Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair

L. Melman, E. D. Jenkins, Nicholas Hamilton, L. C. Bender, M. D. Brodt, C. R. Deeken, S. C. Greco, M. M. Frisella, B. D. Matthews

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Purpose: To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair. Methods: Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard ®Mesh (HWPP, Bard/Davol, http://www.davol.com ), ULTRAPRO ® (LWPP, Ethicon, http://www.ethicon.com ), and GORE ®INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com ). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P <0.05) was determined using a two-way ANOVA and Bonferroni post-test. Results: No significant difference in maximum force was detected between meshes at any of the time points (P > 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P <0.05). No significant difference in stiffness was detected between the mesh types or between timepoints (P > 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P <0.001) and tissue ingrowth reached a slight peak between 1 and 3 months (P ≥ 0.001) but did not significantly change thereafter (P > 0.09). Conclusions: The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points rather than any mesh-specific trend. Histologically, inflammation decreased with time (P ≥ 0.000), and tissue ingrowth increased (P ≥ 0.019) for all meshes. No specific trends were observed between the polypropylene meshes and the monofilament knit PTFE, suggesting that this novel construction may be a suitable alternative to existing polypropylene meshes.

Original languageEnglish (US)
Pages (from-to)423-431
Number of pages9
JournalHernia
Volume15
Issue number4
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Ventral Hernia
Polypropylenes
Herniorrhaphy
Polytetrafluoroethylene
Swine
Inflammation
Tensile Strength
Abdominal Wall
Fibrosis
Miniature Swine
Incisional Hernia
Hand Strength
Hematoxylin
Eosine Yellowish-(YS)
Hernia
Biomechanical Phenomena

Keywords

  • Biomechanical evaluation
  • Histologic response
  • Knit polytetrafluoroethylene
  • Polypropylene
  • Tissue remodeling
  • Ventral hernia repair

ASJC Scopus subject areas

  • Surgery

Cite this

Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair. / Melman, L.; Jenkins, E. D.; Hamilton, Nicholas; Bender, L. C.; Brodt, M. D.; Deeken, C. R.; Greco, S. C.; Frisella, M. M.; Matthews, B. D.

In: Hernia, Vol. 15, No. 4, 08.2011, p. 423-431.

Research output: Contribution to journalArticle

Melman, L. ; Jenkins, E. D. ; Hamilton, Nicholas ; Bender, L. C. ; Brodt, M. D. ; Deeken, C. R. ; Greco, S. C. ; Frisella, M. M. ; Matthews, B. D. / Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair. In: Hernia. 2011 ; Vol. 15, No. 4. pp. 423-431.
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abstract = "Purpose: To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair. Methods: Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard {\circledR}Mesh (HWPP, Bard/Davol, http://www.davol.com ), ULTRAPRO {\circledR} (LWPP, Ethicon, http://www.ethicon.com ), and GORE {\circledR}INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com ). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P <0.05) was determined using a two-way ANOVA and Bonferroni post-test. Results: No significant difference in maximum force was detected between meshes at any of the time points (P > 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P <0.05). No significant difference in stiffness was detected between the mesh types or between timepoints (P > 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P <0.001) and tissue ingrowth reached a slight peak between 1 and 3 months (P ≥ 0.001) but did not significantly change thereafter (P > 0.09). Conclusions: The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points rather than any mesh-specific trend. Histologically, inflammation decreased with time (P ≥ 0.000), and tissue ingrowth increased (P ≥ 0.019) for all meshes. No specific trends were observed between the polypropylene meshes and the monofilament knit PTFE, suggesting that this novel construction may be a suitable alternative to existing polypropylene meshes.",
keywords = "Biomechanical evaluation, Histologic response, Knit polytetrafluoroethylene, Polypropylene, Tissue remodeling, Ventral hernia repair",
author = "L. Melman and Jenkins, {E. D.} and Nicholas Hamilton and Bender, {L. C.} and Brodt, {M. D.} and Deeken, {C. R.} and Greco, {S. C.} and Frisella, {M. M.} and Matthews, {B. D.}",
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doi = "10.1007/s10029-011-0787-z",
language = "English (US)",
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TY - JOUR

T1 - Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair

AU - Melman, L.

AU - Jenkins, E. D.

AU - Hamilton, Nicholas

AU - Bender, L. C.

AU - Brodt, M. D.

AU - Deeken, C. R.

AU - Greco, S. C.

AU - Frisella, M. M.

AU - Matthews, B. D.

PY - 2011/8

Y1 - 2011/8

N2 - Purpose: To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair. Methods: Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard ®Mesh (HWPP, Bard/Davol, http://www.davol.com ), ULTRAPRO ® (LWPP, Ethicon, http://www.ethicon.com ), and GORE ®INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com ). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P <0.05) was determined using a two-way ANOVA and Bonferroni post-test. Results: No significant difference in maximum force was detected between meshes at any of the time points (P > 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P <0.05). No significant difference in stiffness was detected between the mesh types or between timepoints (P > 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P <0.001) and tissue ingrowth reached a slight peak between 1 and 3 months (P ≥ 0.001) but did not significantly change thereafter (P > 0.09). Conclusions: The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points rather than any mesh-specific trend. Histologically, inflammation decreased with time (P ≥ 0.000), and tissue ingrowth increased (P ≥ 0.019) for all meshes. No specific trends were observed between the polypropylene meshes and the monofilament knit PTFE, suggesting that this novel construction may be a suitable alternative to existing polypropylene meshes.

AB - Purpose: To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair. Methods: Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard ®Mesh (HWPP, Bard/Davol, http://www.davol.com ), ULTRAPRO ® (LWPP, Ethicon, http://www.ethicon.com ), and GORE ®INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com ). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P <0.05) was determined using a two-way ANOVA and Bonferroni post-test. Results: No significant difference in maximum force was detected between meshes at any of the time points (P > 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P <0.05). No significant difference in stiffness was detected between the mesh types or between timepoints (P > 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P <0.001) and tissue ingrowth reached a slight peak between 1 and 3 months (P ≥ 0.001) but did not significantly change thereafter (P > 0.09). Conclusions: The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points rather than any mesh-specific trend. Histologically, inflammation decreased with time (P ≥ 0.000), and tissue ingrowth increased (P ≥ 0.019) for all meshes. No specific trends were observed between the polypropylene meshes and the monofilament knit PTFE, suggesting that this novel construction may be a suitable alternative to existing polypropylene meshes.

KW - Biomechanical evaluation

KW - Histologic response

KW - Knit polytetrafluoroethylene

KW - Polypropylene

KW - Tissue remodeling

KW - Ventral hernia repair

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