Biomaterials for Pelvic Floor Reconstructive Surgery: How Can We Do Better?

Gigliobianco, Giulia; Román, Sabiniano; Osman, Nadir I.; Bissoli, Julio; Bullock, Anthony J.; Chapple, Christopher R.

doi:10.1155/2015/968087

Cited by 53 publications

(71 citation statements)

References 99 publications

(233 reference statements)

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“…Biologically derived materials are classed as acellular collagen matrices and are often derived from the dermis, pericardium, small intestinal submucosa or urinary bladder matrix of bovine or porcine origin [1, 22, 59]. These materials can undergo crosslinking, the formation of excessive intra- and inter-molecular bonds, to improve the longevity of the material [59].…”

Section: Materials Discussionmentioning

confidence: 99%

“…The distinction between applications is important because reported complication rates differ significantly for these two device types [1, 15]. …”

Section: Introductionmentioning

confidence: 99%

“…1 [1]. Of all the materials that are currently in use for mesh applications, polypropylene is the most common, and is the most firmly established [21, 22].…”

Section: Introductionmentioning

confidence: 99%

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In vivo response to polypropylene following implantation in animal models: a review of biocompatibility

Kelly¹,

Macdougall²,

Olabisi³

et al. 2016

Int Urogynecol J

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Introduction and hypothesisPolypropylene is a material that is commonly used to treat pelvic floor conditions such as pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Owing to the nature of complications experienced by some patients implanted with either incontinence or prolapse meshes, the biocompatibility of polypropylene has recently been questioned. This literature review considers the in vivo response to polypropylene following implantation in animal models. The specific areas explored in this review are material selection, impact of anatomical location, and the structure, weight and size of polypropylene mesh types.MethodsAll relevant abstracts from original articles investigating the host response of mesh in vivo were reviewed. Papers were obtained and categorised into various mesh material types: polypropylene, polypropylene composites, and other synthetic and biologically derived mesh.ResultsPolypropylene mesh fared well in comparison with other material types in terms of host response. It was found that a lightweight, large-pore mesh is the most appropriate structure.ConclusionThe evidence reviewed shows that polypropylene evokes a less inflammatory or similar host response when compared with other materials used in mesh devices.Electronic supplementary materialThe online version of this article (doi:10.1007/s00192-016-3029-1) contains supplementary material, which is available to authorized users

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Section: Materials Discussionmentioning

confidence: 99%

“…The distinction between applications is important because reported complication rates differ significantly for these two device types [1, 15]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

In vivo response to polypropylene following implantation in animal models: a review of biocompatibility

Kelly¹,

Macdougall²,

Olabisi³

et al. 2016

Int Urogynecol J

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show abstract

“…Currently, the PPM is one of the most used meshes in clinics for pelvic floor reconstruction. 4 Falagas et al 23 reported an infection rate of 0%-8% and an erosion rate of 0%-33% with PPM, problems which have not been overcome. 23 Because biological meshes have the advantage of being biocompatible and tissue inductive, more and more surgeons and researchers have become interested in the biological meshes for pelvic floor reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…3 However, the limitations of biologically derived mesh include the size of materials, potentially viral or prion transmission, and relatively low mechanical strength. 4 The mechanical strength of biological meshes can be enhanced with cross-linking processes, but many animal studies have shown that cross-linking has a negative effect on the degradation profile and host response to the materials. [5][6][7] Currently, there is no consensus on the optimal material for POP repair.…”

Section: Introductionmentioning

confidence: 99%

Preclinical animal study and human clinical trial data of co-electrospun poly(L-lactide-co-caprolactone) and fibrinogen mesh for anterior pelvic floor reconstruction

Wang

Zhu

et al. 2016

IJN

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Synthetic and biological materials are commonly used for pelvic floor reconstruction. In this study, host tissue response and biomechanical properties of mesh fabricated from co-electrospun poly( l -lactide-co-caprolactone) (PLCL) and fibrinogen (Fg) were compared with those of polypropylene mesh (PPM) in a canine abdominal defect model. Macroscopic, microscopic, histological, and biomechanical evaluations were performed over a 24-week period. The results showed that PLCL/Fg mesh had similar host tissue responses but better initial vascularization and graft site tissue organization than PPM. The efficacy of the PLCL/Fg mesh was further examined in human pelvic floor reconstruction. Operation time, intraoperative blood loss, and pelvic organ prolapse quantification during 6-month follow-up were compared for patients receiving PLCL/Fg mesh versus PPM. According to the pelvic organ prolapse quantification scores, the anterior vaginal wall 3 cm proximal to the hymen point (Aa point), most distal edge of the cervix or vaginal cuff scar point (C point), and posterior fornix point (D point) showed significant improvement ( P <0.01) at 1, 3, and 6 months for both groups compared with preoperatively. At 6 months, improvements at the Aa point in the PLCL/Fg group were significantly more ( P <0.005) than the PPM group, indicating that, while both materials improve the patient symptoms, PLCL/Fg mesh resulted in more obvious improvement.

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Methacrylic Acid Copolymer Coating Enhances Constructive Remodeling of Polypropylene Mesh by Increasing the Vascular Response

Coindre

Carleton

Sefton

2019

Adv Healthcare Materials

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This study reports that a methacrylic acid (MAA)‐based copolymer coating generates constructive remodeling of polypropylene (PP) surgical mesh in a subcutaneous model. This coating is non‐bioresorbable and follows the architecture of the mesh without impeding connective tissue integration. Following implantation, the tissue response is biased toward vascularization instead of fibrosis. The vessel density around the MAA mesh is double that of the uncoated mesh two weeks after implantation. This initial vasculature regresses after two weeks while mature vessels remain, suggesting an enhanced healing response. Concurrently, the MAA coating alters the foreign body response to the mesh. Fewer infiltrating cells, macrophages, and foreign body giant cells are found at the tissue–material interface three weeks after implantation. The coating also dampens inflammation, with lower expression levels of pro‐inflammatory and fibrogenic signals (e.g., Tgf‐β1, Tnf‐α, and Il1‐β) and similar expression levels of anti‐inflammatory cytokines (e.g., Il10 and Il6) compared to the uncoated mesh. Contrary to other coatings that aim to mitigate the foreign body response to PP mesh, a MAA coating does not require the addition of any biological agents to have an effect, making the coated mesh an attractive candidate for soft tissue repair.

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Biomaterials for Pelvic Floor Reconstructive Surgery: How Can We Do Better?

Cited by 53 publications

References 99 publications

In vivo response to polypropylene following implantation in animal models: a review of biocompatibility

In vivo response to polypropylene following implantation in animal models: a review of biocompatibility

Preclinical animal study and human clinical trial data of co-electrospun poly(L-lactide-co-caprolactone) and fibrinogen mesh for anterior pelvic floor reconstruction

Methacrylic Acid Copolymer Coating Enhances Constructive Remodeling of Polypropylene Mesh by Increasing the Vascular Response

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