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Schmitz SM, Helmedag MJ, Kossel KM, Eickhoff RM, Heise D, Kroh A, Mechelinck M, Gries T, Jockenhoevel S, Neumann UP, Lambertz A. Novel Elastic Threads for Intestinal Anastomoses: Feasibility and Mechanical Evaluation in a Porcine and Rabbit Model. Int J Mol Sci 2022; 23:ijms23105389. [PMID: 35628199 PMCID: PMC9141788 DOI: 10.3390/ijms23105389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/01/2022] [Accepted: 05/09/2022] [Indexed: 12/10/2022] Open
Abstract
Gastrointestinal anastomoses are an important source of postoperative complications. In particular, the ideal suturing material is still the subject of investigation. Therefore, this study aimed to evaluate a newly developed suturing material with elastic properties made from thermoplastic polyurethane (TPU); Polyvinylidene fluoride (PVDF) and TPU were tested in two different textures (round and a modified, “snowflake” structure) in 32 minipigs, with two anastomoses of the small intestine sutured 2 m apart. After 90 days, the anastomoses were evaluated for inflammation, the healing process, and foreign body reactions. A computer-assisted immunohistological analysis of staining for Ki67, CD68, smooth muscle actin (SMA), and Sirius red was performed using TissueFAXS. Additionally, the in vivo elastic properties of the material were assessed by measuring the suture tension in a rabbit model. Each suture was tested twice in three rabbits; No major surgical complications were observed and all anastomoses showed adequate wound healing. The Ki67+ count and SMA area differed between the groups (F (3, 66) = 5.884, p = 0.0013 and F (3, 56) = 6.880, p = 0.0005, respectively). In the TPU-snowflake material, the Ki67+ count was the lowest, while the SMA area provided the highest values. The CD68+ count and collagen I/III ratio did not differ between the groups (F (3, 69) = 2.646, p = 0.0558 and F (3, 54) = 0.496, p = 0.686, respectively). The suture tension measurements showed a significant reduction in suture tension loss for both the TPU threads; Suturing material made from TPU with elastic properties proved applicable for intestinal anastomoses in a porcine model. In addition, our results suggest a successful reduction in tissue incision and an overall suture tension homogenization.
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Affiliation(s)
- Sophia M. Schmitz
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany; (R.M.E.); (D.H.); (A.K.); (U.P.N.); (A.L.)
- Correspondence: (S.M.S.); (M.J.H.); Tel.: +49-241-80-36215 (S.M.S)
| | - Marius J. Helmedag
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany; (R.M.E.); (D.H.); (A.K.); (U.P.N.); (A.L.)
- Correspondence: (S.M.S.); (M.J.H.); Tel.: +49-241-80-36215 (S.M.S)
| | - Klas-Moritz Kossel
- Institute fuer Textiltechnik, RWTH Aachen University, 52074 Aachen, Germany; (K.-M.K.); (T.G.)
- Department of Biohybrid and Medical Textiles (BioTex) at AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany;
| | - Roman M. Eickhoff
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany; (R.M.E.); (D.H.); (A.K.); (U.P.N.); (A.L.)
| | - Daniel Heise
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany; (R.M.E.); (D.H.); (A.K.); (U.P.N.); (A.L.)
| | - Andreas Kroh
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany; (R.M.E.); (D.H.); (A.K.); (U.P.N.); (A.L.)
| | - Mare Mechelinck
- Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany;
| | - Thomas Gries
- Institute fuer Textiltechnik, RWTH Aachen University, 52074 Aachen, Germany; (K.-M.K.); (T.G.)
| | - Stefan Jockenhoevel
- Department of Biohybrid and Medical Textiles (BioTex) at AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany;
| | - Ulf P. Neumann
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany; (R.M.E.); (D.H.); (A.K.); (U.P.N.); (A.L.)
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Andreas Lambertz
- Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany; (R.M.E.); (D.H.); (A.K.); (U.P.N.); (A.L.)
