Expanded Polytetrafluoroethylene Patch Research Articles

Application of Bovine Pericardium and Expanded Polytetrafluoroethylene Patches in Tricuspid Valvuloplasty after Cardiac Surgery.

Leaflet augmentation is often required to correct an inadequate leaflet size due to leaflet thickening, contracture and junctional fusion in patients with tricuspid valve regurgitation (TR) after left-side valve surgery (LSVS). However, the ideal material for leaflet augmentation remains controversial. This article aims to compare the medium- and long-term results of tricuspid valve repair with bovine pericardium (BP) and expanded Polytetrafluoroethylene (ePTFE) patches for the augmentation of tricuspid leaflets and to compare the durability of the two materials. From January 2015 to April 2023, a total of 69 patients with severe isolated TR underwent tricuspid valvuloplasty (TVP) by leaflets augmentation with patches in our institute. According to the different types of patches, they were divided into the BP group (n = 44) and the ePTFE group (n = 25). There were 3 perioperative deaths (4.3%), one case was due to low cardiac output syndrome in the BP group, and 2 cases were due to acute respiratory dysfunction syndrome and low cardiac output syndrome in the ePTFE group, respectively. Before discharge, the area of the TR jet on echocardiography decreased from 23.5 9.1 to 4.2 3.4 . One case in each group was found to have increased blood flow velocity at the tricuspid orifice. After discharge, one patient in each group underwent repeat TVP, in the BP group because of shortened chordae and in the ePTFE group because of calcification of the patch. During the entire follow-up period, there were 7 cases of severe TR (10.1%), 5 in the BP group and 2 in the ePTFE group, a total of 5 cases of tricuspid stenosis (7.2%), 4 in the BP group and 1 in the ePTFE group, and a total of 6 deaths (8.7%), 5 in the BP group and 1 in the ePTFE group. Transthoracic ultrasound in a patient with tricuspid stenosis suggests stiff leaflet movement and poor motion. Leaflet patch enlargement can be safely used in tricuspid valve repair, but BP patches carry a risk of reduced flexibility and stiffness of movement, and ePTFE patches carries a risk of calcification.

Pericardial Closure With Expanded Polytetrafluoroethylene Patch in Left Ventricular Assist Device Surgery.

To reduce adhesions after left ventricular assist device (LVAD) implantation, pericardial closure using an expanded polytetrafluoroethylene (ePTFE) patch has been suggested. However, as foreign material, ePTFE patches could increase the risk of infectious complications. In this single-center retrospective study, we investigated outcomes of pericardial closure using an ePTFE patch in LVAD implantation. We included all patients who underwent LVAD implantation at our center between 2011 and 2020 (n = 166). Primary endpoint was development of mediastinitis at any point of time between LVAD implantation and heart transplantation (HTx) or death. Secondary endpoint was overall survival. Preoperative and postoperative clinical data were collected to ensure comparability between the groups. We included 166 patients with LVAD. A total of 116 patients (70%) underwent pericardial closure using an ePTFE patch. There were significant differences between the groups in treatment setting, previous cardiac surgery, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level, development of driveline infection, and HTx. Patients with an ePTFE patch developed mediastinitis more frequently (16%) than patients without ePTFE patch (4%) ( p = 0.039). A significant difference in overall survival between the groups could not be confirmed ( p = 0.29). The use of PTFE patches for pericardial closure in LVAD implantation was associated with a higher incidence of mediastinitis, but not with a difference in overall survival.

Outcomes of pulmonary valve leaflet augmentation for transannular repair of tetralogy of Fallot

