
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube Laboratoire de mécanique multiphysique et multiéchelle, F-59000, Lille, France.
| | - M Brieu
- Univ. Lille, CNRS, Centrale Lille, UMR 9013 LaMcube Laboratoire de mécanique multiphysique et multiéchelle, F-59000, Lille, France; California State University, Los Angeles College Engineering, Computer Science and Technology, Dept. Mechanical Engineering, USA
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8
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Lubowiecka I, Tomaszewska A, Szepietowska K, Szymczak C, Śmietański M. In vivo performance of intraperitoneal onlay mesh after ventral hernia repair. Clin Biomech (Bristol, Avon) 2020; 78:105076. [PMID: 32535476 DOI: 10.1016/j.clinbiomech.2020.105076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ventral hernia repair needs to be improved since recurrence, postoperative pain and other complications are still reported in many patients. The behavior of implants in vivo is not sufficiently understood to design a surgical mesh mechanically compatible with the human abdominal wall. METHODS This analysis was based on radiological pictures of patients who underwent laparoscopic ventral hernia repair. The pictures show the trunk of the patient at rest in a standing position and under side bending. The change in the distance between different tacks due to trunk movement was analyzed, which allowed us to determine the in vivo elongation of the mesh incorporated into the abdominal wall. FINDINGS The relative elongations of the surgical mesh varied from a few percent to greater than 100% in two cases. The median of the median relative elongations obtained for all patients is 9.5%, and the median of the maximum relative elongations for all patients is 32.6%. The maximum elongation occurs between tacks that are next to each other. Trunk movement causes implant deformation, and this study provides quantitative information regarding changes in the distance between fasteners. INTERPRETATION The physiological movement of the human abdomen must be regarded as a very important factor in mesh deformation and should be considered in surgical practice to reduce the hernia recurrence rate and postoperative pain.
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Affiliation(s)
- Izabela Lubowiecka
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland.
| | - Agnieszka Tomaszewska
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland
| | - Katarzyna Szepietowska
- Gdansk University of Technology, Faculty of Civil and Environmental Engineering, Gdańsk, Poland
| | - Czesław Szymczak
- Gdansk University of Technology, Faculty of Ocean Engineering and Ship Technology, Gdańsk, Poland
| | - Maciej Śmietański
- Medical University of Gdańsk, 2(nd) Department of Radiology, Hospital Swissmed S.A., Department of Surgery, Poland
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9
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Hu W, Zhang Z, Zhu L, Wen Y, Zhang T, Ren P, Wang F, Ji Z. Combination of Polypropylene Mesh and in Situ Injectable Mussel-Inspired Hydrogel in Laparoscopic Hernia Repair for Preventing Post-Surgical Adhesions in the Piglet Model. ACS Biomater Sci Eng 2020; 6:1735-1743. [PMID: 33455390 DOI: 10.1021/acsbiomaterials.9b01333] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Polypropylene (PP) mesh has been used successfully for a long time in clinical practice as an impressive prosthesis for ventral hernia repair. To utilize a physical barrier for separating mesh from viscera is a general approach for preventing adhesions in clinical practice. However, a serious abdominal adhesion between the mesh and viscera can possibly occur post-hernia, especially with the small intestine; this can lead to a series of complications, such as chronic pain, intestinal obstruction, and fistula. Thus, determining how to prevent abdominal adhesions between the mesh and viscera is still an urgent clinical problem. In this study, a dopamine-functionalized polysaccharide derivative (oxidized-carboxymethylcellulose-g-dopamine, OCMC-DA) was synthesized; this was blended with carboxymethylchitosan (CMCS) to form a hydrogel (OCMC-DA/CMCS) in situ at the appropriate time. The physical and chemical properties of the hydrogel were characterized successfully, and its excellent biocompatibility was presented by the in vitro cell test. The combination of this hydrogel and PP mesh was used in laparoscopic surgery for repairing the abdominal wall defect, where the hydrogel could become fixed in situ on the PP mesh to form an anti-adhesion gel-mesh. The results showed that the gel-mesh could prevent abdominal adhesions effectively in the piglet model. Moreover, the histology and immunohistochemical staining proved that the gel-mesh could effectively alleviate the inflammation reaction and deposition of collagen around the mesh, and it did not disturb the integration between mesh and abdominal wall. Thus, the gel-mesh has superior tissue compatibility.
