Resorbable Mesh Research Articles

Results at 3-year follow-up of totally extraperitoneal (TEP) hernia surgery with long-term resorbable mesh

IntroductionSynthetic non-resorbable mesh is almost standard in hernia surgery. However, several studies have showed negative effects of permanent implants such as chronic inflammation and complications involving different organs bordering the mesh. Such complications can raise the risk of chronic post-operative pain (CPP). Recently promising results regarding CPP have been published in patients with Lateral Inguinal Hernia (LIH) using a slowly resorbable mesh in Lichtenstein technique. For this reason the aim of the present study was to find the effect of a slowly resorbable implant on the long-term rate of hernia recurrence and chronic post-operative pain in patients with LIH repaired with TEP procedure.MethodsProspective pilot study of TEP repair using TIGR® Matrix Surgical Mesh in 35 primary LIH. At 3-year follow-up the Visual Analogue Scale (VAS) and the Inguinal Pain Questionnaire were employed to assess pain. Recurrence was determined by ultrasound and clinical examination.ResultsAll patients completed the pain questionnaires but one patient did not attend the planned clinical examination for the 3-year follow-up. No patients had CPP, as defined in the World Guidelines for Groin Hernia Management. Almost all patients had lower VAS score in any activity 3 years following surgery in comparison to the preoperative period. Three patients (8.8%) suffered symptomatic recurrence during the 3-year follow-up.ConclusionTEP repair in patients with LIH using a synthetic long-term resorbable mesh was found to be encouraging respecting chronic post-operative pain at 3-year follow-up but at the cost of an increased risk of recurrence.

Safety and efficacy of prophylactic resorbable biosynthetic mesh in loop-ileostomy reversal: a case-control study.

Loop ileostomy (LI) is a widely used temporary stoma technique. Reversal of LI is generally considered a minor and safe procedure, with very low short-term postoperative mortality and morbidity rates. Complications include incisional hernia (IH), carrying a high probability of surgical repair. Clinical measures to reduce the IH rate warrant consideration. Recent researches suggest the use of a prophylactic non-absorbable mesh to reduce IH rate; however, surgeons are reluctant to implant a permanent foreign material in contaminated operative fields, because of a higher risk of mesh-related complications, infection, seroma, and pain. The aim of the present study is to assess feasibility, potential benefits, and safety of a prophylactic biosynthetic mesh placed during LI reversal. From January 2016 to December 2018, 26 consecutive patients underwent LI reversal positioning a resorbable biosynthetic mesh in an on-lay position [mesh group (MG)]. The mesh used was a GORE BIO-A tissue reinforcement, a biosynthetic mesh composed of a bioabsorbable polyglycolide-trimethylene carbonate copolymer. The MG was matched with 58 patients [control group (CG)], undergoing LI reversal without mesh placement from January 2013 to December 2018. To detect IH, abdominal wall was studied according to clinical and ultrasonographic criteria. Primary endpoint was IH rate on LI site, at 6 and 12months after stomal reversal. Secondary endpoints included incidence of wound events. Thirty-day morbidity was classified according to Clavien-Dindo score; mortality and length of hospital stay were also collected. Mean follow-up was 15.4 ± 2.3months (range 12.4-22.0) for MG vs 37.2 ± 26.9 (range 24.9-49.7) for. CG. At 1year of follow-up, IH rate was lower in MG (n = 1/26 [3.8%]) vs CG (n = 19/58 [32.7%]; P < 0.05). A clinically evident IH was less frequent in MG (n = 0 [0%]) vs CG (n = 13 [68%]; P < 0.05). A radiologic IH was less frequent in MG (n = 1 [3%]) vs CG (n = 6 [31%]; P < 0.05). Stoma site hernia was repaired in 9/19 patients (47%) in CG; no patient of MG has hernia repaired. Incarcerated IH was observed in one patient of CG. No postoperative mortality was reported. Overall postoperative morbidity showed no difference comparing MG and MG (n = 5 [17%] vs n = 15 [19%], respectively; P > 0.05). Surgical site infections (SSI) were treated with antibiotic therapy, no debridement was necessary. Seroma occurred in two patients, one for each group. No statistically significant difference for surgical outcomes was found between the two groups at 30days. Early results of the present study suggest that an on-lay prophylactic placement of GORE BIO-A tissue reinforcement might lower IH rate at LI site. The procedure seems to be safe and effective, even long-term results and further studies are needed.