ObjectiveTo evaluate the midterm results of pulmonary valve leaflet augmentation in transannular repair of tetralogy of Fallot (TOF). MethodsFrom 2007 to 2019, 131 patients underwent a transannular repair with pulmonary leaflet augmentation for TOF (n = 120) and double outlet right ventricle with pulmonary stenosis (n = 11). Patch material was expanded polytetrafluoroethylene (n = 76), glutaraldehyde-treated autologous pericardium (n = 47) and bovine pericardium (n = 8). ResultsMedian age at repair was 8.9 months (interquartile range, 5.4-14.8). There was no operative mortality. Median follow-up was 6.25 years (interquartile range, 2.77-7.75). Freedom from severe pulmonary regurgitation (PR) was 85% (95% confidence interval [CI], 77%-90%) and 76% (95% CI, 66%-83%) at 1 and 5 years, respectively. Freedom from moderate or greater PR was 69% (95% CI, 60%-76%) and 30% (95% CI, 21%-39%) at 5 and 10 years, respectively. Three patients required pulmonary valve replacement for PR. Nine patients required pulmonary balloon valvuloplasty. Freedom from intervention for pulmonary valve stenosis was 98% (95% CI, 93%-99%) and 94% (95% CI, 87%-97%) at 1 and 5 years, respectively. One patient with severe PR had an indexed right ventricular volume >160 mL/m2. Use of expanded polytetrafluoroethylene resulted in a greater freedom from moderate or greater PR (log-rank test P < .001; Cox regression hazard ratio, 0.40; 95% CI, 0.25-0.63; P < .001). ConclusionsAt midterm follow-up of transannular repair with pulmonary valve leaflet augmentation, severe PR occurs in less than 50% of patients. The expanded polytetrafluoroethylene patch performs better than pericardium.

Surgical outcome of pulmonary artery reconstruction using the expanded polytetrafluoroethylene patch in patients with lung cancer.

Pulmonary artery reconstruction is sometimes utilized as an alternative to pneumonectomy in lung cancer surgery. We herein report our experience of pulmonary artery reconstruction using an expanded polytetrafluoroethylene (ePTFE) patch based on the surgical results and long-term outcome. Clinical records of lung cancer patients who underwent patch plasty were reviewed retrospectively. Between 2003 and 2017, pulmonary artery patch plasty were performed in 21 patients [18 males, 3 females; mean age 65 (range 47-79) years]. Induction chemoradiotherapy was performed in three patients. Bronchoplasty was performed in five patients. The pathologic stages were stage I in 3 patients, stage II in 6 and stage III in 12. Pneumonectomy, lobectomy and segmentectomy were performed in 2, 18 and 1 patient, respectively. The left upper lobe was the most frequent origin of lung cancer (15 patients). There was no reconstruction-related morbidity or mortality. The overall survival rate at 5years was 64.1% with a mean follow-up of 39.5months, and the survival rates for N0-1 and N2-3 were 80.8% and 28.6%, respectively. Patch angioplasty using the ePTFE sheet is a reliable procedure in radical surgery for lung cancer.

Three-Dimensional Printing for Chest Wall Reconstruction in Thoracic Surgery: Building on Experience.

Patients undergoing surgery for locally advanced lung cancer involving the chest wall require anatomical lung with extensive en-bloc chest wall resection and appropriate reconstruction.In this proof-of-concept study, we aimed to produce personalized three-dimensional (3D)-printed chest wall prosthesis for a patient undergoing chest wall resection and reconstruction using clinically obtained computed tomography (CT) data. Preoperative CT scans of three patients undergoing chest wall resection were analyzed and the areas of resection segmented. This was then used to produce a 3D print of the chest wall and a silicone mold was created from the model. This mold was sterilized and used to produce methyl methacrylate prostheses which were then implanted into the patients. Three patients had their chest wall reconstructed using this technique to produce a patient specific prosthesis. There were no early complications or deaths. It is possible to use 3D printing to produce a patient specific chest wall reconstruction for patients undergoing chest wall resection for malignancy that is cost-effective. This chest wall is thought to provide stability in the form of prosthetic ribs as well compliance in the form of an expanded polytetrafluoroethylene patch. Further research is required to measure chest wall compliance during the respiratory cycle and long-term follow-up from this method.

Surgical treatment of pulmonic stenosis in dogs under cardiopulmonary bypass: outcome in nine dogs.