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Affiliation(s)
- 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.,Collaborative Innovation Center of Tissue Repair Material of Sichuan Province, College of Life Science, China West Normal University, Nanchong 637009, China
| | - Zhigang 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.,Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Long Zhu
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Yazhou Wen
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, 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
| | - 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
| | - Faming Wang
- 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, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
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G.Doucède, Morch A, Pouseele B, Lecomte-Grosbras P, Brieu M, Cosson M, Rubod C. Evolution of the mechanical properties of a medical device regarding implantation time. Eur J Obstet Gynecol Reprod Biol 2019; 242:139-143. [DOI: 10.1016/j.ejogrb.2019.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/12/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
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11
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Pascual G, Mesa-Ciller C, Rodríguez M, Pérez-Köhler B, Gómez-Gil V, Fernández-Gutiérrez M, San Román J, Bellón JM. Pre-clinical assay of the tissue integration and mechanical adhesion of several types of cyanoacrylate adhesives in the fixation of lightweight polypropylene meshes for abdominal hernia repair. PLoS One 2018; 13:e0206515. [PMID: 30388135 PMCID: PMC6214531 DOI: 10.1371/journal.pone.0206515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Lightweight (LW) polypropylene (PP) meshes better adapt to host tissue, causing less fibrosis and inflammatory responses than high-density meshes. Mesh fixation using tissue adhesives (TA) that replace conventional sutures may improve the process of hernia repair and tissue trauma. This preclinical study compares the behavior of different cyanoacrylate-based adhesives in the fixation of LW-PP meshes for hernia repair. METHODS Partial abdominal wall defects were repaired using LW-PP Optilene meshes in New Zealand rabbits. The following groups were established according to the mesh fixation method: Suture (control), Glubran 2 (n-butyl), Ifabond (n-hexyl), SafetySeal (n-butyl) and Evobond (n-octyl). At 14, 90 and 180 days after surgery, the recovered implants were examined to assess the host tissue integration, the macrophage response and the biomechanical strength. RESULTS All the groups showed optimal host tissue incorporation regardless of the fixation procedure. Significantly increased levels of collagen 1 and collagen 3 gene expression (p<0.001) were observed at 14 days compared to the medium- and long-term durations, where the Suture and Glubran groups showed the highest expression of collagen 1. All the adhesives increased the macrophage reaction (p<0.001) compared to sutures at all implant times. Maximal macrophage response was observed in the short-term Glubran group (p<0.01) compared to the rest of the groups. Although SafetySeal and Evobond did not reach the biomechanical resistance of sutures at 14 days, all the adhesives did reach this level in the medium- to long-term periods, providing significantly higher resistance (p<0.05). CONCLUSIONS All the cyanoacrylates, despite inducing a significantly increased macrophage response versus sutures, showed optimal host tissue integration and long-term mechanical behavior; thus, they might be good choices for LW-PP mesh hernia repairs.
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Affiliation(s)
- Gemma Pascual
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
- * E-mail:
| | - Claudia Mesa-Ciller
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Marta Rodríguez
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Bárbara Pérez-Köhler
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Verónica Gómez-Gil
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
| | - Mar Fernández-Gutiérrez
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
- Polymer Biomaterials Group, Polymer Science and Technology Institute-Consejo Superior de Investigaciones Científicas (ICTP-CSIC), Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Julio San Román
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
- Polymer Biomaterials Group, Polymer Science and Technology Institute-Consejo Superior de Investigaciones Científicas (ICTP-CSIC), Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Juan M. Bellón
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
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Lu X, Khanna A, Luzinov I, Nagatomi J, Harman M. Surface modification of polypropylene surgical meshes for improving adhesion with poloxamine hydrogel adhesive. J Biomed Mater Res B Appl Biomater 2018; 107:1047-1055. [PMID: 30267644 DOI: 10.1002/jbm.b.34197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/29/2018] [Accepted: 06/27/2018] [Indexed: 01/18/2023]
Abstract
Tissue adhesive has notable clinical benefits in hernia repair fixation. A novel poloxamine tissue adhesive was previously shown to successfully bond collagen tissue with adequate adhesive strength. In application related to attachment of polypropylene (PP) mesh, the adhesive strength between the mesh and poloxamine hydrogel adhesive is limited by the hydrophobicity of PP monofilaments and lack of covalent bond formation. The purpose of this study was to compare two different surface modifications [bovine serum albumin (BSA) adsorption and poly-glycidyl methacrylate/human serum albumin (PGMA/HSA) grafting] of PP mesh for improving the adhesive strength between poloxamine hydrogel adhesive and PP mesh. The PGMA/HSA surface modification significantly improved the adhesive strength for meshes attached with poloxamine hydrogel tissue adhesive compared with unmodified meshes and meshes modified by BSA adsorption. An area of 1 cm2 adhesive provided for a maximum adhesive strength of 65-70 kPa for meshes modified by PGMA/HSA, 4-13 kPa for meshes modified by BSA, and 22-45 kPa for unmodified meshes. Optical microscopy and infrared spectroscopy (FTIR) confirmed the improved adhesive strength was achieved through mechanical interlock of the hydrogel tissue adhesive into the PP mesh pores and chemical bonding of the albumin after successful PGMA/HSA grafting onto the PP monofilaments. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1047-1055, 2019.