Safety and Efficacy of Crura Augmentation with Phasix ST Mesh for Large Hiatal Hernia: 3-Year Single-Center Experience

Background: Safety and effectiveness of absorbable meshes for laparoscopic hiatus hernia repair are still debated. This may be due to patient selection, technique of repair, type and shape of mesh, definition of recurrent hernia, and length of follow-up. The aim of this study was to assess safety, short-term efficacy, and quality of life after laparoscopic repair of hiatal hernia reinforced with a biosynthetic absorbable mesh. Materials and Methods: A single-center observational cohort study was conducted in patients with large type III-IV hiatal hernia who underwent laparoscopic crural repair reinforced with Phasix ST®, a monofilament resorbable mesh (poly-4-hydroxybuterate) with a hydrogel barrier on one side. Patient data were extracted from hospital charts and a prospectively updated research database. Both generic Short Form-36 (SF-36) and disease-specific (Gastro-Esophageal Reflux Disease Health-Related Quality of Life [GERD-HRQL]) questionnaires were used to assess preoperative and postoperative quality of life. Results: From January 2017 to July 2019, 73 consecutive patients were implanted with Phasix ST mesh. The median follow-up was 17 (interquartile range 9-24) months. Recurrent hernia was found in 2 of 62 (3.2%) patients followed for more than 6 months after surgery, but none required reoperation. The overall postoperative morbidity rate was 8.2%. No mesh-related complications occurred. Compared to baseline, there was a statistically significant improvement of all items of the SF-36 questionnaire (P < .001) and of the median GERD-HRQL score (P < .001). Conclusion: The use of Phasix ST mesh to reinforce crural repair for large hiatus hernias is safe, is effective in the short-term follow-up, and is associated to improved quality of life.

A case of resorbable mesh cranioplasty in infant, technical considerations, outcome and literature review

Calvaria defects in children present a reconstructive challenge. When autogenous bone is not available, synthetic materials can be used; however, they present many drawbacks limiting their use in infants. Children, especially under the age of two, represent an incomparable limitation and they are infrequently reported in literature. The reconstructive strategies presented in the last decades are different without a clear consensus about the best procedure and material for a specific range of age. We report our experience with resorbable mesh cranioplasty using a polylactic acid / polyglycolic acid resorbable mesh plate with bone matrix in a 3-month old child who previously underwent decompressive craniectomy. This reconstructive strategy failed, and the patient was scheduled for a second procedure. After the case presentation, the literature is reviewed and discussed focusing on infants and young children.

P177 REINFORCED CRURAL REPAIR FOR LARGE HIATUS HERNIA: PRELIMINARY RESULTS WITH PHASIX ST® MESH

Abstract Aim The aim of the study was to assess safety, quality of life and recurrence rate after laparoscopic repair of hiatal hernia reinforced with a biosynthetic absorbable mesh (PHASIX ST®). Background &amp; Methods Safety and effectiveness of absorbable meshes for laparoscopic hiatus hernia repair are still debated, with several studies reporting conflicting outcomes. This may be due to patient selection, technique of repair, type of mesh, definition of recurrent hernia and length of follow up. An observational, single-center study was conducted in patients undergoing laparoscopic crural repair reinforced with PHASIX ST®, a monofilament resorbable mesh (poly-4-hydroxybuterate) with a hydrogel barrier on one side. Data were extracted from hospital charts and a prospectively updated research database. The quality of life was assessed by the GastroEsophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaire. Clinical evaluation, upper gastrointestinal endoscopy and/or barium swallow study were performed at 6 – 24 months of follow up. Recurrent hernia was defined as the maximum vertical height of stomach &gt; 2 cm above diaphragm at endoscopy and/or barium swallow study. Results 103 consecutive patients were implanted with PHASIX ST® mesh from January 2017 to May 2019. The overall postoperative morbidity rate was 2.9%. The average follow up was 13 months with 31 (30%) patients reaching 2-year. The mean postoperative GERD-HRQL score significantly improved compared to baseline (4.6 ± 3.9 vs 16.6 ± 4.1, p&lt;0,001). Recurrent hernia was found in 3 of 79 (3.8%) patients followed for at least 6 months after surgery. None of the patients required reoperation for adverse events or symptomatic hernia recurrence. Conclusion The use of PHASIX ST® mesh to reinforce crural repair for large hiatus hernias is safe and seems to be effective in the short-term follow up.

