Synthetic Prosthetic Material Research Articles

History of the Creation of Self-Gripping Mesh.

Self-gripping mesh (ProgripTM, Sofradim Production, Trévoux, France) was introduced in 2006 as a synthetic prosthetic material for reinforcement of the abdominal wall in open inguinal hernia repair. As of September 2022, the self-gripping mesh has been implanted 4 million times. In June 2014 at the annual Mesh congress in Paris during an informal conversation with Dr. Chastan, Dr. Muysoms became intrigued by the history of the invention and creation of this self-gripping mesh. His fascination on this topic, was the initial bead implanted for this project to write down the history of the creation of self-gripping mesh.

Chest wall reconstructions with synthetic prosthetic materials

Chest wall reconstructions with synthetic prosthetic materials

Closed Incision Negative Pressure Therapy Achieves Better Outcome Than Standard Wound Care: Clinical Outcome and Cost-Effectiveness Analysis in Open Ventral Hernia Repair With Synthetic Mesh Positioning.

BackgroundSurgical site infections (SSIs) and surgical site occurrences (SSOs) are frequent post-operative complications that are dependent on the presence of different risk factors. The use of closed incision negative pressure therapy (ciNPT) is considered a measure by the WHO guidelines for prevention of SSIs. The prevention of SSOs is an extremely important issue in the ventral hernia repair (VHR) surgical field. SSO onset not only affects the patient’s quality of life, but can also cause the onset of life-threatening conditions that may require re-hospitalization, re-intervention and often mesh removal. Such outcome can become extremely costly, contributing to increased health care costs for the patient as well as the hospital. This study aims (1) to describe the epidemiological characteristics of SSOs following VHR in our experience; (2) to compare the post-operative outcomes of those who underwent VHR with synthetic mesh when treated with standard wound care (SWC) using gauze dressings vs ciNPT, and finally (3) to perform a spending review of the ciNPT in the hypothesis of its application after VHR with use of synthetic prosthetic material; financial savings including cost-effectiveness were investigated in terms of prevention of wound complications.Materials and methodsA retrospective review was performed on patients who underwent open VHR with synthetic mesh positioning by analyzing the hospital medical records between January 2015 and December 2017, with a primary focus on high risk post-operative complications, such as age > 65, pre-existed wound infection, pulmonary diseases, BMI > 25 kg/m2, malnutrition, ascites, hypertension, diabetes, active smoking, previous radiation therapy, steroid use, pharmacological immunosuppression, chronic inflammatory diseases. In the final analysis, the outcomes of 70 patients who received ciNPT and 110 who were managed with using adherent gauze dressings were compared.ResultsNine (12.8%) patients in the ciNPT group and 48 (43.6%) in the control group developed a wound complication (p < 0.0001). The relative risk (RR) was 0.29 (0.15 - 0.56), suggesting that infection is less likely to occur in ciNPT-treated incisions, compared with standard wound care. The differences observed between the superficial infection rate and the deep infection rate were significant with p respectively 0.0006 and 0.04. Wound complications were reported in patients after discharge from the hospital. Fever was reported in 28.6% of patients in the ciNPT group vs 54.5% in the control group (p = 0.0006; RR (95% CI) 0.52 (0.35 - 0.79); OR (95% CI) 0.33 (0.18 - 0.63)); leukocytosis affected 21.4% of patients treated with ciNPT vs 45.4% of patients in the control group (p = 0.001; RR (95% CI) 0.47 (0.29 - 0.77); OR 0.33 (0.16 - 0.65)). ciNPT patients had shorter hospitalization stay than control group (3 ± 1.37 vs 6 ± 2.39; p < 0.00001). The cost-effectiveness deterministic analysis estimated that if the ciNPT is routinely adopted, the reduction of total costs would be €166’944.00 for 100 patients.ConclusionsThis study demonstrates that ciNPT use in high-risk populations following VHR with synthetic mesh positioning is associated with positive clinical and economic outcomes.

Long term comparative evaluation of two types of absorbable meshes in partial abdominal wall defects: an experimental study in rabbits.

