Absorbable Synthetic Mesh Research Articles

Immediate Breast Reconstruction After Nipple-Sparing Mastectomy with Prepectoral Implant Placement Supported by a Partial Coverage Technique Employing Late Absorbable Synthetic Mesh

Immediate Breast Reconstruction After Nipple-Sparing Mastectomy with Prepectoral Implant Placement Supported by a Partial Coverage Technique Employing Late Absorbable Synthetic Mesh

Ventral Hernia Repair With a Hybrid Absorbable-permanent Preperitoneal Mesh.

To analyze device safety and clinical outcomes of ventral hernia repair with the GORE SYNECOR Preperitoneal Biomaterial (PRE device), a permanent high-strength mesh with bioabsorbable web scaffold technology. This multicenter retrospective review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥1 year from study enrollment. Included in this analysis were 148 patients with a mean age of 56 years; 66.2% met the Ventral Hernia Working Group grade 2 classification. Median hernia size was 30.0cm 2 and 58.8% of patients had an incisional hernia. Repairs were primarily a robotic (53.4%) or open approach (41.9%). All meshes were placed extraperitoneal. Procedure-related adverse events within 30 days occurred in 13 (8.8%) patients and included 7 (4.8%) patients with surgical site infection, 2 (1.4%) with surgical site occurrence (SSO), 4 (2.7%) requiring readmission, and 3 (2.0%) who had reoperation. The rate of SSO events requiring procedural intervention was 2.7% (4 patients) through 30 days and 3.4% (5 patients) at 12 months. The rate of procedure-related surgical site infection remained at 4.8% through 12 months (no further reports after 30d) and 3.4% for SSO (2 reports after 30d). There were no site-reported clinically diagnosed hernia recurrences throughout the study. Median patient follow-up including in-person visit, physical examination, reported adverse event, explant, death, and questionnaire response was 28 months (n = 148). Median patient follow-up with patient questionnaire was 36 months (n = 88). Use of the PRE device, which incorporates the proven advantages of both an absorbable synthetic mesh and the long-term durability of a permanent macroporous mesh, is safe and effective in complex ventral hernia repairs. When used in the retromuscular space, the combination of these 2 materials had lower wound complications and recurrence rates than either type of material alone.

Elective complex ventral hernia repair in contaminated fields: A propensity score–matched analysis of long-term quality of life and outcomes between different prostheses

BackgroundRandomized studies have endorsed nonabsorbable prosthetics for contaminated ventral hernia surgery, yet the broader applicability and impact on patient-reported outcomes are still questioned. Here, we evaluated the long-term outcomes of elective contaminated ventral hernia repairs (based on Centers of Disease Control and Prevention [CDC] wound classification) using real-world data from a multicenter US cohort, focusing on quality of life and postoperative pain. MethodsThe Abdominal Core Health Quality Collaborative database was queried for patients undergoing elective contaminated (CDC class II–IV) ventral hernia repair (2013–2023). After propensity matching, we compared long-term differences in patient-reported quality of life and pain scores (by HerQLes and PROMIS questionnaires) among those who underwent repair with nonabsorbable, absorbable synthetic, and biologic mesh. ResultsA total of 1,073 patients were included, of whom 920 (86%), 56 (5%), and 97 (9%) underwent repair with nonabsorbable, absorbable synthetic, and biologic mesh, respectively. Among them, the median age was 62 years (interquartile range [IQR] 53–70), and 523 (49%) were male. The median length and width of the defect were 20 cm (IQR 12–25) and 13 cm (IQR 8–16), respectively. A transversus abdominis release was performed in 716 patients (67% of all cases). In most cases, the mesh was positioned in the retro-rectus (85%) and/or the preperitoneal space (45%). Before and after propensity matching (n = 185), the change from baseline in HerQLes and PROMIS scores at 6 months and at 1, 3, 5, and 6 years was comparable between different types of mesh. Lastly, there were no differences in readmission, surgical site infection, or surgical site occurrence at 30 days. Recurrence at 1 year was also comparable among groups. ConclusionIn the long term, there were no differences in quality of life or pain scores with nonabsorbable, absorbable synthetic, or biologic mesh for elective ventral hernia repair in contaminated fields.