Horizontal ridge augmentation with resorbable collagen membrane versus titanium mesh using a mixture of particulated autogenous bone and an organic bovine bone in atrophic maxilla

Horizontal ridge augmentation with resorbable collagen membrane versus titanium mesh using a mixture of particulated autogenous bone and an organic bovine bone in atrophic maxilla

P117. TIGR Matrix synthetic long-term resorbable mesh for pre-pectoral and sub-pectoral implant based breast reconstruction: outcomes of two years’ practice

Introduction: The use of biological matrices to assist implant-based breast reconstruction is a widespread but costly technique. Our unit has used TIGR Matrix, a synthetic long-term resorbable mesh, as our primary method to assist implant coverage since 2016. We present our initial outcomes.

Comparative study on long-term stability in mandibular sagittal split ramus osteotomy: hydroxyapatite/poly-l-lactide mesh versus titanium miniplate

BackgroundResorbable devices have recently been adopted in the field of orthognathic surgery with controversies about their postoperative skeletal stability. Hence, we determined the long-term skeletal stability of unsintered hydroxyapatite/poly-l-lactic acid (HA/PLLA) mesh for osteofixation of mandibular sagittal split ramus osteotomy (SSRO), and compared it with that of titanium miniplate.MethodsPatients were divided into resorbable mesh and titanium miniplate fixation groups. A comparative study of the change in the mandibular position was performed with preoperative, 1-day, 6-month, and 2-year postoperative lateral cephalograms.ResultsAt postoperative 6 months—compared with postoperative 1 day, point B (supra-mentale) was significantly displaced anteriorly in the titanium-fixation group. Moreover, at postoperative 2 years—compared with postoperative 6 months, point B was significantly displaced inferiorly in the titanium-fixation. However, the HA/PLLA mesh-fixation group did not show any significant change with respect to point B postoperatively.ConclusionsThe HA/PLLA mesh-fixation group demonstrated superior long-term skeletal stability with respect to the position of mandible, when compared with the titanium-fixation group.

Comparison of the host macrophage response to synthetic and biologic surgical meshes used for ventral hernia repair

The host innate immune response to a surgical mesh is arguably the most important determinant of tissue remodeling and functional outcome. Macrophage phenotype and the associated secretion of pro-inflammatory or anti-inflammatory cytokines during the first 10–14 days following implantation has been strongly associated with downstream events such as chronic inflammation vs. functional tissue remodeling, respectively, and the associated clinical consequences. A persistent, pro-inflammatory (M1-like) macrophage phenotype is typically associated with fibrosis and scarring. In contrast, an early transition to a regulatory, pro-remodeling (M2-like) macrophage phenotype is predictive of organized, site-appropriate connective tissue deposition. The ratio of M2-like to M1-like macrophages in the early post-implantation period defines the microenvironmental milieu and the associated tissue response. The present study evaluated the early macrophage response to a synthetic non-resorbable (Bard® Mesh), synthetic resorbable (TIGR® Matrix Surgical Mesh and GORE® BIO-A® Tissue Reinforcement), synthetic mesh composed of the naturally occurring molecule 4-hydroxybutyrate, (Phasix™ Mesh), and a biologic surgical mesh composed of dermal extracellular matrix (Strattice™ Reconstructive Tissue Matrix); all of which are used in ventral hernia repair. The spatiotemporal distribution of pro-inflammatory (CD68+CD86+TNF-α+) and pro-remodeling (CD68+CD206+) macrophages, and the remodeling response in terms of vascularization, total number of infiltrating cells, presence of multinucleate giant cells (MNGC), and cell layer thickness around the implanted materials was evaluated at 3, 7, 14, 21, and 35 days post implantation. Results showed an association of the synthetic non-resorbable and resorbable meshes with a robust, pro-inflammatory response within 3 days of implantation, and an increased presence of MNGC around the mesh fibers at longer time points. Phasix™ Mesh was associated with an increased presence of M2-like macrophages immediately adjacent to the mesh fibers at earlier time points, and a favorable tissue remodeling outcome at 35 days. Results of the present study are consistent with the premise that an early shift of M1-like to M2-like macrophages is associated with favorable outcomes, including reduced fibrosis, at later time points.