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Affiliation(s)
- Xinyue Lu
- Bioengineering Department, Clemson University, Clemson, South Carolina
| | - Astha Khanna
- Bioengineering Department, Clemson University, Clemson, South Carolina
| | - Igor Luzinov
- Materials Science and Engineering Department, Clemson University, Clemson, South Carolina
| | - Jiro Nagatomi
- Bioengineering Department, Clemson University, Clemson, South Carolina
| | - Melinda Harman
- Bioengineering Department, Clemson University, Clemson, South Carolina
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13
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Computational modeling of abdominal hernia laparoscopic repair with a surgical mesh. Int J Comput Assist Radiol Surg 2017; 13:73-81. [DOI: 10.1007/s11548-017-1681-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022]
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14
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Biomechanical and histologic evaluation of two application forms of surgical glue for mesh fixation to the abdominal wall. J Mech Behav Biomed Mater 2017; 75:434-441. [DOI: 10.1016/j.jmbbm.2017.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/30/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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15
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Deeken CR, Lake SP. Mechanical properties of the abdominal wall and biomaterials utilized for hernia repair. J Mech Behav Biomed Mater 2017; 74:411-427. [DOI: 10.1016/j.jmbbm.2017.05.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 12/29/2022]
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16
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Modelling of compressible and orthotropic surgical mesh implants based on optical deformation measurement. J Mech Behav Biomed Mater 2017; 74:400-410. [DOI: 10.1016/j.jmbbm.2017.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/06/2017] [Accepted: 06/09/2017] [Indexed: 12/29/2022]
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17
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Todros S, Pachera P, Pavan PG, Natali AN. Investigation of the Mechanical Behavior of Polyester Meshes for Abdominal Surgery: A Preliminary Study. J Med Biol Eng 2017. [DOI: 10.1007/s40846-017-0337-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Kahan LG, Lake SP, McAllister JM, Tan WH, Yu J, Thompson D, Brunt LM, Blatnik JA. Combined in vivo and ex vivo analysis of mesh mechanics in a porcine hernia model. Surg Endosc 2017; 32:820-830. [DOI: 10.1007/s00464-017-5749-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/14/2017] [Indexed: 12/29/2022]
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19
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Multi-directional mechanical analysis of synthetic scaffolds for hernia repair. J Mech Behav Biomed Mater 2017; 71:43-53. [DOI: 10.1016/j.jmbbm.2017.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/17/2022]
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20
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Kahan LG, Guertler C, Blatnik JA, Lake SP. Validation of Single C-Arm Fluoroscopic Technique for Measuring In Vivo Abdominal Wall Deformation. J Biomech Eng 2017; 139:2633404. [DOI: 10.1115/1.4037073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Indexed: 11/08/2022]
Abstract
Hernia meshes significantly reduce the recurrence rates in hernia repair. It is known that they affect the abdominal wall postimplantation, yet the understanding of in vivo mechanics in the mesh placement area is lacking. We established a single C-arm biplane fluoroscopic system to study strains at the interface between the mesh and repaired abdominal tissues. We aimed to validate this system for future porcine hernia repair studies. Custom matlab programs were written to correct for pincushion distortion, and direct linear transformation (DLT) reconstructed objects in 3D. Using a custom biplane-trough setup, image sets were acquired throughout the calibrated volume to evaluate a radio-opaque test piece with known distances between adjacent beads. Distances were measured postprocessing and compared to known measurements. Repeatability testing was conducted by taking image sets of the test piece in a fixed location to determine system movement. The error in areal stretch tracking was evaluated by imaging a square plate with fixed radio-opaque beads and using matlab programs to compare the measured areal stretch to known bead positions. Minor differences between measured and known distances in the test piece were not statistically different, and the system yielded a 0.01 mm bias in the XY plane and a precision of 0.61 mm. The measured areal stretch was 0.996, which was not significantly different than the expected value of 1. In addition, preliminary stretch data for a hernia mesh in a porcine model demonstrated technique feasibility to measure in vivo porcine abdominal mechanics.