"The GalaFLEX 'Empanada' for Direct to Implant Prepectoral Breast Reconstruction".

Therapeutic, IV.

Use of polyglactin mesh coated with platelet-rich plasma for diaphragmatic defect healing in rabbits. Protocol for a Randomised Controlled Trial

Absorbable, biosynthetic scaffolds are a promising option for repair of diaphragmatic defects, since they are associated with less mesh-related complications than non-absorbable synthetic meshes. Coating of absorbable synthetic meshes with anti-inflammatory and healing agents, such as platelet-rich plasma (PRP), is a widely studied technique for improving mesh-tissue integration and reducing recurrence rate. The aim of this study is to investigate the synergic effect of a PRP-coated synthetic absorbable polyglactin mesh 2cmx2cm in healing of a diaphragmatic defect in an experimental rabbit model. Animals will be equally randomised in the PGM-PRP group (absorbable polyglactin mesh enriched with PRP) or the PGM group (use of absorbable polyglactin mesh only). Rabbits will undergo laparotomy under general anaesthesia and resection of a portion of the diaphragmatic central tendon 1cmx1cm. Samples will be euthanised on the 91th postoperative day and samples of 3cmx3cm will be harvested. The mesh-tissue integration will be assessed based on macroscopic, microscopic, immunohistochemical and morphometric parameters. The study is indesign stage and results are expected to be available by the end of the following year. High-quality evidence is expected regarding the synergic effect of PRP and synthetic absorbable polyglactin meshes in diaphragm repair.

Open transversus abdominis release in incisional hernia repair: technical limits and solutions.

Incisional hernias with a defect width of more than10cm are considered complex. The European Hernia Society guidelines recommend that such hernias should only be repaired by surgeons with experience of component separation. The standard component separation technique now is posterior component separation with transversus abdominis release (PCSTAR). Questions are raised about the limits of this technique. A literature search of publications on PCSTAR was performed for any references to the limits of this technique in open incisional hernia repair. We found 26 publications relevant to answer this research questions. The standard PCSTAR can generally be used for a defect width of up to 15-17cm. For defects greater than 17cm problems must be expected with procedural tasks involving closure of the posterior layer and anterior fascia. No data are available in the literature on the bridging rate for the posterior layer. However, our own experiences show that gaps (holes) occur in the very thin peritoneum/fascia transversalis during dissection and these must be carefully closed. Furthermore, bridging with an absorbable synthetic mesh is needed not so rarely. Closure of the anterior fascia is successful in 81.0-97.2% of cases. In addition to a further mesh for anterior fascial closure, the hernia sac bound with multiple, accordion-like stitches can also be used. For a defect width greater than 17cm, the limits of PCSTAR become increasingly evident and can be overcome through special technical solutions for closure of the posterior layer and the anterior fascia.

Immediate breast reconstruction in breast cancer patients with the use of Serasynth and SeragynBR synthetic meshes. Single-oncological center experience, analysis of complications.