A post-market, prospective, multi-center, single-arm clinical investigation of Phasix\u2122 mesh for VHWG grade 3 midline incisional hernia repair: a research protocol

BackgroundIncisional heia is a frequent complication of midline laparotomy. The use of mesh in hernia repair has been reported to lead to fewer recurrences compared to primary repair. However, in Ventral Hernia Working Group (VHWG) Grade 3 hernia patients, whose hernia is potentially contaminated, synthetic mesh is prone to infection. There is a strong preference for resorbable biological mesh in contaminated fields, since it is more able to resist infection, and because it is fully resorbed, the chance of a foreign body reaction is reduced. However, when not crosslinked, biological resorbable mesh products tend to degrade too quickly to facilitate native cellular ingrowth. Phasix™ Mesh is a biosynthetic mesh with both the biocompatibility and resorbability of a biological mesh and the mechanical strength of a synthetic mesh. This multi-center single-arm study aims to collect data on safety and performance of Phasix™ Mesh in Grade 3 hernia patients.MethodsA total of 85 VHWG Grade 3 hernia patients will be treated with Phasix™ Mesh in 15 sites across Europe. The primary outcome is Surgical Site Occurrence (SSO) including hematoma, seroma, infection, dehiscence and fistula formation (requiring intervention) through 3 months. Secondary outcomes include recurrence, infection and quality of life related outcomes after 24 months. Follow-up visits will be at drain removal (if drains were not placed, then on discharge or staple removal instead) and in the 1st, 3rd, 6th, 12th, 18th and 24th month after surgery.ConclusionBased on evidence from this clinical study Depending on the results this clinical study will yield, Phasix™ Mesh may become a preferred treatment option in VHWG Grade 3 patients.Trial registrationThe trial was registered on March 25, 2016 on clinicaltrials.gov: NCT02720042.

Orbital wall restoring surgery with resorbable mesh plate.

BackgroundOrbital resorbable mesh plates are adequate to use for isolated floor and medial wall fractures with an intact bony buttress, but are not recommended to use for large orbital wall fractures that need load bearing support. The author previously reported an orbital wall restoring surgery that restored the orbital floor to its prior position through the transnasal approach and maintained temporary extraorbital support with a balloon in the maxillary sinus. Extraorbital support could reduce the load applied on the orbital implants in orbital wall restoring surgery and the use of resorbable implants was considered appropriate for the author’s orbital wall restoring technique.MethodsA retrospective review was conducted of 31 patients with pure unilateral orbital floor fractures between May 2014 and May 2018. The patients underwent transnasal restoration of the orbital floor through insertion of a resorbable mesh plate and maintenance of temporary balloon support. The surgical results were evaluated by the Hertel scale and a comparison of preoperative and postoperative orbital volume ratio (OVR) values.ResultsThe OVR decreased significantly, by an average of 6.01% (p< 0.05) and the preoperative and postoperative Hertel scale measurements decreased by an average of 0.34 mm with statistical significance (p< 0.05). No complications such as buckling or sagging of the implant occurred among the 31 patients.ConclusionThe use of resorbable mesh plate in orbital floor restoration surgery is an effective and safe technique that can reduce implant deformation or complications deriving from the residual permanent implant.

Use of resorbable mesh and fibrin glue for restoration in comminuted fracture of anterior maxillary wall.