Synthetic prosthetic materials that are fully absorbable seek to reduce the host foreign body reaction and promote host tissue regeneration. This preclinical trial was designed to analyse, in the long term, the behaviour of two prosthetic meshes, one synthetic and one composed of porcine collagen, in abdominal wall reconstruction. Partial defects were created in the abdominal walls of New Zealand rabbits and repaired using a synthetic absorbable mesh (Phasix™) or a non-crosslinked collagen bioprosthesis (Protexa™). After 3, 6, 12 and 18months, specimens were recovered for light microscopy and collagen expression analysis to examine new host tissue incorporation, macrophage response and biomechanical strength. Both materials showed good host tissue incorporation in line with their spatial structure. At 18months postimplant, Protexa™ was highly reabsorbed while the biodegradation of Phasix™ was still incomplete. Collagenization of both materials was good. Macrophage counts steadily decreased over time in response to Phasix™, yet persisted in the collagen meshes. At 18months, zones of loose tissue were observed at the implant site in the absence of herniation in both implant types. The stress-stretch behaviour of Phasix™ implants decreased over time, being more pronounced during the period of 12-18months. Nevertheless, the abdominal wall repaired with Protexa™ became stiffer over time. Eighteen months after the implant both materials showed good compatibility but the biodegradation of Phasix™ and Protexa™ wasincomplete. No signs of hernia were observed at 18months with the stress-stretch relations being similar for both implants, regardless of the more compliant abdominal wall repaired with Protexa™ at short term.

Experience in the use of synthetic prosthetic material in genital prolapse surgery.

Experience in the use of synthetic prosthetic material in genital prolapse surgery.

Use of Synthetic Protetic Materials in Surgical Abdominal Defects. Analysis of the Advantages and Lack of the Liechtenstein Method

Liechtenstein procedure represents the most frequent technique used for surgical abdominal interventions. Although, it is a modern and inovative procedure, it still has a relative risk for complications. A number of 93 subjects were included in our research. We develop our study in General Surgery Department of County Emergency Hospital of Craiova, Romania between 1st July 2017-31th March 2018. From the total of 93 patients, 88% were men. Most of subjects had ages between 70 and 79 years old, were operated by Liechtenstein technique and they were coming from quite equal percent from rural and urban areas.The incidence for complications(seroma, hematoma, infection, abscess) was generally lower for the patients diagnosticated with Liechtenstein procedure comparing with the subjects operated by other technique. Liechtenstein procedureis recommended especially for its simplicity and efficiency, reproducibility and safety. It is very important to choose the perfect synthetic prosthetic material to have a good evolution of the disorder and a small recurrence rate.

Clinical and Biochimical Comorbidities and Complications in Abdominal Surgery Using Synthetic Prosthetic Material

Hernia can be defined as an organ disorder which protrudes the wall that contains it. Synthetic material for the repair of the abdominal wall are used frequently with good results and less complications. Our research included a number of 135 patients diagnosed with inguinal hernia hospitalized and operated in Clinical County Hospital of Craiova, between 1st January 2017-31 October 2017. The purpose of our work was to identify and analyze comorbidities and complications for inguinal hernia repaired with synthetic prosthetic material. hernia repair was performed in 135 patients, 16 were women and 119 were men. Tension free meshplasty was accomplished in 131 patients with uncomplicated inguinal hernia and herniorrhaphy was successfully performed at 4 patients with complicated inguinal hernia. From our study 107 patients had a remarkable recovery without any complication. Patients who underwent tension-free hernia surgery using prosthetic mesh,short-term complications were represented by 19 patients with urinary retention, 6 surgical local infection (superficial infections) and 2 scrotal edema. Nowadays surgeons try to find the best elective repair of inguinal hernia,to be safety for the patients despite of their age and with few complications and low mortality rate. Risks assessment include general conditions and associated comorbidities of the patients. In our study we reveal the type of comorbidities which we meet. We considered that it is significant to optimize cardiopulmonary status and the other comorbidities of the patient before to repair abdominal wall hernia in order to avoid both short and long term complication.

Chest Wall Reconstruction with Porcine Acellular Dermal Matrix (Strattice) and Autologous Tissue Transfer for High Risk Patients with Chest Wall Tumors.