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Affiliation(s)
- Lindsey G. Kahan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63130 e-mail:
| | - Charlotte Guertler
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO 63130 e-mail:
| | - Jeffrey A. Blatnik
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63130 e-mail:
| | - Spencer P. Lake
- Mem. ASME Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130
- Department of Orthopaedic Surgery, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130
- Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130 e-mail:
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Ciritsis A, Horbach A, Staat M, Kuhl CK, Kraemer NA. Porosity and tissue integration of elastic mesh implants evaluatedin vitroandin vivo. J Biomed Mater Res B Appl Biomater 2017; 106:827-833. [DOI: 10.1002/jbm.b.33877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/03/2017] [Accepted: 02/20/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Alexander Ciritsis
- Department of Diagnostic and Interventional Radiology; RWTH University Hospital Aachen; Aachen Germany
| | - Andreas Horbach
- Institute for Bioengineering; FH Aachen University of Applied Sciences, Jülich Campus; Jülich Germany
| | - Manfred Staat
- Institute for Bioengineering; FH Aachen University of Applied Sciences, Jülich Campus; Jülich Germany
| | - Christiane K. Kuhl
- Department of Diagnostic and Interventional Radiology; RWTH University Hospital Aachen; Aachen Germany
| | - Nils Andreas Kraemer
- Department of Diagnostic and Interventional Radiology; RWTH University Hospital Aachen; Aachen Germany
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22
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Experimental study of the mechanical behavior of an explanted mesh: The influence of healing. J Mech Behav Biomed Mater 2017; 65:190-199. [DOI: 10.1016/j.jmbbm.2016.07.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 11/17/2022]
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23
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Calvo B, Pascual G, Peña E, Pérez-Khöler B, Rodríguez M, Bellón J. Biomechanical and morphological study of a new elastic mesh (Ciberlastic) to repair abdominal wall defects. J Mech Behav Biomed Mater 2016; 59:366-378. [DOI: 10.1016/j.jmbbm.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/28/2016] [Accepted: 02/04/2016] [Indexed: 11/30/2022]
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24
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PAVAN PIEROGIOVANNI, PACHERA PAOLA, TODROS SILVIA, TIENGO CESARE, NATALI ARTURONICOLA. MECHANICAL CHARACTERIZATION OF ANIMAL DERIVED GRAFTS FOR SURGICAL IMPLANTATION. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bioprostheses obtained from animal models are often adopted in abdominal surgery for repair and reconstruction. The functionality of these prosthetic implants is related also to their mechanical characteristics that are analyzed here. This work illustrates a constitutive model to describe the short-term mechanical response of Permacol[Formula: see text] bioprostheses. Experimental tests were developed on tissue samples to highlight mechanical non-linear characteristics and viscoelastic phenomena. Uni-axial tensile tests were developed to evaluate the strength and strain stiffening. Incremental uni-axial stress relaxation tests were carried out at nominal strain ranging from 10% to 20% and to monitor the stress relaxation process up to 400[Formula: see text]s. The constitutive model effectively describes the mechanical behavior found in experimental testing. The mechanical response appears to be independent on the loading direction, showing that the tissue can be considered as isotropic. The viscoelastic response of the tissue shows a strong decay of the stress in the first seconds of the relaxation process. The investigation performed is aimed at a general characterization of the biomechanical response and addresses the development of numerical models to evaluate the biomechanical performance of the graft with surrounding host tissues.
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Affiliation(s)
- PIERO GIOVANNI PAVAN
- Department of Industrial Engineering, Centre of Mechanics of Biological Materials, University of Padova, Via G. Colombo 3, Padova I-35131, Italy
| | - PAOLA PACHERA
- Department of Industrial Engineering, Centre of Mechanics of Biological Materials, University of Padova, Via G. Colombo 3, Padova I-35131, Italy
| | - SILVIA TODROS
- Department of Industrial Engineering, Centre of Mechanics of Biological Materials, University of Padova, Via G. Colombo 3, Padova I-35131, Italy
| | - CESARE TIENGO
- Department of Molecular Medicine, University of Padova, Via A. Gabelli 63, Padova I-35131, Italy
| | - ARTURO NICOLA NATALI
- Department of Industrial Engineering, Centre of Mechanics of Biological Materials, University of Padova, Via G. Colombo 3, Padova I-35131, Italy
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25
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Todros S, Pavan PG, Pachera P, Natali AN. Synthetic surgical meshes used in abdominal wall surgery: Part II-Biomechanical aspects. J Biomed Mater Res B Appl Biomater 2015; 105:892-903. [PMID: 26687728 DOI: 10.1002/jbm.b.33584] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/26/2015] [Accepted: 11/18/2015] [Indexed: 01/29/2023]
Abstract
This work reports the second part of a review on synthetic surgical meshes used for abdominal hernia repair. While material and structural characteristics, together with mesh-tissue interaction, were considered in a previous article (Part I), biomechanical behavior is described here in more detail. The role of the prosthesis is to strengthen the impaired abdominal wall, mimicking autologous tissue without reducing its compliance. Consequently, mesh mechanical properties play a crucial role in a successful surgical repair. The main available techniques for mechanical testing, such as uniaxial and biaxial tensile testing, ball burst, suture retention strength, and tear resistance testing, are described in depth. Among these methods, the biaxial tensile test is the one that can more faithfully reproduce the physiological loading condition. An outline of the most significant results documented in the literature is reported, showing the variety of data on mesh mechanical properties. Synthetic surgical meshes generally follow a non-linear stress-strain behavior, with mechanical characteristics dependant on test direction due to mesh anisotropy. Ex-vivo tests revealed an increased stiffness in mesh explants due to the gradual ingrowth of the host tissue after implant. In general, the absence of standardization in test methods and terminology makes it difficult to compare results from different studies. Numerical models of the abdominal wall interacting with surgical meshes were also discussed representing a potential tool for the selection of suitable prostheses. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 892-903, 2017.
