Abstract
IntroductionComposite 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.MethodsDefects (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.ResultsThe 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.ConclusionsAll 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.
Highlights
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
Some full-thickness abdominal wall defects caused by an incisional hernia [3,4] or an invading tumour [5] require the use of a biomaterial that shows optimal behaviour at each implant-host tissue interface [6]
These hernias were confirmed by laparoscopy and repaired by open surgery, in which their contents were reduced and the defect closed with a 4/0 polypropylene suture
Summary
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. Conclusions: All composites showed optimal peritoneal behaviour, inducing good peritoneal regeneration and scarce postoperative adhesion formation. Some full-thickness abdominal wall defects caused by an incisional hernia [3,4] or an invading tumour [5] require the use of a biomaterial that shows optimal behaviour at each implant-host tissue interface [6]. It is possible to achieve the tissue repair of these defects using conventional prosthetic materials Such prostheses, generally in the form of a macroporous mesh, induce the generation of a peritoneal interface that is far from optimal with inadequate mesothelial development [7]. Besides comprising a macroporous mesh, these composites have an added laminar, or sheet, component to promote good peritoneal behaviour
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