To describe the outcome for nine dogs with pulmonic stenosis treated by open patch grafting using expanded polytetrafluoroethylene under cardiopulmonary bypass. Data were collected from the hospital records of all dogs that had undergone right ventricular outflow tract grafting with an expanded polytetrafluoroethylene patch under cardiopulmonary bypass between 2006 and 2012 for the treatment of pulmonic stenosis. Echocardiographic images were reviewed and the pressure gradient across the right ventricular outflow tract re-measured. Owners of dogs still alive at the time of writing were invited to return to the hospital for reassessment. Nine dogs met the inclusion criteria. Median pressure gradient preoperatively was 118 mmHg, (range 102 to 259 mmHg) reducing to a median of 20 mmHg (range 7 to 53 mmHg) at 48 hours postoperatively and 14 mmHg (range 10 to 70 mmHg), with a median percentage reduction of 89% (range 41 to 94%) at long-term follow-up. Eight of nine dogs survived surgery, with six of nine surviving to hospital discharge. Two dogs were still alive over 6 and 8 years postoperatively. No long-term deaths were believed to be attributable to pulmonic stenosis. Expanded polytetrafluoroethylene patch grafting of the right ventricular outflow tract for treatment of severe pulmonic stenosis in dogs is feasible and can be an effective method to reduce the severity of right ventricular outflow tract obstruction.

The effect of a silk Fibroin/Polyurethane blend patch on rat Vessels

ABSTRACTPatch grafts are widely used in various kind of vascular surgeries such as detect repair or dilation of vascular stenosis. Expanded polytetrafluoroethylene (ePTFE) patches are flexible and handle well, but have shown problems with calcification as they are non-bioabsorbable and therefore permanently remain in the body. It is important to develop an alternative biocompatible patch. Silk fibroin (SF) was developed as a biocompatible material, but it lacks of the elasticity required for surgery as a patch. Polyurethane (PU) is also a well-known elastomer so this study focused on the SF and the PU blend materials with a weight ratio of 5:5 (SF/PU). To evaluate the SF/PU patch, the patches were implanted into the abdominal aortas of rats, using the ePTFE patch in the control group. Because it was more flexible the SF/PU patch was easier to implant than the ePTFE patch. At 1 week after implantation, the SF/PU patch had been infiltrated with cells and collagen fiber. The ePTFE control patch did not accumulate collagen fiber until 3 months and calcification occurred at 4 weeks. The SF/PU patch did not present any signs of calcification for 3 months. This study addressed the problems associated with using SF in isolation and showed that the SF/PU patch can be considered as a useful alternative to the ePTFE to overcome the problem of calcification.

Adherence of Staphylococcus aureus to Dyneema Purity® Patches and to Clinically Used Cardiovascular Prostheses.

Various materials that are used for vascular and heart valve prostheses carry drawbacks: some require anticoagulant drugs or have moderate durability; others are not suitable for endovascular treatment. These prostheses are associated with bacterial infections. A material potentially suitable for prostheses is Dyneema Purity®, made of ultra—high-molecular-weight polyethylene. Dyneema Purity® fibers are very thin, flexible, resistant to fatigue and abrasion, and have high strength. S. aureus adherence to Dyneema Purity® was tested and compared with currently used cardiovascular prostheses. We compared adhesion of S. aureus to Dyneema Purity® (1 membrane-based and 1 yarn-composed patch) with 5 clinically used yarn-composed polyester and membrane-based expanded polytetrafluoroethylene patches. Patches were contaminated with S. aureus bacteria and bacterial adherence was quantified. S. aureus adherence was also visualized in flow conditions. Overall, bacterial adherence was higher on yarn-composed prosthesis materials, with a rough surface, than on the membrane-based materials, with a smooth surface. Adherence to Dyneema Purity® materials was non-inferior to the currently used materials. Therefore, patches of Dyneema Purity® might be attractive for use in cardiovascular applications such as catheter-based heart valves and endovascular prostheses by their good mechanical properties combined with their noninferiority regarding bacterial adhesion.

Partial anomalous pulmonary venous connection and partial atrioventricular septal defect in an adult: Report of a case

A partial anomalous pulmonary venous connection (PAPVC) associated with partial atrioventricular septal defect (AVSD) is a rare combination. A 51-year-old man who experienced dyspnea on exertion was found to have a PAPVC with the middle portion of the superior vena cava and a comorbid partial AVSD. A patch diversion was successfully performed using an expanded polytetrafluoroethylene patch to create a pulmonary venous drainage route while preserving the cavoatrial junction. The postoperative course was uneventful. The patient was in good health, without arrhythmia and thromboembolism, 3 years after the operation.