Tenets of chest wall reconstruction for malignancy are well known; however, the insertion of synthetic prosthetic material to achieve rigid and nonrigid skeletal reconstruction could be associated with more complications including infection and extrusion especially in high risk patients. This includes fungating, infected tumors, previous radiotherapy, scars, smoking, diabetes, and morbid obesity. Bioprosthesis Acelluar Dermal Matrix Strattice would be a substitute to resist infection and provide stable coverage. A retrospective data analysis study on 8 high-risk patients who underwent chest wall resection and reconstruction with bioprosthesis (Strattice) with/without titanium plates in the period between 2012 and 2017 was performed. Patient's demographics, risk factors, clinico-pathological, radiological, operative details, adjuvant therapy, postoperative morbidity, and follow-up data were recorded. Sarcoma was the pathology in 7 and recurrent breast cancer in 1 with age range from 21 to 71 years (mean, 50) and preponderance of female patients (n = 5). Defects were located anterior/anterolateral with size ranging from 270 to 1,050 cm2 (mean, 511). Reconstruction was performed using Strattice only in 4 patients, whereas in 4 it was combined with titanium plates. All patients required flap reconstruction (3 pedicled and 5 free). The follow-up ranged from 9 to 52 months (mean, 24.8). Minor complications occurred in 2 patients; however, good functional outcome was achieved in all. Strattice would act as a safe alternative modality for chest wall reconstruction to resist infection in high-risk patients with extensive defects. It should be considered as a valuable tool in the armamentarium of chest wall reconstruction.

Repair of Sternal Cleft in Children

The goal of this paper is to review the surgical techniques for the correction of sternal cleft in children. Various surgical techniques have been developed for the correction of sternal cleft since 1949, when the first successful repair was reported. Sternal cleft is an uncommon congenital chest wall deformity. The optimal correction can be achieved by primary repair of the defect in patients younger than 1 year of age, especially during the neonatal period, mostly with an easy technique. In older children, more extensive techniques are applied, using either autologous tissues or synthetic prosthetic materials, with satisfactory functional and aesthetic results.

Pelvic reconstruction after abdominoperineal resection: a pilot study using an absorbable synthetic prosthesis

Abdominoperineal resection (APR) is not free of complications, in particular complications due to the occupation of the pelvis by the small bowel after surgery. A number of surgical techniques have been described to prevent the small bowel from entering and adhering to the pelvis (pelvic partition), but there is no agreement concerning their use. The aim of this study was to evaluate the feasibility, effectiveness and safety of using an absorbable synthetic prosthetic material for pelvic partitioning after APR. A prospective non-randomised longitudinal pilot study was carried out on a series of 10 patients who underwent APR due to lower-third rectal cancer, in order to evaluate the feasibility, safety and efficacy of pelvic partitioning with an absorbable synthetic prosthetic material. In all the patients, it was possible to perform a radical resection and to install the prosthesis. After a mean follow-up of 9months (range: 4-18months), no abdominal or perineal complications were detected. One patient (10%) suffered chronic pelvic pain. Pelvic partition after APR of the rectum with an absorbable synthetic prosthesis is feasible, effective and safe.

Surgical treatment of complex enterocutaneous fistulas in IBD patients using human acellular dermal matrix

Inflammatory bowel disease (IBD) patients represent a high-risk group for enterocutaneous fistula (ECF) formation, related to both their disease process and the need for multiple surgeries. Often the abdominal wall is significantly involved with the ECF and requires partial resection. The use of synthetic prosthetic material to reconstruct the abdominal wall after ECF surgery is associated with increased risk of infection and recurrent fistulas. Herein we report the use human acellular dermal matrix (hADM) in the surgical treatment and reconstruction of the abdominal wall in 11 consecutive IBD patients with complex and medically refractory ECF. After resection of the involved bowel segment and the overlying abdominal wall, a single sheet of hADM was used to reconstruct the defect. Pre- and perioperative risk factors were reviewed and patients were followed prospectively for a year (360 +/- 118 days). Operative mortality was nil. Three patients (27%) developed subcutaneous seroma and there were 2 cases (18%) of superficial wound infection, all of which resolved with conservative management. The mean length of hospital stay was 13.5 (+/-7.2) days and all patients were tolerating an oral diet at the time of dismissal. There were no recurrences. One patient with Crohn's disease developed a new ECF from a separate bowel site on postoperative day 145, which was treated with the same surgical approach. No further complications have occurred. Our results indicate that in a high-risk IBD patient population with multiple perioperative risk factors the use of hADM during ECF takedown is an effective and well-tolerated treatment option.

