PurposeThe purpose of this study was to evaluate the biocompatibility, local tissue effects and performance of a synthetic long-term resorbable test mesh (TIGR® Matrix Surgical Mesh) compared to a non-resorbable polypropylene control mesh following implantation in a sheep model.MethodsFull-thickness abdominal wall defects were created in 14 sheep and subsequently repaired using test or control meshes. Sacrifices were made at 4, 9, 15, 24 and 36 months and results in terms of macroscopic observations, histology and collagen analysis are described for 4, 9, 15, 24 and 36 months.ResultsThe overall biocompatibility was good, and equivalent in the test and control meshes while the resorbable mesh was characterized by a collagen deposition more similar to native connective tissue and an increased thickness of the integrating tissue. The control polypropylene mesh provoked a typical chronic inflammation persistent over the 36-month study period. As the resorbable test mesh gradually degraded it was replaced by a newly formed collagen matrix with an increasing ratio of collagen type I/III, indicating a continuous remodeling of the collagen towards a strong connective tissue. After 36 months, the test mesh was fully resorbed and only microscopic implant residues could be found in the tissue.ConclusionsThis study suggests that the concept of a long-term resorbable mesh with time-dependent mechanical characteristics offers new possibilities for soft tissue repair and reinforcement.

The history of resorbable polymers containing glycolide, lactide, ε-caprolactone and trimethylene carbonate, with a special emphasis being placed on the time frame of the 1960s–1990s is described. Reviewing the history is valuable when looking into the future perspectives regarding how and where these monomers should be used. This story includes scientific evaluations indicating that these polymers are safe to use in medical devices, while the design of the medical device is not considered in this report. In particular, we present the data regarding the tissue response to implanted polymers, as well as the toxicity and pharmacokinetics of their degradation products. In the translation of these polymers from “the bench to the bedside,” various challenges have been faced by surgeons, medical doctors, biologists, material engineers and polymer chemists. This Perspective highlights the visionary role played by the pioneers, addressing the problems that occurred on a case by case basis in translational medicine.

Linear poly(urethane urea) containing a biodegradable soft segment and a hard segment built solely from methyl-2,6-diisocyanatehexanoate (LDI) is presented, using a procedure where no chain extender is required. By having LDI in excess, together with a soft segment, and adding water in the vapor phase continuously creates amines in situ resulting in hard segments containing multiple LDI units linked via urea linkages. As soft segments, polymers of trimethylene carbonate (TMC) and copolymers of TMC, epsilon-caprolactone, and D,L-lactic acid (DLLA) were used. High inherent viscosity, 0.95-1.65 dL/g, was afforded even when DLLA-containing soft segments were used, which usually undergo aminolysis. With a hard segment content between 12% and 18%, all of the materials showed very high elongation at breakage, ranging from 1600% to 4700%, and an elastic modulus from 2.1 to 140 MPa. This one-pot synthesis is simple and has now been shown to be applicable to a large number of systems.

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Poly(urethane urea)s with hard segments derived only from diisocyanate linked via urea linkages were synthesized using a new and simple one-pot method. The creation of urea linkages were done via creating the amine in situ by adding water in vapor phase slowly and continuously. This synthesis method eliminates the tedious control to approach stoichiometry, is less sensitive to impurities, involves no intermediate isolation steps, and does not involve any chain extender. A study using a two-armed poly(ε-caprolactone) as soft segment and methyl 2,6-diisocyantohexanoate (LDI) as the hard segment was performed. The length of the hard segment was varied from 4.8 to 11.6 LDI units. Stress−strain measurements showed an increase in elastic modulus, 146 to 235 MPa, when increasing the hard segment length, while the elongation at break decreased, 980 to 548%. IR spectroscopy showed an increase in hydrogen bonding when increasing the hard segment length. The synthesis was also shown to be applicable to common diisocyanates such as HDI, TDI, and MDI.