Large Ruptured Carotid Artery Pseudo-aneurysm in Behcet’s Disease: Report of a Case

This is a case report of a 36-year-old male with Behcet’s disease (BD) whose bilateral extracranial carotid arteries were involved. Computed tomography angiography showed a large ruptured pseudo-aneurysm of the left common carotid artery, and complete occlusion of the right one. The pseudo-aneurysm was excised and the left common carotid artery was repaired with an expanded polytetrafluoroethylene patch successfully. To our knowledge, this is the first ruptured and largest carotid pseudo-aneurysm in BD reported in the literature, combined with complete occlusion of the contralateral carotid artery in the meantime, which obviously increased surgical difficulty and risk of irreversible cerebral ischaemia during operation.

Use of an Expanded Polytetrafluoroethylene Patch as an Artificial Leaflet in Mitral Valve Plasty: An Early Experience

The purpose of this study was to examine the usefulness of polytetrafluoroethylene (PTFE) patches as artificial mitral leaflets in complex mitral valve plasty. Nineteen patients (mean age, 66 +/- 9 years) who were in need of mitral valve replacement successfully underwent mitral valve plasty with enlargement of the basal anterior leaflet using a PTFE patch. Operative and in-hospital mortality was 0%. Patients were followed-up by maintaining their history, physical examinations, and echocardiography. The mean follow-up period was 30 +/- 15 months (2 to 52 months) with one late mortality and one reoperation. A thin neointimal layer was observed on the explanted PTFE patch. The PTFE patch maintained its pliability with no signs of calcification, excessive thickening, or perforation for 4 years. Mean motion angle of the patch on echocardiography decreased from 41.1 +/- 10.6 to 35.2 +/- 12.5 degrees (p < 0.05) during 26.7 +/- 15.5 months of study (range, 6-46 months). The mean mitral valve area was 2.9 +/- 0.7 cm(2) at last follow-up. The PTFE patches may be a promising material for artificial mitral leaflets.

Invited Commentary

Ischemic mitral regurgitation (MR) is a serious clinical problem in coronary artery disease and it is associated with poor long-term outcomes. Mitral valve repair has been reported to be better than mitral valve replacement regarding early mortality and late outcomes. Lateral replacement of the papillary muscle with the enlarged left ventricle caused tethering of the chordae, and resulted in restricted systolic motion of the mitral leaflet. Undersized ring annuloplasty has been the first choice for reduction of the dilated mitral annulus. However, because the incidence of recurrent MR was greater than 30%, a more sophisticated approach to ischemic MR is necessary. Mitral leaflet augmentation is one of the options to repair tethered mitral leaflet, besides papillary muscle approximation, secondary chordal cutting, and surgical relocation of the papillary muscle. The authors [1Ito T. Maekawa A. Yamana K. Yoshizumi T. Sunada M. Use of an expanded polytetrafluoroethylene patch as an artificial leaflet in mitral valve plasty: an early experience.Ann Thorac Surg. 2010; 89: 1620-1624Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar] reported anterior mitral leaflet augmentation with the polytetrafluoroethylene (PTFE) patch to increase coaptation zone against posterior leaflet. This procedure was similar to a previously used technique, which was leaflet augmentation with autologous or xenopericardium for functional MR or rheumatic MR. The fate of the pericardium has been shrinkage or calcification with time. Redo surgery is sometimes the situation after coronary artery bypass grafting for the treatment of ischemic MR. As autologous pericardium is difficult or impossible to harvest during a redo situation, the commercially available PTFE patch must be useful. We have used expanded PTFE sutures for chordal replacement in degenerative mitral regurgitation for 20 years [2Kobayashi J. Sasako Y. Bando K. et al.Ten-year experience of chordal replacement with expanded polytetrafluoroethylene in mitral valve repair.Circulation. 2000; 102: III-30-III-34Crossref Google Scholar]. The sutures became completely endothelialized with anti-thrombotic characteristics. Although the Gore-Tex sutures (Ethicon, Somerville, NJ) were thicker than the original material with absorption of protein from the serum with time, the CV-4 sutures have been flexibly working even 15 years after the operation in all cases. As the authors [1Ito T. Maekawa A. Yamana K. Yoshizumi T. Sunada M. Use of an expanded polytetrafluoroethylene patch as an artificial leaflet in mitral valve plasty: an early experience.Ann Thorac Surg. 2010; 89: 1620-1624Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar] reported the motion angle of the patch decreased from 41 degrees to 35 degrees in 2 years, meticulous follow-up of the PTFE with echocardiography should be mandatory. In addition, there must be a limitation of this procedure for functional MR. The indication of this procedure with regard to the tethering height or other index should be delineated in the future. Use of an Expanded Polytetrafluoroethylene Patch as an Artificial Leaflet in Mitral Valve Plasty: An Early ExperienceThe Annals of Thoracic SurgeryVol. 89Issue 5PreviewThe purpose of this study was to examine the usefulness of polytetrafluoroethylene (PTFE) patches as artificial mitral leaflets in complex mitral valve plasty. Full-Text PDF