<br><b>Introduction:</b> The use of meshes in mastectomies with immediate breast reconstruction (IBR) has become the gold standard.</br> <br><b>Aim:</b> The use of meshes in mastectomies with immediate breast reconstruction (IBR) has become a gold standard. The purpose of the study was to analyze the complications and own experience with the use of Serasynth fully absorbable and SeragynBR partially absorbable synthetic meshes.</br> <br><b>Material and methods:</b> In the period from December 2017 to July 2020, 118 IBR were performed in the Author's Department with the use of SeragynBR and Serasynth meshes in 93 patients operated for breast cancer. 78 Serasynth meshes (Group 1) and 40 SeragynBR meshes (Group 2) were implanted.</br> <br><b>Results:</b> The most common complication was persistent seroma collection, which was reported in 17.9% of cases in Group 1 and 25% in Group 2. Skin inflammation was reported in 7.6% and 17.5%, while infections in 2.5% and 5% of the operated breasts in Group 1 and Group 2. Reoperation was required in 5.1% and 5% of the patients in Group 1 and Group 2. The percentage of complications was lower when Serasynth rather than Seragyn BR meshes were implanted. The frequent incidence of the seroma collection did not contribute in any significant way to serious complications such as removal of mesh/implant or infection. The complications, which developed following the implantation of both mesh types, were similar to those presented in other publications concerning mastectomy with IBR with the use of synthetic meshes. The percentage of implant losses/explanations in the discussed groups was lower than that reported in the literature.</br> <br><b>Conclusion:</b> Despite the complications, both types of meshes can be considered as safe additions to reconstructive breast surgeries.</br> <br><b>Level of Evidence:</b> Level III.</br&gt.

Slowly absorbable mesh in sublay ventral hernia repair in contaminated fields.

In the past years, there has been increasing evidence that supports the use of permanent mesh in contaminated wounds. Given this increased evidence, the indications to opt for slowly absorbable "biosynthetic" prostheses have been questioned. To address this, we compared the outcomes of slowly absorbable mesh in contaminated cases in a well-matched multicentric cohort. The Abdominal Core Health Quality Collaborative (ACHQC) database was queried for patients undergoing elective ventral hernia repair in Centers for Disease Control (CDC)-III operations (2013-2022). We compared demographics, hernia characteristics, and postoperative outcomes among types of mesh. We used propensity score matching to adjust for sex, diabetes, body mass index, smoking status, and operative time between mesh groups. Patients within other CDC classes and those with mesh positioned elsewhere than retro-rectus/preperitoneal space were excluded. A total of 760 patients were included in the analysis. Slowly absorbable synthetic mesh (SA) was utilized in only 7% of the cases, while permanent (P) and biologic (B) mesh in 77% and 16%, respectively. After matching, 255 patients were studied. There was no difference in surgical site occurrence (8% SA, 16% P, 10% B, p = 0.27), surgical site infection (20% SA, 17% P, 12% B p = 0.54), surgical site occurrence requiring intervention (18% SA, 13% P, 14% B p = 0.72), readmission (12% SA, 14% P, 12% B, p = 0.90), or reoperation (8% SA, 2% P, 4% B, p = 0.14) at 30days. In patients with 1-year follow-up, there was no difference in recurrence among groups (20% SA, 26% P, 24% B p = 0.90). Based on our findings, SA has comparable outcomes to other types of mesh, particularly when an optimal retro-rectus repair is performed.

439. ACUTE GASTRIC VOLVULUS—LATE OCCURRENCE AFTER HIATAL HERNIA REPAIR WITH MESH

Abstract Video presentation of acute gastric volvulus in one patient with previous history of a giant recurrent hiatal hernia, corrected with synthetic absorbable mesh one year prior to the event. The video contains the first surgery, follow-up studies, the intra operative findings (mesh status) and resolution. It raises the question whether, in extremely large hiatal hernias, specially recurred ones, adjuvant techniques should be associated. https://www.dropbox.com/s/tkj2vt35cd3pn91/Acute%20Gastric%20Volvulus.mov?dl=0.

Rare case of gastrocutaneous fistula recurrence treated with laparoscopic approach and absorbable synthetic mesh

Rare case of gastrocutaneous fistula recurrence treated with laparoscopic approach and absorbable synthetic mesh

Early Clinical Outcomes of Polydioxanone Mesh for Prepectoral Prosthetic Breast Reconstruction.