BackgroundThe facial bone has a complex structure compared to other bones, and various types of fractures can occur due to its characteristics. Among them, in comminuted fractures of anterior maxillary wall, multiple depressed and impacted bony segments cannot be reduced easily when performing internal fixation using plates and screws or wires, and inadequate restoration leads to a range of complications. This paper introduces an alternative technique using a resorbable mesh with fibrin glue to restore comminuted fractures of anterior maxillary wall.MethodsThirteen patients were diagnosed with comminuted fractures of anterior maxillary wall between March 2017 and February 2018 in the authors’ hospital. All patients with comminuted fractures of anterior maxillary wall underwent restoration using resorbable mesh with fibrin glue. The patients’ demographics, causes of facial trauma, mean operation time, length of hospital stay, follow-up period, and complications were recorded.ResultsNo major complications and only one hypoesthesia of the skin area was noted. Three months after surgery, the hypoesthesia recovered completely. After surgery (mean, 3.9 months; range, 2–12 months), computed tomography showed that the bone fragments in all patients were fixed successfully in their anatomical places.ConclusionIn comminuted fractures of anterior maxillary wall, the use of a resorbable mesh with fibrin glue can be an advantageous and effective method for a successful restoration without complications.

TIGR matrix for implant-based breast reconstruction – a long-term resorbable mesh

ABSTRACTThe use of biological and synthetic meshes to aid implant coverage in implant-based breast reconstruction is well established. This technique allows single stage implant-based reconstruction compared to the traditional technique which required tissue expansion before permanent implant placement and therefore involved two operations for the patient. They can further be used for pre-pectoral implant reconstructions in a similar direct-to-implant strategy.This retrospective observational study by Pompei et al has evaluated the use of TIGR Matrix, a long-term resorbable mesh, in 49 patients with 60 operated breasts for both reconstructive and aesthetic cases. They have reported their operative method and followed up their cases for a mean of 12 months.They have reported a cumulative mesh complication rate of 5.4% and one implant was explanted due to infection. They identified a significant correlation between obesity and mesh-related complications.This study is significant as there remains little data regarding the long term outcomes of resorbable synthetic mesh for breast reconstruction. Their reported complication rates are consistent with those in other studies for synthetic meshes. As synthetic meshes can be significantly cheaper than their biological counterparts, this work could promote more widespread use.

The Value Proposition for Complex Abdominal Wall Reconstruction: How to Make It Work.

The challenge for health care in the 21st century is to understand how to measure and improve value in the context of each patient care process for the entire cycle of care. For patients who undergo an abdominal wall reconstruction, there is a great opportunity to improve value because of the high cost and variability in outcomes for this complex operation. For almost a decade, our hernia team has been applying the principles of systems and data science to actual patient care. Tools from systems and data science applied to patient care include clinical quality improvement and nonlinear analytical methods such as factor analysis. The most important outcome to measure and improve is the value of care provided for the entire cycle of care. Many measurement and improvement ideas have been applied to the abdominal wall reconstruction process in our hernia program, including the use of a less costly long-term resorbable mesh, multimodal pain management and enhanced recovery process improvement ideas, and surgical technique improvements that have led to decreased wound complications and the elimination of abdominal wall drains. More recently, the data analysis has shown an opportunity to improve outcomes through a robust prehabilitation program, including cognitive therapy to induce neural rewiring before surgery. Improving value for patients who undergo abdominal wall reconstruction and for all patients in our global health care system should be a unifying goal. Understanding and applying systems and data science tools appropriately are necessary to achieve this goal.

A Current Review of Long-Acting Resorbable Meshes in Abdominal Wall Reconstruction.

Concern for chronic infection of a permanent synthetic material in contaminated and "high risk" ventral hernia repairs has led to the development and dissemination of slowly resorbable biosynthetic materials at a lower cost compared with biologic mesh counterparts. Here, we review the preclinical and clinical data available for each long-acting resorbable mesh, with a candid comparison to biologic and synthetic equivalents.

Prophylactic mesh used in ileal conduit formation following radical cystectomy: a retrospective cohort.