(Repairing Large Duodenal Injuries in Dogs by Expanded Polytetrafluoroethylene Patch. J Surg Res 2008;144:17-21)

(Repairing Large Duodenal Injuries in Dogs by Expanded Polytetrafluoroethylene Patch. J Surg Res 2008;144:17-21)

Using Expanded Polytetrafluoroethylene Patches to Repair Perforations of the Gastrointestinal Tract: A Two-Case Report

Using Expanded Polytetrafluoroethylene Patches to Repair Perforations of the Gastrointestinal Tract: A Two-Case Report

Repairing Large Duodenal Injuries in Dogs by Expanded Polytetrafluoroethylene Patch

One of the most challenging problems in clinical surgery is management of injured duodenum. In this experimental study, we treated large duodenal defects by an expanded polytetrafluoroethylene (ePTFE, Gore-Tex; W.L. Gore, Elkton, MD) soft-tissue patch and compared it with the jejunal serosal patch. A duodenal defect (about 50% of the total circumference) was created in the second portion of the duodenum in 20 dogs. The effectiveness and gross and histological examinations of the ePTFE patch technique was compared with the jejunal serosal patch. No significant difference was found in early survival rates (90.9% versus 88.9%; P = 0.711). The whole grafted area was covered by neomucosa at the end of the sixth week in all animals with the ePTFE patch. The scar was small; no significant narrowing of lumen was noted and serosal healing was uniformly complete. In histological examination, complete coverage of the ePTFE grafts by neomucosa consisting of columnar epithelium with short villous formations was observed. Use of the ePTFE patch method is easy, reliable, and comparable to the jejunal serosal patch. It can be used in the treatment of large duodenal defects, which cannot be repaired by duodenorraphy.

In Vivo Evaluation of a Porous, Elastic, Biodegradable Patch for Reconstructive Cardiac Procedures

Several synthetic materials have been used for cardiac reconstruction in patients with complex congenital heart defects. These materials are not viable, do not grow with children, and may necessitate reoperation. We report here on the cardiac implantation of a recently developed, degradable porous material designed to facilitate cellular ingrowth during the healing process. An elastomeric, biodegradable polyester urethane urea (PEUU) was processed into circular scaffolds and used to replace a surgical defect in the right ventricular outflow tract of adult rats. Control rats were implanted with expanded polytetrafluoroethylene. Histologic evaluation was performed at 4, 8, and 12 weeks postsurgery. All animals survived the surgery. Both PEUU and expanded polytetrafluoroethylene were encapsulated with fibrous tissue and had complete endothelialization on the endocardial surface with no aneurysm formation or thrombus noted. With PEUU patching, fibroblast ingrowth occurred at 4 weeks, increasing with time. In contrast, expanded polytetrafluoroethylene patches exhibited no ingrowth and elicited local inflammation that moderated with time. The PEUU patch demonstrated suitable mechanical properties and biocompatible characteristics in the right ventricular outflow tract replacement model, permitting cellular integration and endocardial endothelialization with minimal inflammation. Future application of this material as a cardiovascular scaffold seems promising.

Mesothelium regeneration on acellular bovine pericardia loaded with an angiogenic agent (ginsenoside Rg 1) successfully reduces postsurgical pericardial adhesions