Background:Many biologic matrices and synthetic meshes are available as adjuncts for prosthetic and autologous breast reconstructions to help control implant position and to reinforce abdominal flap donor sites. Absorbable synthetic meshes may have advantages over biologic matrices and permanent meshes, such as lower cost and better long-term biocompatibility. We present a prospective case series of patients undergoing two-stage, prepectoral breast reconstruction with polydioxanone (PDO) mesh.Methods:This prospective, consecutive single-surgeon series of patients who received PDO mesh during two-stage, prepectoral breast reconstruction involved incorporation of the PDO mesh at stage 1 as an anterior tarp over the tissue expander. A detailed description of surgical technique is provided herein. Surgical complications monitored included surgical site infection, wound dehiscence, mastectomy skin flap necrosis, hematoma or seroma requiring operative intervention, and reconstructive failure.Results:Seven patients with fourteen breast reconstructions were included in the study. All patients had unilateral cancer and underwent bilateral mastectomies with immediate reconstruction. The average age of patient was 50.0 (SD 7.4) and BMI was 29.3 (SD 2.7). Patients were followed for a median of 274 days, during which only one late infection (7.1%) occurred requiring expander removal.Conclusions:PDO mesh has an acceptable short-term complication rate in two-stage prepectoral prosthetic breast reconstruction. Future investigations should elucidate its comparative efficacy and safety against alternative products with respect to long-term outcomes.

Long-term outcome of absorbable synthetic mesh in clean ventral hernia repairs.

There are many materials available for the reinforcement of complex abdominal wall reconstruction, including permanent synthetic, biologic, and absorbable synthetic meshes. The recurrence rate of complex hernia repairs beyond 5years has not been reported. We hypothesized that the use of absorbable synthetic mesh in clean wounds would yield favorable long-term outcomes. Patients who underwent open complex ventral hernia repair with clean wounds (CDC class 1) using absorbable synthetic mesh (Bio-A, Gore, Flagstaff, AZ) in the retrorectus position were retrospectively reviewed. Chart review and a validated telephone questionnaire to screen for recurrence were utilized to evaluate and document hernia recurrence. A total of 49 patients were included in this study. Patients were followed for recurrences for up to 105months, with a mean follow-up time of 62.4months (5.2years). The total number of midline hernia recurrence was 7 out of the original 49 patients (14%). The mean and median recurrence time are 37.4 and 38.8months, respectively. Kaplan-Meier survival analysis estimated hernia recurrence rate as 2%, 4.6%, 7.1%, 12%, 15%, and 18% at 12, 24, 36, 48, 60, and 72months, respectively. The use of absorbable synthetic mesh in clean wound ventral hernia repair resulted in favorable long-term recurrence rates. The recurrence rate of absorbable synthetic mesh is similar to that of permanent synthetic mesh, which gives a viable option for patients in whom permanent synthetic mesh is not an option.

P109 MANAGEMENT OF THE OPEN ABDOMEN WITH COMBINED THERAPIES. HOW TO AVOID VENTRAL HERNIAS AND BE ABLE TO PERFORM THE REPAIR OF THE ABDOMINAL WALL IN A DEFINITIVE WAY

Abstract Aim To demonstrate that in patients with abdominal sepsis, delayed primary fascial closure and definitive abdominal wall repair can be achieved, in the same hospitalization, using combined therapies, which reduces the percentage of ventral hernias. Material and Methods Medical records, tomography images and outpatient controls of 9 patients were reviewed, which required open abdomen management for abdominal sepsis using negative pressure therapy combined with a dynamic fascial mesh traction, from February 2020 until May 2021. Results 9 patients (2 men and 7 women), all Grade 2C open abdomen according to Björck clasification, with a median age of 43 years (25-71). The median time therapy was 29±3 days. The primary fascial closure rate was 100% (n = 9), 77.8% (n = 7) underwent a definitive repair of the abdominal wall with absorbable synthetic mesh in the same hospitalization, while 22.2% (n = 2) did not, due to being cancer patients. The mortality rate was 11.1% (n = 1) due to pneumonia and the fistula rate was 11.1% (n = 1). None developed an incisional hernia at the one-year follow-up. Conclusions The combination of negative pressure therapy with dynamic fascial mesh traction, in the management of the open abdomen, allows us to achieve a 100% delayed primary fascial closure, avoiding ventral hernia. In the same hospitalization, while the patient leaves the critical stage, we can achieve a definitive repair of the abdominal wall using absorbable synthetic meshes returning the biomechanics to the abdominal wall, improving the quality of life of these patients.