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Helmedag M, Heise D, Eickhoff R, Kossel KM, Gries T, Jockenhoevel S, Neumann UP, Klink CD, Lambertz A. Cross-section modified and highly elastic sutures reduce tissue incision and show comparable biocompatibility: in-vitro and in-vivo evaluation of novel thermoplastic urethane surgical threads. J Biomed Mater Res B Appl Biomater 2020; 109:693-702. [PMID: 33098257 DOI: 10.1002/jbm.b.34734] [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: 03/04/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/11/2022]
Abstract
Surgical sutures are indispensable for a vast majority of operative procedures. An ideal suture is characterized by high tissue compliance without cutting into the mended tissue and optimal biocompatibility. Therefore, we assessed these mechanical and biological properties for novel elastic thermoplastic polyurethane (TPU) and cross-sectional modified "snowflake" sutures. Circular and "snowflake"-shaped TPU threads were manufactured and compared to similar surface modified polyvinylidene fluoride (PVDF) sutures. Regular PVDF sutures were used as the control group. Single-axis tensile test with and without gelatinous tissue surrogates were performed to evaluate the suture incision into the specimens. Biocompatibility was evaluated by subcutaneous implantation (n = 18) in rats for 7 and 21 days. Histology and immunohistology was conducted for assessment of the foreign body reaction. Regular and modified TPU threads showed a significant reduction of incision into the tissue surrogates compared to the control. Both TPU sutures and the modified PVDF sutures achieved comparable biocompatibility versus regular PVDF threads. Detailed histology revealed novel tissue integration into the notches of the surface modified sutures, we termed this newly shaped granuloma "intrafilamentous" granuloma. Elastic TPU threads showed a significant reduction of tissue surrogate incision and suture tension loss. Biocompatibility did not significantly differ from standard PVDF. Histology demonstrated tissue ingrowth following the surface modification of the suture referred to as "intrafilamentous" granuloma. Further in vivo studies are required to illuminate the exact potential of the new sutures to optimize intestinal anastomosis.
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Affiliation(s)
- Marius Helmedag
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Roman Eickhoff
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Klas-Moritz Kossel
- Institute of Textile Technology and Chair for Textile Machinery, RWTH Aachen University, Aachen, Germany.,Department of Biohybrid and Medical Textiles (BioTex) at AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Thomas Gries
- Institute of Textile Technology and Chair for Textile Machinery, RWTH Aachen University, Aachen, Germany
| | - Stefan Jockenhoevel
- Department of Biohybrid and Medical Textiles (BioTex) at AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian Daniel Klink
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Eickhoff RM, Kroh A, Eickhoff S, Heise D, Helmedag MJ, Tolba RH, Klinge U, Neumann UP, Klink CD, Lambertz A. A peritoneal defect covered by intraperitoneal mesh prosthesis effects an increased and distinctive foreign body reaction in a minipig model. J Biomater Appl 2020; 35:732-739. [PMID: 33331198 DOI: 10.1177/0885328220963918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of incisional hernia is with up to 30% one of the frequent long-term complication after laparotomy. After establishing minimal invasive operations, the laparoscopic intraperitoneal onlay mesh technique (lap. IPOM) was first described in 1993. Little is known about the foreign body reaction of IPOM-meshes, which covered a defect of the parietal peritoneum. This is becoming more important, since IPOM procedure with peritoneal-sac resection and hernia port closing (IPOM plus) is more frequently used. METHODS In 18 female minipigs, two out of three Polyvinylidene-fluoride (PVDF) -meshes (I: standard IPOM; II: IPOM with modified structure [bigger pores]; III: IPOM with the same structure as IPOM II + degradable hydrogel-coating) were placed in a laparoscopic IPOM procedure. Before mesh placement, a 2x2cm peritoneal defect was created. After 30 days, animals were euthanized, adhesions were evaluated by re-laparoscopy and mesh samples were explanted for histological and immunohistochemichal investigations. RESULTS All animals recovered after implantation and had no complications during the follow-up period. Analysing foreign body reaction, the IPOM II mesh had a significant smaller inner granuloma, compared to the other meshes (IPOM II: 8.4 µm ± 1.3 vs. IPOM I 9.1 µm ± 1.3, p < 0.001). The degradable hydrogel coating does not prevent adhesions measured by Diamond score (p = 0.46). A peritoneal defect covered by a standard or modified IPOM mesh was a significant factor for increasing foreign body granuloma, the amount of CD3+ lymphocytes, CD68+ macrophages and decrease of pore size. CONCLUSION A peritoneal defect covered by IPOM prostheses leads to an increased foreign body reaction compared to intact peritoneum. Whenever feasible, a peritoneal defect should be closed accurately before placing an IPOM-mesh to avoid an excessive foreign body reaction and therefore inferior biomaterial properties of the prosthesis.