Long‐Term Outcome of 254 Complex Incisional Hernia Repairs Using the Modified Rives‐Stoppa Technique

Repair of complex incisional hernias poses a major challenge. The aim of this study was to review the outcomes of the modified Rives-Stoppa repair of complex incisional hernias using a synthetic prosthesis. We reviewed patients undergoing a modified Rives-Stoppa repair of complex incisional hernias from 1990 to 2003. Patients were followed through clinic visits and mailed questionnaires. Follow-up data were complete in all patients (mean 70 months, range 24-177 months), and 87% of patients completed a mailed questionnaire. Primary outcome included mortality, morbidity, and hernia recurrence. Secondary outcome measures were duration of hospital stay, long-term abdominal wall pain, and self-reported patient satisfaction. Altogether, 254 patients underwent a modified Rives-Stoppa repair. Among them, 60% had a significant co-morbidity, and 30% had one or more previously failed hernia repairs. Mortality was zero, and overall morbidity was 13% (wound infection 4%, prosthetic infection 3%, seroma/hematoma 4%). The overall hernia recurrence rate was 5%, including explantation of mesh because of infection. Wound/prosthetic infection was predictive for hernia recurrence (31% vs. 4%, p = 0.003). Among the respondents, 89% reported overall satisfaction with their repair. The Rives-Stoppa repair of complex incisional hernias using synthetic prosthetic materials is safe with a low recurrence rate (5%) and high patient satisfaction. Postoperative wound infection is a risk factor for hernia recurrence.

Organ culture in 3-dimensional matrix: in vitro model for evaluating biological compliance of synthetic meshes for abdominal wall repair.

A new in vitro method to evaluate the early critical interactions between synthetic prosthetic materials and growing tissues is reported. The correct spatial organization and proper cell to cell interaction required to mimic the in vivo environment was obtained in a 3-dimensional (3-D) embryo organ culture. The clot formed by plasma and chick-embryo extract provided a natural 3-D extracellular matrix that was able to support the growth and differentiation of intestinal tissue dissected from 12-day-old chick embryos. Different materials used for the repair of abdominal wall defects were taken as standards; all the prosthetic materials were devoid of any evident cytotoxic potential over a 10-day culture period, so they did not interfere with the organogenesis process. A polyglactin mesh (Vicryl) was fully incorporated into the growing tissue, but early signs of its degradation were detectable. The biologically inert materials polyethylene terephthalate (Mersilene) and polypropylene (Marlex, Prolene, and Herniamesh) retained their structural integrity when incubated with cultured tissue at 37 degrees C, and they did not hinder cellular proliferation or fibroblast migration. However, the outgrowth behavior was very different while the connective tissue invaded the interstices of the polyethylene terephthalate mesh; the explants and the migrating cells were repelled by hydrophobic polypropylene meshes. These findings are in agreement with other reported results in in vivo studies. Therefore, this method can be considered as reliable and predictable for the evaluation of biopolymers.

Incisional Hernia

Incisional hernias are a relatively common occurrence after abdominal operations, having been reported to occur in 2% to 11% of all patients undergoing such procedures. Although many hernias become manifest early, others may not be noted until many years after the index procedure. Predisposing factors for incisional hernia have been well described, and several of these can be altered by the surgeon, including the technique employed for repair. For many years, the repair of incisional hernia was associated with a high recurrence rate. In more recent years, the introduction of synthetic prosthetic materials has provided the opportunity to perform a tension-free repair, thereby reducing the rate of recurrence.

Effects of traumatic manipulations on grafts, sutures, and host arteries during vascular surgery procedures. Experiments on dogs.

Scanning electron microscopy was used to diagnose incidents of trauma and the pattern of healing following surgical implantation of microporous blood vessel substitutes. Vascular reconstruction procedures using autogenous or synthetic prosthetic material inflict damage to the adjacent tissues as well as the prosthesis. This affects the thrombotic behavior and healing pattern of the area. The prognosis for long-term success are, as a consequence, directly influenced. Various vessel-occluding devices were evaluated in canine models with respect to their ability to damage blood vessels at the clamped site. The impact of suture needles on tissues and prosthetic materials was also considered. Of the various vessel-clamping devices which are commercially available, those which have elastomeric shields on the clamping components were found to be most satisfactory. The development of less traumatic surgical devices is discussed with the aim of further reducing surgical trauma.