P110 MANAGEMENT OF THE OPEN ABDOMEN WITH COMBINED THERAPIES. HOW TO AVOID THE VENTRAL HERNIA AND BE ABLE TO PERFORM THE REPAIR OF THE ABDOMINAL WALL IN A DEFINITIVE WAY

Abstract Aim To demonstrate that in patients with abdominal sepsis, delayed primary fascial closure and definitive abdominal wall repair can be achieved, in the same hospitalization, using combined therapies, which reduces the percentage of ventral hernias. Material and Methods Medical records, tomography images and outpatient controls of 9 patients were reviewed, which required open abdomen management for abdominal sepsis using negative pressure therapy combined with a dynamic fascial mesh traction, from February 2020 until May 2021. Results 9 patients (2 men and 7 women), all Grade 2C open abdomen according to Björck clasification, with a median age of 43 years (25-71). The median time therapy was 29±3 days. The primary fascial closure rate was 100% (n = 9), 77.8% (n = 7) underwent a definitive repair of the abdominal wall with absorbable synthetic mesh in the same hospitalization, while 22.2% (n = 2) did not, due to being cancer patients. The mortality rate was 11.1% (n = 1) due to pneumonia and the fistula rate was 11.1% (n = 1). None developed an incisional hernia at the one-year follow-up. Conclusions The combination of negative pressure therapy with dynamic fascial mesh traction, in the management of the open abdomen, allows us to achieve a 100% delayed primary fascial closure, avoiding ventral hernia. In the same hospitalization, while the patient leaves the critical stage, we can achieve a definitive repair of the abdominal wall using absorbable synthetic meshes returning the biomechanics to the abdominal wall, improving the quality of life of these patients.

The Use of Absorbable Mesh in Implant-Based Breast Reconstruction: A 7-Year Review

We read with great interest the article entitled “The Use of Absorbable Mesh in Implant-Based Breast Reconstruction: A 7-Year Review” by Faulkner et al.,1 which aimed to evaluate the advantages of using Vicryl mesh in single-stage direct-to-implant breast reconstruction. The authors presented a retrospective review of 227 patients who underwent implant-based breast reconstruction with absorbable mesh as a safe alternative to acellular dermal matrix. Although other articles in the literature have studied absorbable mesh in breast reconstructive surgery,2,3 this article was the largest long-term study to date on the use of Vicryl mesh in prosthetic breast reconstruction. We compliment the authors on their excellent efforts in this respect, and would also like to express some considerations regarding this article. First, the authors compared the incidence of postoperative complications for prosthesis breast reconstruction using an absorbable mesh with that for acellular dermal matrix–assisted breast reconstruction; they concluded that the incidence of complications was lower when using absorbable mesh. However, the authors did not specify a specific follow-up time, and we believe that it is best to compare the incidence of complications in reconstruction with or without absorbable mesh to make the results more convincing. In addition, according to the authors’ description, a half piece of Vicryl mesh was used for one breast, for patients with unilateral breast reconstruction after mastectomy. The remaining half of the Vicryl mesh could be wasted. We think that two pieces of the mesh could be utilized, one inferior for support and one lateral for further strengthening, both to avoid the waste and to ensure the further stability of the pocket. Also, according to published literature, Vicryl mesh is absorbed 3 to 4 weeks after implantation, thus losing its function as a supporting structure and leading to insufficient blood supply to the lower part of the flap, which may lead to complications such as flap ischemia.4 Therefore, we suggest that further studies on the blood flow of the flap be conducted to determine the relationship between the use of absorbable mesh and flap ischemia. By the way, there is an error in this article. In the fifth line in the first paragraph of the Results section, the text states that bilateral cases were performed in 146 patients, but 146 patients should have accounted for 64.3 percent, instead of the 65.6 percent in the article. We are very grateful to the authors for carrying out this study, which has brought us to the understanding that synthetic absorbable mesh can be a reasonable alternative to acellular dermal matrix in prosthetic breast reconstruction, which has the characteristics of safety and economy. We also hope to see the progress of their research on the use of Vicryl mesh in prepectoral prosthetic breast reconstruction soon. DISCLOSURE Neither author has a financial interest to declare in relation to the content of this communication. Haoran Li, M.M.Dali Mu, M.D.Department of Aesthetic and Reconstructive Breast SurgeryPlastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, People’s Republic of China