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Affiliation(s)
- Roman Marius Eickhoff
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Simon Eickhoff
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Germany and Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Centre Jülich, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marius Julian Helmedag
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Rene H Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Uwe Klinge
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian Daniel Klink
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Affiliation(s)
- Gregory A Dumanian
- Division of Plastic Surgery, Northwestern Memorial Hospital, Northwestern Feinberg School of Medicine, 675 North St. Clair, Suite 19-250, Chicago, IL 60611, USA.
| | - Simon Moradian
- Division of Plastic Surgery, Northwestern Memorial Hospital, Northwestern Feinberg School of Medicine, 675 North St. Clair, Suite 19-250, Chicago, IL 60611, USA
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Eickhoff R, Heise D, Kroh A, Helmedag M, Klinge U, Neumann UP, Klink CD, Lambertz A. Improved tissue integration of a new elastic intraperitoneal stoma mesh prosthesis. J Biomed Mater Res B Appl Biomater 2020; 108:2250-2257. [PMID: 31967402 DOI: 10.1002/jbm.b.34562] [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: 06/23/2019] [Revised: 12/03/2019] [Accepted: 01/08/2020] [Indexed: 11/06/2022]
Abstract
Parastomal herniation is a frequent complication in colorectal surgery, occurring with a prevalence of 30-80%. The aim of the study was to create a new intraperitoneal colostoma mesh prosthesis (IPST) with enhanced elastic properties made with thermoplastic polyurethane (TPU) monofilaments. We performed open terminal sigmoid colostomies reinforced with either a 10 cm by 10 cm polyvinylidene fluoride (PVDF) or a new TPU/PVDF composite mesh in a total of 10 minipigs. Colostoma was placed paramedian in the left lower abdomen and IPST meshes were fixed intraperitoneal. After 8 weeks, the animals were euthanized after laparoscopic exploration and specimen were explanted for histological investigations. Implantation of a new IPST-mesh with enhanced elastic properties was feasible in a minipig model within an observation period of 8 weeks. Immunohistochemically, Collagen I/III ratio as a marker of tissue integration was significantly higher in TPU-group versus PVDF group (9.4 ± 0.5 vs. 8.1 ± 0.5, p = 0.002) with a significantly lower inflammatory reaction measured by a smaller inner granuloma at mesh-colon interface (17.6 ± 3.3 μm vs. 23 ± 5 μm, p < 0.001). A new TPU/PVDF composite mesh with enhanced elastic properties as IPST was created. Stoma surgery and especially the evaluation of the new stoma mesh prosthesis are feasible with reproducible results in an animal model. Tissue integration expressed by Collagen I/III ratio seems to be improved in comparison to standard-elastic PVDF-IPST meshes.