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Affiliation(s)
- S Todros
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - P G Pavan
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - P Pachera
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - A N Natali
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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26
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Todros S, Pavan PG, Natali AN. Synthetic surgical meshes used in abdominal wall surgery: Part I-materials and structural conformation. J Biomed Mater Res B Appl Biomater 2015; 105:689-699. [PMID: 26671827 DOI: 10.1002/jbm.b.33586] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/26/2015] [Accepted: 11/18/2015] [Indexed: 01/08/2023]
Abstract
Surgical implants are commonly used in abdominal wall surgery for hernia repair. Many different prostheses are currently offered to surgeons, comprising permanent synthetic polymer meshes and biologic scaffolds. There is a wide range of synthetic meshes currently available on the market with differing chemical compositions, fiber conformations, and mesh textures. These chemical and structural characteristics determine a specific biochemical and mechanical behavior and play a crucial role in guaranteeing a successful post-operative outcome. Although an increasing number of studies report on the structural and mechanical properties of synthetic surgical meshes, nowadays there are no consistent guidelines for the evaluation of mechanical biocompatibility or common criteria for the selection of prostheses. The aim of this work is to review synthetic meshes by considering the extensive bibliography documentation of their use in abdominal wall surgery, taking into account their material and structural properties, in Part I, and their mechanical behavior, in Part II. The main materials available for the manufacture of polymeric meshes are described, including references to their chemical composition, fiber conformation, and textile structural properties. These characteristics are decisive for the evaluation of mesh-tissue interaction process, including foreign body response, mesh encapsulation, infection, and adhesion formation. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 689-699, 2017.
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Affiliation(s)
- S Todros
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - P G Pavan
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - A N Natali
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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27
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Biaxial Mechanical Evaluation of Absorbable and Nonabsorbable Synthetic Surgical Meshes Used for Hernia Repair: Physiological Loads Modify Anisotropy Response. Ann Biomed Eng 2015; 44:2181-8. [DOI: 10.1007/s10439-015-1503-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
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28
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Todros S, Pavan PG, Natali AN. Biomechanical properties of synthetic surgical meshes for pelvic prolapse repair. J Mech Behav Biomed Mater 2015; 55:271-285. [PMID: 26615384 DOI: 10.1016/j.jmbbm.2015.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 12/27/2022]
Abstract
Synthetic meshes are widely used for surgical repair of different kind of prolapses. In the light of the experience of abdominal wall repair, similar prostheses are currently used in the pelvic region, to restore physiological anatomy after organ prolapse into the vaginal wall, that represent a recurrent dysfunction. For this purpose, synthetic meshes are surgically positioned in contact with the anterior and/or posterior vaginal wall, to inferiorly support prolapsed organs. Nonetheless, while mesh implantation restores physiological anatomy, it is often associated with different complications in the vaginal region. These potentially dangerous effects induce the surgical community to reconsider the safety and efficacy of mesh transvaginal placement. For this purpose, the evaluation of state-of-the-art research may provide the basis for a comprehensive analysis of mesh compatibility and functionality. The aim of this work is to review synthetic surgical meshes for pelvic organs prolapse repair, taking into account the mechanics of mesh material and structure, and to relate them with pelvic and vaginal tissue biomechanics. Synthetic meshes are currently available in different chemical composition, fiber and textile conformations. Material and structural properties are key factors in determining mesh biochemical and mechanical compatibility in vivo. The most significant results on vaginal tissue and surgical meshes mechanical characterization are here reported and discussed. Moreover, computational models of the pelvic region, which could support the surgeon in the evaluation of mesh performances in physiological conditions, are recalled.
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Affiliation(s)
- S Todros
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, I-35131 Padova, Italy.