Leveraging a statewide quality collaborative to understand population-level hernia care

BackgroundAlthough ventral hernia repair (VHR) is extremely common, there is profound variation in operative technique and outcomes. This study describes the results of a statewide registry capturing hernia-specific variables to understand population-level practice patterns. MethodsRetrospective analysis of adult patients in a new statewide hernia registry undergoing VHR in 2020. Results919 patients underwent VHR across 57 hospitals and 279 surgeons. Hernia width was <2 cm in 233 (25%) patients, 2–5 cm in 420 (46%) patients, 5–10 cm in 171 (19%) patients, and >10 cm in 95 (10%) patients. Mesh was used in 79% of cases and varied in use from 53% of hernias <2 cm to 95% of hernias >10 cm. The most common mesh type was synthetic non-absorbable (46%), followed by synthetic absorbable mesh (37%). The incidence of complications was significantly associated with hernia width. ConclusionsA population-level, hernia-specific database captured operative details for 919 patients in 1 year. There was significant variation in mesh use and outcomes based on hernia size. These nuanced data may inform higher quality clinical practice.

Evaluation of Absorbable Mesh for Prophylactic Mesh Augmentation in High-Risk Patients

Purpose: Hernia prevention following abdominal surgery has become a subject of growing interest in general surgery. Prophylactic mesh augmentation (PMA) is an emerging technique to prevent incisional hernia in high-risk populations. The aim of this study was to determine the efficacy and safety of PMA using an absorbable mesh. Methods: A retrospective review was performed on patients who underwent PMA between July 2014 and March 2020. A prophylactic synthetic absorbable mesh (Phasix™; Becton Dickinson, Franklin Lakes, NJ) was placed at the surgeon’s discretion according to the indication for the primary operation. The primary outcome was the incisional hernia rate. Secondary outcomes included mesh-related or other complications. Results: Fifty patients underwent PMA following cystectomy with ileal conduit, open aortic surgery, or colostomy creation/takedown. Overall, 10 patients (20%) developed hernia at a median follow-up of 2.2 years. Six of these 10 hernias occurred at incisions where mesh was not placed. There were no documented mesh infections. One mesh (2%) in the AAA group was explanted due to an infected endograft, but there was no evidence of mesh complication. Two patients (4%) developed seroma. Two (4%) patients developed superficial surgical site infections (SSI). There were no documented deep-space SSI. Conclusion: PMA is an emerging technique with a low rate of incisional hernia in high-risk patients, such as those undergoing stoma creation or open aortic intervention. The use of an absorbable mesh seems promising, however more and longer-term research is needed.

C-reactive protein is a predictive factor for complications after incisional hernia repair using a biological mesh