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Affiliation(s)
- Roman Eickhoff
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Marius Helmedag
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Uwe Klinge
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ulf P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian D Klink
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Eickhoff RM, Bolle T, Kossel K, Heise D, Kroh A, Lambertz A, Blaeser A, Gries T, Jockenhoevel S, Neumann UP, Klink CD. Improved biocompatibility of profiled sutures through lower macrophages adhesion. J Biomed Mater Res B Appl Biomater 2018; 107:1772-1778. [PMID: 30452123 DOI: 10.1002/jbm.b.34269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/12/2018] [Accepted: 09/30/2018] [Indexed: 12/21/2022]
Abstract
The biocompatibility of a textile implant is determined by various parameters, such as material composition and surface chemistry. However, little is known about the influence of geometry of sutures on biocompatibility. To elucidate this factor we focused on geometry-modification resulting in ultrafine polyethylene terephthalate (UFPET) suture and a snowflake like shaped polyvenylidenfluorid (PVDF) suture. Forty-eight rats were divided into two observation periods. In each rat 3 out of 4 sutures (profiled UFPET, snowflake-like profiled PVDF, reference Prolene and Mersilene suture) were randomly placed into the subcutaneous tissue. Rats were euthanized after 7 and 21 days and samples were explanted. Foreign body granuloma was measured and expression of CD68, TUNEL, Ki-67 and Collagen I/III ratio were determined. The profiled (snowflake) suture showed a significantly smaller FBG in comparison to standard sutures (p < 0.001). Both modified sutures showed a significant lower tissue remodeling by Ki-67 and TUNEL expression (p < 0.03). Furthermore, profiled sutures caused a lower inflammatory reaction expressed in a significant lower amount of CD68 positive macrophages after 21 days (p < 0.001). Modifications of suture geometry alter the foreign body granuloma and the inflammatory reaction. Therefore, profiled sutures might be a promising approach to improve biocompatibility of textile mesh prosthesis. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1772-1778, 2019.
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Affiliation(s)
- Roman M Eickhoff
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Tim Bolle
- Institut fuer Textiltechnik of RWTH Aachen University, Aachen, Germany
| | - Klas Kossel
- Institut fuer Textiltechnik of RWTH Aachen University, Aachen, Germany
| | - Daniel Heise
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Kroh
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Lambertz
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Andreas Blaeser
- Institut fuer Textiltechnik of RWTH Aachen University, Aachen, Germany
| | - Thomas Gries
- Institut fuer Textiltechnik of RWTH Aachen University, Aachen, Germany
| | - Stefan Jockenhoevel
- Department of Biohybrid and Medical Textiles (BioTex) at AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Ulf P Neumann
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian D Klink
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Dumanian GA, Lanier ST, Souza JM, Young MW, Mlodinow AS, Boller AM, Mueller KH, Halverson AL, McGee MF, Stulberg JJ. Mesh sutured repairs of contaminated incisional hernias. Am J Surg 2017; 216:267-273. [PMID: 29108644 DOI: 10.1016/j.amjsurg.2017.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/24/2017] [Accepted: 10/05/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND We sought to evaluate the results of a new mesh sutured repair technique for closure of contaminated incisional hernias. METHODS 48 patients with contaminated hernias 5 cm wide or greater by CT scan were closed with mesh sutures. Surgical site occurrence, infections, and hernia recurrence were compared to similar patient series reported in the literature. RESULTS Of the 48 patients, 20 had clean-contaminated wounds, 16 had contaminated wounds, and 12 were infected. 69% of the patients underwent an anterior perforator sparing components release for hernias that averaged 10.5 cm transversely (range 5 cm-25 cm). SSO occurred in 27% of patients while SSI was 19%. There were no fistulas or delayed suture sinuses. With a mean follow-up of almost 12 months, 3 midline hernias recurred (6%). In these same patients, three parastomal hernias repaired with mesh sutures failed out of 4 attempted for a total failure rate of 13%. CONCLUSION Mesh sutured closure represents a simplified and effective surgical strategy for contaminated midline incisional hernia repair.