| | - P G Pavan
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, I-35131 Padova, Italy
| | - A N Natali
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, I-35131 Padova, Italy
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Simón-Allué R, Montiel J, Bellón J, Calvo B. Developing a new methodology to characterize in vivo the passive mechanical behavior of abdominal wall on an animal model. J Mech Behav Biomed Mater 2015. [DOI: 10.1016/j.jmbbm.2015.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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30
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Lambertz A, van den Hil LCL, Schöb DS, Binnebösel M, Kroh A, Klinge U, Neumann UP, Klink CD. Analysis of adhesion formation of a new elastic thermoplastic polyurethane (TPU) mesh in comparison to polypropylene (PP) meshes in IPOM position. J Mech Behav Biomed Mater 2015; 53:366-372. [PMID: 26406584 DOI: 10.1016/j.jmbbm.2015.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/28/2015] [Accepted: 08/30/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postsurgical adhesions severely affect the patients' quality of life causing various complications like bowel obstruction or chronic pain. Especially the implantation of alloplastic prostheses in IPOM position for hernia repair carries a high risk of adhesion formation due to the close contact between mesh and viscera. The extent of adhesions mainly depends on the type and textile characteristics of the implanted mesh. The aim of this study was to examine the degree of adhesion formation of a newly developed, elastic thermoplastic polyurethane (TPU) mesh in comparison to polypropylene (PP) meshes in IPOM position in a rabbit model. METHODS Sixteen female chinchilla rabbits were laparoscopically operated. Two different meshes were placed to the left and the right lower abdominal wall in IPOM position in each rabbit. After 7 or 21 days, midline laparotomy was performed, the degree of adhesion formation was examined by the Diamond score and mesh elongation was measured under a force of 3N. Finally, the abdominal walls were explanted for immunohistochemical and histopathological investigations. RESULTS TPU meshes showed significantly lower Diamond scores than PP meshes. After explantation, mesh elongation of the TPU mesh was significantly larger than expansion of PP under a force of 3N. Thus, the TPU mesh preserved its elastic properties after 7 and 21 days. The amount of CD68 positive, Ki67 positive and apoptotic cells within the granuloma around the fibers did not show significant differences between the study groups. CONCLUSIONS The newly developed TPU mesh seems to reduce peritoneal adhesion formation in IPOM position in a rabbit model compared to PP meshes after 7 and 21 days. Immunohistochemistry did not reveal differences in biocompatibility of the two meshes used.
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Affiliation(s)
- A Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany.
| | - L C L van den Hil
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany; Department of General Surgery, Maastricht University Medical Centre, Netherlands
| | - D S Schöb
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - M Binnebösel
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - A Kroh
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - U Klinge
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
| | - C D Klink
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Germany
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Mechanical biocompatibility of highly deformable biomedical materials. J Mech Behav Biomed Mater 2015; 48:100-124. [DOI: 10.1016/j.jmbbm.2015.03.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/22/2015] [Accepted: 03/24/2015] [Indexed: 12/20/2022]
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Lambertz A, Vogels RRM, Binnebösel M, Schöb DS, Kossel K, Klinge U, Neumann UP, Klink CD. Elastic mesh with thermoplastic polyurethane filaments preserves effective porosity of textile implants. J Biomed Mater Res A 2015; 103:2654-60. [DOI: 10.1002/jbm.a.35411] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/10/2014] [Accepted: 01/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Andreas Lambertz
- Department of General; Visceral and Transplantation Surgery; RWTH Aachen University Hospital; 52074 Aachen Germany
| | - Ruben R. M. Vogels
- Department of General; Visceral and Transplantation Surgery; RWTH Aachen University Hospital; 52074 Aachen Germany
- Department of General Surgery; Maastricht University Medical Centre; 6211 LK Maastricht The Netherlands
| | - Marcel Binnebösel
- Department of General; Visceral and Transplantation Surgery; RWTH Aachen University Hospital; 52074 Aachen Germany
| | - Dominik S. Schöb
- Department of General; Visceral and Transplantation Surgery; RWTH Aachen University Hospital; 52074 Aachen Germany
| | - Klas Kossel
- Institut Fuer Textiltechnik at RWTH Aachen University; 52074 Aachen Germany
| | - Uwe Klinge
- Department of General; Visceral and Transplantation Surgery; RWTH Aachen University Hospital; 52074 Aachen Germany
| | - Ulf P. Neumann
- Department of General; Visceral and Transplantation Surgery; RWTH Aachen University Hospital; 52074 Aachen Germany
| | - Christian D. Klink
- Department of General; Visceral and Transplantation Surgery; RWTH Aachen University Hospital; 52074 Aachen Germany
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Podwojewski F, Otténio M, Beillas P, Guérin G, Turquier F, Mitton D. Mechanical response of human abdominal walls ex vivo: Effect of an incisional hernia and a mesh repair. J Mech Behav Biomed Mater 2014; 38:126-33. [DOI: 10.1016/j.jmbbm.2014.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/26/2014] [Accepted: 07/01/2014] [Indexed: 11/15/2022]
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Lambertz A, Vogels RRM, Busch D, Schuster P, Jockenhövel S, Neumann UP, Klinge U, Klink CD. Laparotomy closure using an elastic suture: A promising approach. J Biomed Mater Res B Appl Biomater 2014; 103:417-23. [DOI: 10.1002/jbm.b.33222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/25/2014] [Accepted: 05/17/2014] [Indexed: 11/11/2022]
Affiliation(s)
- A. Lambertz
- Department of General; Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen; Aachen Germany
| | - R. R. M. Vogels
- Department of General; Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen; Aachen Germany
- Department of General Surgery; Maastricht University Medical Centre; Maastricht The Netherlands