The introduction of biological or absorbable synthetic meshes has provided an alternative to conventional repair for incisional hernia. The ability to predict the development of complications after hernia surgery is important, as it guides surgical planning and patient management. This retrospective study assessed whether the postoperative C-reactive protein (CRP) level can predict complications after incisional hernia repair using biological mesh reinforcement. Patients who underwent incisional hernia repair surgery using biological meshes between February 2009 and February 2015 were screened for study inclusion. Patients included in the study were divided into two groups: those with and without postoperative complications. The two groups were analysed based on sex, surgical operation, length of intensive care unit stay (ICU), complications and mortality. Laboratory values, including white blood cell (WBC) count and CRP levels, were determined preoperatively and up to postoperative day (POD) 10. Postoperative complications requiring further management occurred in 32 of the 60 patients (53.3%). Among 47 patients, the mean CRP and WBC levels were 6.6 mg/L and 9.073 G/L in the group without complications vs. 141.0 mg/L, 16.704 G/L in the group with complications (p < 0.001). Patients with complications also had a longer ICU stay (10.1 vs. 0.6 days, p < 0.0001). A cut-off was 101 mg/L and offered 80.00% sensitivity (IC 61.43% to 92.29) and 95.24% specificity (76.18% to 99.88%) for postoperative complication. The rate of postoperative complications before POD10 was 95% in the group with CRP > 100 mg/L vs. 46% in the group with CRP < 100 mg/L (p = 0.000372). A high postoperative CRP level (> 100 mg/L) up to POD10 may serve as a predictor of postoperative complications in patients undergoing incisional hernia using biological meshes.

Antibiotic-Eluting Envelopes to Prevent Cardiac-Implantable Electronic Device Infection: Past, Present, and Future.

Objective: Cardiac-implantable electronic device (CIED) infections are associated with significant morbidity and mortality. In this review, we describe the risk factors and pathogenesis of CIED infections and review the rationale and the evidence for the use of antibiotic-eluting envelopes (ABEs) in patients at increased risk for CIED infections.Findings: The majority of CIED infections are caused by staphylococci that involve generator pocket and occur due to contamination of the device or the pocket tissues at the time of implantation. Clinical trials have shown that extending the duration of post-operative systemic antibacterial therapy is not beneficial in reducing CIED infection rate. However, ABEs that reduce device migration after implantation and provide sustained local delivery of prophylactic antibiotics at the pocket site, may provide benefit in reducing infection. Currently, there are two types of commercially available CIED envelope devices in the United States. The first ABE device (TYRX™, Medtronic Inc., Monmouth Junction, NJ) is composed of a synthetic absorbable mesh envelope that elutes minocycline and rifampin and has been shown to reduce CIED pocket infections in a large multi-center randomized clinical trial. The second ABE device (CanGaroo-G™, Aziyo Biologics, Silver Spring, MD) is composed of decellularized extracellular matrix (ECM) and was originally designed to stabilize the device within the pocket, limiting risk for migration or erosion, and providing a substrate for tissue ingrowth in a preclinical study. This device has shown promising results in a preclinical study with local delivery of gentamicin. Compared with artificial materials, such as synthetic surgical mesh, biologic ECM has been shown to foster greater tissue integration and vascular ingrowth, a reduced inflammatory response, and more rapid clearance of bacteria.Conclusions and Relevance: ABE devices provide sustained local delivery of antibiotics at the generator pocket site and appear beneficial in reducing CIED pocket infections. Given the continued increase in the use of CIED therapy and resultant infectious complications, innovative approaches to infection prevention are critical.

The Use of Absorbable Mesh in Implant-Based Breast Reconstruction: A 7-Year Review.

Background:Breast reconstruction is most frequently performed using implants or expanders. Adjunctive materials such as acellular dermal matrix and synthetic meshes are used to support the implant or expander. A paucity of large studies exist on the use of synthetic mesh for breast reconstruction.Methods:A retrospective chart review of all patients over the past 7 years who had implant reconstruction with synthetic absorbable mesh at the Massachusetts General Hospital was performed. Data were collected on demographic and surgical outcomes. Statistical analysis was performed.Results:A total of 227 patients (376 mastectomies) were treated with direct-to-implant subpectoral reconstruction with absorbable mesh from 2011 to 2017. The infection rate was 2.1 percent. The rate of capsular contracture was 4.8 percent. Patients who had radiation therapy either preoperatively or postoperatively had a higher rate of complications, including capsular contracture. Cost savings for using mesh instead of acellular dermal matrix surpassed $1.2 million.Conclusion:Synthetic absorbable mesh is a safe alternative to acellular dermal matrix in prosthetic breast reconstruction and provides stable results along with significant cost savings.Clinical Question/Level of Evidence:Therapeutic, IV.