Biomechanical properties of raw meshes used in pelvic floor reconstruction

Krause, Hannah; Bennett, Michael B.; Forwood, Mark R.; Goh, Judith

doi:10.1007/s00192-008-0711-y

Cited by 36 publications

(15 citation statements)

References 15 publications

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“…These procedures can be associated with significant rates of recurrence of the original condition [7–13]. In an attempt to address this problem the use of synthetic materials were explored with incontinence and prolapse meshes, which are designed to provide a longer lasting outcome [3, 9, 14]. …”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…18,19 However, mechanical failure of synthetic mesh products is extremely rare clinically, because the typical failure properties of mesh far exceed in vivo loads and deformations. Rather, this study aims to characterize pore deformation at levels of force that occur in vivo and during surgical implantation, while considering the impact of initial pore orientation.…”

mentioning

confidence: 99%

Textile properties of synthetic prolapse mesh in response to uniaxial loading

Barone

Moalli

Abramowitch

2016

American Journal of Obstetrics and Gynecology

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BACKGROUND Although synthetic mesh is associated with superior anatomic outcomes for the repair of pelvic organ prolapse, the benefits of mesh have been questioned because of the relatively high complication rates. To date, the mechanisms that result in such complications are poorly understood, yet the textile characteristics of mesh products are believed to play an important role. Interestingly, the pore diameter of synthetic mesh has been shown to impact the host response after hernia repair greatly, and such findings have served as design criteria for prolapse meshes, with larger pores viewed as more favorable. Although pore size and porosity are well-characterized before implantation, the changes in these textile properties after implantation are unclear; the application of mechanical forces has the potential to greatly alter pore geometries in vivo. Understanding the impact of mechanical loading on the textile properties of mesh is essential for the development of more effective devices for prolapse repair. OBJECTIVE The objective of this study was to determine the effect of tensile loading and pore orientation on mesh porosity and pore dimensions. STUDY DESIGN In this study, the porosity and pore diameter of 4 currently available prolapse meshes were examined in response to uniaxial tensile loads of 0.1, 5, and 10 N while mimicking clinical loading conditions. The textile properties were compared with those observed for the unloaded mesh. Meshes included Gynemesh PS (Ethicon, Somerville, NJ), UltraPro (Artisyn; Ethicon), Restorelle (Coloplast, Minneapolis, MN), and Alyte Y-mesh (Bard, Covington, GA). In addition to the various pore geometries, 3 orientations of Restorelle (0-, 5-, 45-degree offset) and 2 orientations of UltraPro (0-, 90-degree offset) were examined. RESULTS In response to uniaxial loading, both porosity and pore diameter dramatically decreased for most mesh products. The application of 5 N led to reductions in porosity for nearly all groups, with values decreasing by as much as 87% (P < .05). On loading to 10 N of force, nearly all mesh products that were tested were found to have porosities that approached 0% and 0 pores with diameters >1 mm. CONCLUSION In this study, it was shown that the pore size of current prolapse meshes dramatically decreases in response to mechanical loading. These findings suggest that prolapse meshes, which are more likely to experience tensile forces in vivo relative to hernia repair meshes, have pores that are unfavorable for tissue integration after surgical tensioning and/or loading in urogynecologic surgeries. Such decreases in pore geometry support the hypothesis that regional increases in the concentration of mesh leads to an enhanced local foreign body response. Although pore deformation in transvaginal meshes requires further characterization, the findings presented here provide a mechanical understanding that can be used to recognize potential areas of concern for complex mesh geometries. Understanding mesh mechanics in response to surgical and...

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“…Gynemesh PS, UltraPro, and Novasilk all exhibited significant anisotropy as compared with SmartMesh and Polyform, which may be considered transversely isotropic due to the planar structure of these materials. This study and previous research have highlighted the difference in the structural properties [11, 13, 16, 17] and the importance of understanding the implantation direction prior to mesh placement. The present study offers insight as to why this finding may have been observed.…”

Section: Discussionmentioning

confidence: 73%

Characterizing the ex vivo textile and structural properties of synthetic prolapse mesh products

et al. 2012

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Introduction and hypothesis The use of polypropylene meshes for surgical repair of pelvic organ prolapse (POP) has been limited by complications, including mesh exposure, encapsulation, and pain. Numerous products are available with a wide array of textile and structural properties. It is thought that complications may be related, in part, to mesh structural properties. However, few descriptions of these properties exists to directly compare products. The aim of this study was to determine the textile and structural properties of five commonly used prolapse mesh products using a ball-burst failure protocol. Methods Porosity, anisotropic index, and stiffness of Gynemesh PS (n=8), the prototype polypropylene mesh for prolapse repair, was compared with four newer-generation mesh produces: UltraPro (n=5), SmartMesh (n=5), Novasilk (n=5), and Polyform (n=5). Results SmartMesh was found to be the most porous, at 78 %±1.4 %. This value decreased by 21 % for Gynemesh PS (p<0.001), 14 % for UltraPro and Novasilk (p<0.001), and 28 % for Polyform (p<0.001). Based on the knit pattern, SmartMesh and Polyform were the only products considered to be geometrically isotropic, whereas all other meshes were anisotropic. Comparing the structural properties of these meshes, Gynemesh PS and Polyform were the stiffest: 60 % and 42 % stiffer than SmartMesh (p<0.001) and Novasilk (p<0.001), respectively. However, no significant differences were found between these two mesh products and UltraPro. Conclusions Porosity, anisotropy, and biomechanical behavior of these five commonly used polypropylene mesh products were significantly different. This study provides baseline data for future implantation studies of prolapse mesh products.

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Biomechanical properties of raw meshes used in pelvic floor reconstruction

Cited by 36 publications

References 15 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

Textile properties of synthetic prolapse mesh in response to uniaxial loading

Characterizing the ex vivo textile and structural properties of synthetic prolapse mesh products

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