Use of tantalum mesh in the repair of hernias

Abstract

tantalum mesh in the repair of hernias complicated by tissue deficiency. The use of foreign materia1, such as metaIIic Higrees, grids, plates and mesh, has been resorted to in the past to overcome the diffrcuIties presented by Iarge tissue defects. For the most part these practices have been given up. The avaiIabiIity of a materia1 in the form of tantalum mesh which is strong, pliable and bioIogicaIIy inert, and which forms a scaffoIding for the ingrowth of sturdy, white, fibrous tissue for the firm cIosure of hernial defects, has stimuIated interest in its use as a suitable material for hernia repair when the patient’s own tissues are inadequate or unsuitable for the bridging of tissue defects. Koontz and KimberIey3 in a recent paper have reported further on experimental studies of the tissue reactions to tantalum mesh and wire. Their Iindings indicate that there is a marked Fibrous reaction around and through tantalum mesh implanted in body tissues and that this is a normal fibroblastic reaction which produces soft pIiabIe wound repair. Furthermore, tantalum mesh can be placed next to howe in closing experimentally produced abdominal defects without causing trouble other than a few miId adhesions. They aIso found tantaIum mesh resistant to infection so that good heaIing could be obtained after its implantation in spite of gross infection. The exceIIent descriptions by Throckmorton and by Koontz of methods and results in the use of tantaIum mesh prompted its first use at this hospital in two cases. The successful outcome in both, particularly in one (Case I) which presented a formidable problem of repair, Iead to further use of the method in other cases of hernia that were too Iarge for the conventiona1 repair utilizing the patient’s own tissues, or presented diffrcuIt probIems of closure because of tissue deficiencies. Th e procedure as described by Throckmorton is a simpIe one to perform. A piece of tantalum gauze is cut Iarge enough to cover not onIy the hernia1 defect but also a sufficient surrounding area to provide a secure attachment for its borders to strong fascial supporting structures. The margins of the patch are folded under for about I cm. in order to provide a smooth edge and a doubIe thickness for hoIding the sutures. The suture material is a tantalum wire, monofiIament preferabIy, but there is no reason why other non-absorbable suture materia1, such as silk or cotton, cannot be used. The sutures are pIaced so as to fasten the borders of the tantaIum mesh patch onto strong supporting structures, either white fascia or periosteum. The patch must be Iarge enough to be sutured in pIace without tension. The sutures are appIied interruptedIy, tied with a square knot and cut close to tfre knot. Figure I iIIustrates the appearance of such a tantatum