| | - D. Busch
- Department of General; Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen; Aachen Germany
| | - P. Schuster
- Institut fuer Textiltechnik at RWTH Aachen University; Aachen Germany
| | - S. Jockenhövel
- Institut fuer Textiltechnik at RWTH Aachen University; Aachen Germany
| | - U. P. Neumann
- Department of General; Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen; Aachen Germany
| | - U. Klinge
- Department of General; Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen; Aachen Germany
| | - C. D. Klink
- Department of General; Visceral and Transplantation Surgery, University Hospital of the RWTH Aachen; Aachen Germany
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Revisión de una clasificación de materiales protésicos destinados a la reparación herniaria: correlación entre estructura y comportamiento en los tejidos receptores. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rehah.2014.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gómez-Gil V, Pascual G, Pérez-Köhler B, Cifuentes A, Buján J, Bellón JM. Involvement of transforming growth factor-β3 and betaglycan in the cytoarchitecture of postoperative omental adhesions. J Surg Res 2013; 187:699-711. [PMID: 24332552 DOI: 10.1016/j.jss.2013.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adhesions commonly appear in patients after abdominal surgery, with considerable individual variation in adhesion composition and severity of the repair process. Here, we address the influence of transforming growth factor (TGF)-β3 and betaglycan in this response, in relation to TGF-β1, in an adhesiogenic rabbit model. MATERIALS AND METHODS Omental adhesions were recovered 3, 7, 14, and 90 d after the implantation of a polypropylene mesh on the parietal peritoneum in New Zealand White rabbits. Omentum from nonoperated animals served as control. Tissue specimens were examined for TGF-β3 and TGF-β1 (Western blotting, reverse transcription-polymerase chain reaction), and TGF-β1:TGF-β3 messenger RNA and protein expression ratios were analyzed. Immunohistochemical detection of TGF-β3 and betaglycan was performed. RESULTS Injury to the omentum led to mobilization of TGF-β3 and betaglycan-expressing cells from milky spots. Fibrous zones in adhesions were simultaneous to the presence of TGF-β1 and the membrane-bound form of betaglycan (7-d adhesions), whereas soluble betaglycan appeared in TGF-β1-positive areas showing limited fibrosis (3-d adhesions). The elevated expression of TGF-β3 concurrent with the presence of membrane-bound form of betaglycan was observed in zones of adipose regeneration (14-d adhesions), whereas zones of fibrous consistency were negative for TGF-β3. CONCLUSIONS Milky spots on the omentum contain inflammatory/immune cells positive for TGF-β3, TGF-β1, and betaglycan, playing a role in the damaged omentum repair. Our observations support the contribution of TGF-β3 to tissue repair through adipose tissue regeneration and the profibrotic role of TGF-β1 and suggest that these effects on the local wound repair response could be driven by the expression of betaglycan in its soluble or membrane-bound form.
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Affiliation(s)
- Verónica Gómez-Gil
- Department of Medicine and Medical Specialties, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Gemma Pascual
- Department of Medicine and Medical Specialties, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Bárbara Pérez-Köhler
- Department of Surgery, Medical and Social Sciences, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Alberto Cifuentes
- Department of Medicine and Medical Specialties, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Julia Buján
- Department of Medicine and Medical Specialties, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Juan M Bellón
- Department of Surgery, Medical and Social Sciences, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.
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Pascual G, Sotomayor S, Rodríguez M, Bayon Y, Bellón JM. Behaviour of a new composite mesh for the repair of full-thickness abdominal wall defects in a rabbit model. PLoS One 2013; 8:e80647. [PMID: 24236192 PMCID: PMC3827430 DOI: 10.1371/journal.pone.0080647] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 10/06/2013] [Indexed: 12/31/2022] Open
Abstract
Introduction Composite biomaterials designed for the repair of abdominal wall defects are composed of a mesh component and a laminar barrier in contact with the visceral peritoneum. This study assesses the behaviour of a new composite mesh by comparing it with two latest-generation composites currently used in clinical practice. Methods Defects (7x5cm) created in the anterior abdominal wall of New Zealand White rabbits were repaired using a polypropylene mesh and the composites: PhysiomeshTM; VentralightTM and a new composite mesh with a three-dimensional macroporous polyester structure and an oxidized collagen/chitosan barrier. Animals were sacrificed on days 14 and 90 postimplant. Specimens were processed to determine host tissue incorporation, gene/protein expression of neo-collagens (RT-PCR/immunofluorescence), macrophage response (RAM-11-immunolabelling) and biomechanical resistance. On postoperative days 7/14, each animal was examined laparoscopically to quantify adhesions between the visceral peritoneum and implant. Results The new composite mesh showed the lowest incidence of seroma in the short term. At each time point, the mesh surface covered with adhesions was greater in controls than composites. By day 14, the implants were fully infiltrated by a loose connective tissue that became denser over time. At 90 days, the peritoneal mesh surface was lined with a stable mesothelium. The new composite mesh induced more rapid tissue maturation than PhysiomeshTM, giving rise to a neoformed tissue containing more type I collagen. In VentralightTM the macrophage reaction was intense and significantly greater than the other composites at both follow-up times. Tensile strengths were similar for each biomaterial. Conclusions All composites showed optimal peritoneal behaviour, inducing good peritoneal regeneration and scarce postoperative adhesion formation. A greater foreign body reaction was observed for VentralightTM. All composites induced good collagen deposition accompanied by optimal tensile strength. The three-dimensional macroporous structure of the new composite mesh may promote rapid tissue regeneration within the mesh.