Our objective was to reduce postsurgical pericardial adhesions with porous acellular bovine pericardia loaded with ginsenoside Rg1, an angiogenic agent isolated from Panax ginseng (the Acellular/Rg1 patch). The acellular/Rg1 patch was used as a substitute to repair a defect created in the pericardium of a rabbit model. A commercially available expanded polytetrafluoroethylene patch, the cellular pericardium (the cellular patch), and the acellular pericardium without loading Rg1 (the acellular patch) were used as controls. The implanted samples were retrieved at 1 and 3 months after surgery (n = 5 per group at each time point). It was found that each side of the implanted patch could be remesothelialized provided that regeneration of neo-tissue fibrils occurred initially on its surfaces. Because remesothelialization did not take place on the surfaces of the expanded polytetrafluoroethylene and cellular patches, moderate to severe adhesions to the lung and epicardium were clearly observed. As compared with the cellular patch, the acellular patch significantly reduced postsurgical pericardial adhesions, especially on its lung side, as a result of remesothelialization. In the presence of Rg1, a faster remesothelialization was observed on each side of the acellular/Rg1 patch. Therefore, the acellular/Rg1 patch was free of any adhesions to the lung; however, there was still a filmy adhesion to the epicardium observed in 3 of the 5 studied animals at 3 months after surgery, due to incomplete remesothelialization. The acellular/Rg1 patch effectively repaired pericardial defects in rabbits and successfully reduced the formation of pericardial adhesions.

Expanded polytetrafluoroethylene patch for the repair of large abdominal wall defects

Expanded polytetrafluoroethylene (ePTFE) was used to repair 11 large abdominal wall defects in ten patients. Three patches were fixed to the adjacent abdominal aponeurosis with a single row of sutures; seven patches were implanted with a 1-2 cm overlap of patch and aponeurosis and a double row of sutures. Recurrent buttonhole hernias were found in two patients, in both of whom a single row of sutures had been used. This reherniation was due to insufficient anchorage of the patch to the fascia. It is concluded that ePTFE is a useful material to repair large abdominal wall defects provided the patch is fixed to the aponeurosis with an overlap and a double row of sutures to prevent buttonhole hernias.

Ross Procedure for Aortic Insufficiency Due to Doubly Committed Subarterial Ventricular Septal Defect in Adults

A 52-year-old female, with aortic insufficiency due to doubly committed subarterial ventricular septal defect (VSD) underwent a successful surgical repair by the Ross procedure. Preoperatively, she developed congestive heart failure because of less compliance to oral medication, raising concerns regarding life-threatening thromboembolism if she undergoes mechanical valve replacement. Despite the pulmonary autograft being defective, there were no difficulties in completing the surgery. The defect of pulmonary autograft and the VSD was closed by an expanded polytetrafluoroethylene patch. She tolerated the procedure well and now enjoys improved quality of life. We present a discussion of the indication of Ross procedure in the rare presentation of congenital heart disease, as well as several issues raised in this case.

Ventral Rectus Fascia Closure on Top of Mesh Hernia Repair in the Sublay Technique

Sublay prosthetic herniorrhaphy has become a widely accepted procedure for incisional hernias. To evaluate the effect of fascia closure on top of mesh repair on infection, and the recurrence rate, the authors reviewed their data regarding herniorrhaphy in the sublay technique. This study was a retrospective analysis of 175 consecutive patients who underwent hernia repair by implantation of prostheses by means of the Stoppa-Rives technique from December of 1994 to December of 2001. All 175 patients had the mesh implanted in the subfascial plane, 130 received a light-weight or heavy-weight polypropylene mesh (Vypro or Prolene) (74 percent), eight had a polyester mesh (Mersilene) (5 percent), and 37 had an expanded polytetrafluoroethylene patch (Gore-Tex) (21 percent). After sublay mesh positioning, the mesh could not be covered by the fascia in 50 cases; in 31 of these cases, a second mesh was placed into the fascial defect. To evaluate the influence of the fascia closing procedure on top of the sublay mesh, three groups were differentiated: initial fascia closure (n = 125), no fascia closure and concomitant mesh interposition (n = 31), and no fascia closure without mesh interposition (n = 19). After a mean follow-up of 20 months, 11 deep prosthetic infections (8 percent) and 15 hernia recurrences (9 percent) were observed. There was an increased risk of mesh infection when the fascia could not be closed, but there was no influence of fascia closure on hernia recurrence. When the fascia was left open, the placement of a second mesh inlay technique reduced mesh infection. The authors' data give evidence that closing the ventral fascia after mesh repair in the sublay position is beneficial. When the edges of the hernia defect could not be approximated, the suturing of a second mesh into the fascia defect was a useful tool for reducing the prosthetic infection rate; however, no significant influence on hernia recurrence was observed.