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Affiliation(s)
- Gregory A Dumanian
- Divisions of Plastic Surgery, Northwestern Feinberg School of Medicine, United States.
| | - Steven T Lanier
- Divisions of Plastic Surgery, Northwestern Feinberg School of Medicine, United States
| | - Jason M Souza
- Divisions of Plastic Surgery, Northwestern Feinberg School of Medicine, United States
| | - Mimi Wu Young
- Colorectal Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, United States
| | - Alexei S Mlodinow
- Divisions of Plastic Surgery, Northwestern Feinberg School of Medicine, United States
| | - Anne-Marie Boller
- Colorectal Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, United States
| | - Kyle H Mueller
- Colorectal Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, United States
| | - Amy L Halverson
- Colorectal Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, United States
| | - Michael F McGee
- Colorectal Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, United States
| | - Jonah J Stulberg
- Colorectal Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, United States
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Zhu LM, Schuster P, Klinge U. Mesh implants: An overview of crucial mesh parameters. World J Gastrointest Surg 2015; 7:226-236. [PMID: 26523210 PMCID: PMC4621472 DOI: 10.4240/wjgs.v7.i10.226] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/17/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Hernia repair is one of the most frequently performed surgical interventions that use mesh implants. This article evaluates crucial mesh parameters to facilitate selection of the most appropriate mesh implant, considering raw materials, mesh composition, structure parameters and mechanical parameters. A literature review was performed using the PubMed database. The most important mesh parameters in the selection of a mesh implant are the raw material, structural parameters and mechanical parameters, which should match the physiological conditions. The structural parameters, especially the porosity, are the most important predictors of the biocompatibility performance of synthetic meshes. Meshes with large pores exhibit less inflammatory infiltrate, connective tissue and scar bridging, which allows increased soft tissue ingrowth. The raw material and combination of raw materials of the used mesh, including potential coatings and textile design, strongly impact the inflammatory reaction to the mesh. Synthetic meshes made from innovative polymers combined with surface coating have been demonstrated to exhibit advantageous behavior in specialized fields. Monofilament, large-pore synthetic meshes exhibit advantages. The value of mesh classification based on mesh weight seems to be overestimated. Mechanical properties of meshes, such as anisotropy/isotropy, elasticity and tensile strength, are crucial parameters for predicting mesh performance after implantation.
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Vogels RRM, Lambertz A, Schuster P, Jockenhoevel S, Bouvy ND, Disselhorst‐Klug C, Neumann UP, Klinge U, Klink CD. Biocompatibility and biomechanical analysis of elastic
TPU
threads as new suture material. J Biomed Mater Res B Appl Biomater 2015; 105:99-106. [DOI: 10.1002/jbm.b.33531] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/17/2015] [Accepted: 09/12/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Ruben R. M. Vogels
- Department of General, Visceral and Transplantation SurgeryRWTH Aachen UniversityAachen Germany
- Department of General SurgeryMaastricht University Medical CentreMaastricht The Netherlands
| | - Andreas Lambertz
- Department of General, Visceral and Transplantation SurgeryRWTH Aachen UniversityAachen Germany
| | - Philipp Schuster
- Institut fuer Textiltechnik at RWTH Aachen UniversityAachen Germany
| | | | - Nicole D. Bouvy
- Department of General SurgeryMaastricht University Medical CentreMaastricht The Netherlands
| | - Catherine Disselhorst‐Klug
- Department of Rehabilitation & Prevention Engineering, Institute of Applied Medical EngineeringRWTH Aachen UniversityAachen Germany
| | - Ulf P. Neumann
- Department of General, Visceral and Transplantation SurgeryRWTH Aachen UniversityAachen Germany
| | - Uwe Klinge
- Department of General, Visceral and Transplantation SurgeryRWTH Aachen UniversityAachen Germany
| | - Christian D. Klink
- Department of General, Visceral and Transplantation SurgeryRWTH Aachen UniversityAachen Germany
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11
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Lambertz A, Schröder KM, Schöb DS, Binnebösel M, Anurov M, Klinge U, Neumann UP, Klink CD. Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma. Eur Surg Res 2015; 55:1-11. [DOI: 10.1159/000371797] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/22/2014] [Indexed: 11/19/2022]