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Affiliation(s)
- Gemma Pascual
- Department of Surgery and Medical Specialties. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Faculty of Medicine, Alcalá University, Alcalá de Henares, Madrid, Spain
| | - Sandra Sotomayor
- Department of Surgery and Medical Specialties. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Faculty of Medicine, Alcalá University, Alcalá de Henares, Madrid, Spain
| | - Marta Rodríguez
- Department of Surgery and Medical Specialties. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Faculty of Medicine, Alcalá University, Alcalá de Henares, Madrid, Spain
| | - Yves Bayon
- Covidien – Sofradim Production, Trévoux, France
| | - Juan M. Bellón
- Department of Surgery and Medical Specialties. Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN). Faculty of Medicine, Alcalá University, Alcalá de Henares, Madrid, Spain
- * E-mail:
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Hernández-Gascón B, Peña E, Grasa J, Pascual G, Bellón JM, Calvo B. Mechanical Response of the Herniated Human Abdomen to the Placement of Different Prostheses. J Biomech Eng 2013; 135:51004. [DOI: 10.1115/1.4023703] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 02/19/2013] [Indexed: 01/02/2023]
Abstract
This paper describes a method designed to model the repaired herniated human abdomen just after surgery and examine its static mechanical response to the maximum intra-abdominal pressure provoked by a physiological movement (standing cough). The model is based on the real geometry of the human abdomen bearing a large incisional hernia with several anatomical structures differentiated by MRI. To analyze the outcome of hernia repair, the surgical procedure was simulated by modeling a prosthesis placed over the hernia. Three surgical meshes with different mechanical properties were considered: an isotropic heavy-weight mesh (Surgipro®), a slightly anisotropic light-weight mesh (Optilene®), and a highly anisotropic medium-weight mesh (Infinit®). Our findings confirm that anisotropic implants need to be positioned such that the most compliant axis of the mesh coincides with the craneo-caudal direction of the body.
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Affiliation(s)
| | | | - Jorge Grasa
- Associate Professor e-mail: Aragón Institute of Engineering Research (I3A), University of Zaragoza, CIBER-BBN, Centro de Investigación en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza 50018, Spain
| | - Gemma Pascual
- Associate Professor Faculty of Medicine, Department of Medical Specialities, University of Alcalá, CIBER-BBN, Centro de Investigación en Red en Bioingeniería, Biomateriales y Nanomedicina, Alcalá 28871, Spain e-mail:
| | - Juan M. Bellón
- Professor Faculty of Medicine, Department of Surgery, University of Alcalá, CIBER-BBN, Centro de Investigación en Red en Bioingeniería, Biomateriales y Nanomedicina, Alcalá 28871, Spain e-mail:
| | - Begoña Calvo
- Professor Aragón Institute of Engineering Research (I3A), University of Zaragoza, CIBER-BBN, Centro de Investigación en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza 50018, Spain e-mail:
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Hernández-Gascón B, Espés N, Peña E, Pascual G, Bellón J, Calvo B. Computational framework to model and design surgical meshes for hernia repair. Comput Methods Biomech Biomed Engin 2012; 17:1071-85. [DOI: 10.1080/10255842.2012.736967] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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40
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Podwojewski F, Otténio M, Beillas P, Guérin G, Turquier F, Mitton D. Mechanical response of animal abdominal walls in vitro: evaluation of the influence of a hernia defect and a repair with a mesh implanted intraperitoneally. J Biomech 2012; 46:561-6. [PMID: 23099202 DOI: 10.1016/j.jbiomech.2012.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/04/2012] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
Abstract
Better mechanical knowledge of the abdominal wall is requested to further develop and validate numerical models. The aim of this study was to characterize the passive behaviour of the abdominal wall under three configurations: intact, after creating a defect simulating an incisional hernia, and after a repair with a mesh implanted intraperitonally. For each configuration, controlled boundary conditions were applied (air pressure and then contact loading) to the abdominal wall. 3D local strain fields were determined by digital image correlation. Local strains measured on the internal and external surfaces of the intact abdominal wall showed different patterns. The air pressure and the force applied to the abdominal wall during contact loading were measured and used to determine stiffness. The presence of a defect resulted in a significant decrease of the global stiffness compared to the intact abdominal wall (about 25%). In addition, the presence of the mesh enabled to restore the stiffness to values that were not significantly different from those of the intact wall. These results suggest that intraperitoneal mesh seems to restore the global biomechanics of the abdomen.
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