Given the difficulty of durable repairs, there is continued interest in hernia prevention. One emerging prevention technique for parastomal hernias is prophylactic mesh placement, whereby mesh is inserted during the index procedure as hernia prophylaxis. We evaluated our experience using prophylactic mesh when creating an ileal conduit. We retrospectively reviewed patients undergoing robotic cystectomy with ileal conduit from 6/2010 to 8/2017. Patient demographics and operative/perioperative outcomes were documented. We evaluated hernia recurrence using postoperative computed tomography scanning or physical exam. Prophylactic mesh was inserted at the operating surgeon's discretion using a synthetic resorbable or biologic mesh. During the study period, 38 patients underwent robotic-assisted cystectomy with ileal conduit formation. Average patient age was 68 years, with 28 (74%) male and 35 (92%) Caucasian patients. Three patients (8%) required conversion to open, and one patient (3%) had a concomitant colorectal resection. Thirty-one (88%) patients had postoperative computed tomography scanning. Prophylactic mesh was used in 18 patients (47%) in a retrorectus position. Of these, 15 (83%) patients had synthetic resorbable mesh and 3 (17%) patients had biologic mesh. At average follow-up of 21 months, one hernia recurred (5%) in a patient without mesh placement at the time of ileal conduit. At an average follow-up of 11 months, there have been no recurrences and no mesh-related complications in the prophylactic mesh group. Using prophylactic mesh in ileal conduit, creation is feasible and may decrease the parastomal hernia formation rate. Further study of using synthetic resorbable and biologic meshes for hernia prophylaxis is warranted.

Sliding free transverse rectus abdominis myocutaneous flap for closure of a massive abdominal wall defect: A case report

Despite considerable advances in reconstructive surgery, massive abdominal wall defects continue to pose a significant surgical challenge. We report the case of a 72-year-old morbidly obese female patient with Clostridium septicum-related gas gangrene of the abdominal wall. After multidisciplinary treatment and multiple extensive debridements, a massive full-thickness defect (40 cm × 35 cm) of the right abdominal wall was present. The abdominal contents were covered with a resorbable mesh to prevent evisceration. Finally, the composite defect was successfully reconstructed through a contralateral extended free transverse rectus abdominis myocutaneus (TRAM) flap (50 cm × 38 cm). An arterio-venous loop to the superficial femoral vessels using the great saphenous vein was necessary to allow the flap to reach the defect. Postoperatively, a minor wound healing disorder of the flap was successfully treated with split skin grafting. Six month after surgery, the patient presented with a completely healed flap coverage area and a small abdominal hernia without the need of further surgical revision. This case illustrates the use of a sliding free TRAM flap for closure of a massive abdominal wall defect.

Prospective evaluation of poly-4-hydroxybutyrate mesh in CDC class I/high-risk ventral and incisional hernia repair: 18-month follow-up.

Long-term resorbable mesh represents a promising technology for complex ventral and incisional hernia repair (VIHR). Preclinical studies indicate that poly-4-hydroxybutyrate (P4HB) resorbable mesh supports strength restoration of the abdominal wall. This study evaluated outcomes of high-risk subjects undergoing VIHR with P4HB mesh. This was a prospective, multi-institutional study of subjects undergoing retrorectus or onlay VIHR. Inclusion criteria were CDC Class I, defect 10-350cm2, ≤ 3 prior repairs, and ≥ 1 high-risk criteria (obesity (BMI: 30-40kg/m2), active smoker, COPD, diabetes, immunosuppression, coronary artery disease, chronic corticosteroid use, hypoalbuminemia, advanced age, and renal insufficiency). Physical exam and/or quality of life surveys were performed at regular intervals through 18months (to date) with longer-term, 36-month follow-up ongoing. One hundred and twenty-one subjects (46M, 75F) with an age of 54.7 ± 12.0years and BMI of 32.2 ± 4.5kg/m2 (mean ± SD), underwent VIHR. Comorbidities included the following: obesity (n = 95, 78.5%), hypertension (n = 72, 59.5%), cardiovascular disease (n = 42, 34.7%), diabetes (n = 40, 33.1%), COPD (n = 34, 28.1%), malignancy (n = 30, 24.8%), active smoker (n = 28, 23.1%), immunosuppression (n = 10, 8.3%), chronic corticosteroid use (n = 6, 5.0%), advanced age (n = 6, 5.0%), hypoalbuminemia (n = 3, 2.5%), and renal insufficiency (n = 1, 0.8%). Hernia types included the following: primary ventral (n = 17, 14%), primary incisional (n = 54, 45%), recurrent ventral (n = 15, 12%), and recurrent incisional hernia (n=35, 29%). Defect and mesh size were 115.7 ± 80.6 and 580.9 ± 216.1cm2 (mean ± SD), respectively. Repair types included the following: retrorectus (n = 43, 36%), retrorectus with additional myofascial release (n = 45, 37%), onlay (n = 24, 20%), and onlay with additional myofascial release (n = 8, 7%). 95 (79%) subjects completed 18-month follow-up to date. Postoperative wound infection, seroma requiring intervention, and hernia recurrence occurred in 11 (9%), 7 (6%), and 11 (9%) subjects, respectively. High-risk VIHR with P4HB mesh demonstrated positive outcomes and low incidence of hernia recurrence at 18months. Longer-term 36-month follow-up is ongoing.