Abstract
Background: Biocompatibility and tissue integration of a surgical suture are decisive factors for wound healing and therefore for the success of sutures. The optimal suture material is still under discussion. Polyvinylidene fluoride (PVDF) is described to have superior properties of biocompatibility and is therefore frequently used as a mesh component. Only little information is available about its use as a suture material. The aim of this study was to evaluate the biocompatibility of PVDF as a suture material in comparison to 5 different established sutures in a rat model. Methods: In 30 male rats, a monofilamental PVDF suture (Resopren®) and 5 established control suture materials [polyester (Miralene®), polytetrafluoroethylene (Gore®), poliglecaprone (Monocryl®), polydioxanone (Monoplus®), polyglactin 910 (Vicryl®), USP size 3-0] were placed in the subcutaneous layer of the abdominal wall without knot or tension. After 3, 7 or 21 days, the abdominal walls were explanted for histopathological and immunohistochemical investigation with special regard to the size and quality of foreign body granuloma and the length of the comet tail-like infiltrate (CTI). Results: The PVDF sutures showed the smallest size of foreign body granuloma (60 ± 14 µm) and the smallest CTI length (343 ± 60 µm) of all polymers after 21 days. Only PVDF (Resopren) and polydioxanone (Monoplus) showed a significant collagen I/III ratio increase between days 3 and 21 (p = 0.009 and p = 0.016). The quality of foreign body reaction regarding inflammation, proliferation and fibrotic remodeling was similar between all suture materials. Conclusions: Our data indicate that monofilamental PVDF sutures show a favorable foreign body reaction with small granuloma sizes and CTI length in comparison to established sutures. Its use as a suture material in general surgery could therefore be extended in the future. To reinforce these findings, further clinical studies need to be conducted.
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Kössler W, Fiebeler A, Willms A, ElAidi T, Klosterhalfen B, Klinge U. Formation of translational risk score based on correlation coefficients as an alternative to Cox regression models for predicting outcome in patients with NSCLC. Theor Biol Med Model 2011; 8:28. [PMID: 21794149 PMCID: PMC3156745 DOI: 10.1186/1742-4682-8-28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 07/27/2011] [Indexed: 01/24/2023] Open
Abstract
Background Personalised cancer therapy, such as that used for bronchial carcinoma (BC), requires treatment to be adjusted to the patient's status. Individual risk for progression is estimated from clinical and molecular-biological data using translational score systems. Additional molecular information can improve outcome prediction depending on the marker used and the applied algorithm. Two models, one based on regressions and the other on correlations, were used to investigate the effect of combining various items of prognostic information to produce a comprehensive score. This was carried out using correlation coefficients, with options concerning a more plausible selection of variables for modelling, and this is considered better than classical regression analysis. Methods Clinical data concerning 63 BC patients were used to investigate the expression pattern of five tumour-associated proteins. Significant impact on survival was determined using log-rank tests. Significant variables were integrated into a Cox regression model and a new variable called integrative score of individual risk (ISIR), based on Spearman's correlations, was obtained. Results High tumour stage (TNM) was predictive for poor survival, while CD68 and Gas6 protein expression correlated with a favourable outcome. Cox regression model analysis predicted outcome more accurately than using each variable in isolation, and correctly classified 84% of patients as having a clear risk status. Calculation of the integrated score for an individual risk (ISIR), considering tumour size (T), lymph node status (N), metastasis (M), Gas6 and CD68 identified 82% of patients as having a clear risk status. Conclusion Combining protein expression analysis of CD68 and GAS6 with T, N and M, using Cox regression or ISIR, improves prediction. Considering the increasing number of molecular markers, subsequent studies will be required to validate translational algorithms for the prognostic potential to select variables with a high prognostic power; the use of correlations offers improved prediction.
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Affiliation(s)
- Wolfgang Kössler
- Institute of Computer Science, Humboldt University, Berlin, Germany
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