Comparison of Resorbable Mesh (Poly L-Lactide/Glycolic Acid) and Porous Polyethylene in Orbital Floor Fractures in an Experimental Model.

Resorbable mesh and porous polyethylene are frequently used alloplastic materials for the treatment of the orbital blowout fractures. The literature lacks reports comparing their long-term effects on experimental models. Our aim was to radiologically and histologically evaluate the effectiveness and safety of porous polyethylene and resorbable mesh in a rabbit orbital blowout fracture model. Twelve New Zealand white rabbits (24 orbits) were randomized to 4 groups. In group 1, only orbital floor dissection was done. In group 2, following orbital floor dissection, a 10-mm defect was created without any extra procedure. In group 3, following a 10-mm defect creation, a 12-mm-round cut porous polyethylene was placed on the defect. In group 4, following a 10-mm defect creation, a 12-mm-round cut resorbable mesh was placed on the defect. Computed tomographic analysis was performed during follow-up period. Orbital floors were evaluated histologically at month 6. No clinical complications were observed during follow-up period. In radiological evaluation, there was no statistically significant difference between groups regarding bone formation. In histological evaluation, the connective tissue was denser, and organized and better bone formation was observed in group 3 and 4 when compared with other groups. Although no significant radiological changes were present, porous polyethylene and resorbable mesh performed better histologically. They were effective and well tolerated for reconstruction of the isolated orbital floor defects.

Cranioplasty with Adipose-Derived Stem Cells, Beta-Tricalcium Phosphate Granules and Supporting Mesh: Six-Year Clinical Follow-Up Results.

Several alternative techniques exist to reconstruct skull defects. The complication rate of the cranioplasty procedure is high and the search for optimal materials and techniques continues. To report long‐term results of patients who have received a cranioplasty using autologous adipose‐derived stem cells (ASCs) seeded on beta‐tricalcium phosphate (betaTCP) granules. Between 10/2008 and 3/2010, five cranioplasties were performed (four females, one male; average age 62.0 years) using ASCs, betaTCP granules and titanium or resorbable meshes. The average defect size was 8.1 × 6.7 cm2. Patients were followed both clinically and radiologically. The initial results were promising, with no serious complications. Nevertheless, in the long‐term follow‐up, three of the five patients were re‐operated due to graft related problems. Two patients showed marked resorption of the graft, which led to revision surgery. One patient developed a late infection (7.3 years post‐operative) that required revision surgery and removal of the graft. One patient had a successfully ossified graft, but was re‐operated due to recurrence of the meningioma 2.2 years post‐operatively. One patient had an uneventful clinical follow‐up, and the cosmetic result is satisfactory, even though skull x‐rays show hypodensity in the borders of the graft. Albeit no serious adverse events occurred, the 6‐year follow‐up results of the five cases are unsatisfactory. The clinical results are not superior to results achieved by conventional cranial repair methods. The use of stem cells in combination with betaTCP granules and supporting meshes in cranial defect reconstruction need to be studied further before continuing with clinical trials. Stem Cells Translational Medicine 2017;6:1576–1582