A polypropylene mesh modified with poly-ε-caprolactone nanofibers in hernia repair: large animal experiment

Abstract

PurposeIncisional hernia repair is an unsuccessful field of surgery, with long-term recurrence rates reaching up to 50% regardless of technique or mesh material used. Various implants and their positioning within the abdominal wall pose numerous long-term complications that are difficult to treat due to their permanent nature and the chronic foreign body reaction they trigger. Materials mimicking the 3D structure of the extracellular matrix promote cell adhesion, proliferation, migration, and differentiation. Some electrospun nanofibrous scaffolds provide a topography of a natural extracellular matrix and are cost effective to manufacture.Materials and methodsA composite scaffold that was assembled out of a standard polypropylene hernia mesh and poly-ε-caprolactone (PCL) nanofibers was tested in a large animal model (minipig), and the final scar tissue was subjected to histological and biomechanical testing to verify our in vitro results published previously.ResultsWe have demonstrated that a layer of PCL nanofibers leads to tissue overgrowth and the formation of a thick fibrous plate around the implant. Collagen maturation is accelerated, and the final scar is more flexible and elastic than under a standard polypropylene mesh with less pronounced shrinkage observed. However, the samples with the composite scaffold were less resistant to distracting forces than when a standard mesh was used. We believe that the adverse effects could be caused due to the material assembly, as they do not comply with our previous results.ConclusionWe believe that PCL nanofibers on their own can cause enough fibroplasia to be used as a separate material without the polypropylene base, thus avoiding potential adverse effects caused by any added substances.

Design of a new dual mesh with an absorbable nanofiber layer as a potential implant for abdominal hernia treatment

“…Whereas these meshes are designed to support the healing of the wound on one side, the other surface that contacts with the viscera has to have nonsticking property. Many in vitro and in vivo studies have provided evidence to support these properties of composite meshes (Bellon et al, 2005;East et al, 2018;Emans et al, 2009;Jacob, Hogle, Durak, Kim, & Fowler, 2007;Judge, Parker, & Dinsmore, 2007;Plencner et al, 2014;Xiaolong et al, 2018). The nonsticky layer of the composite meshes may exhibit a temporary or permanent nonsticky property, where the temporary layer is needed until the wound healing process is completed.…”

Engineering multifunctional bactericidal nanofibers for abdominal hernia repair

“…Considering regulatory aspects, since hernia support scaffolds are generally considered as medical devices and not as drugs, this will have considerable milder regulatory process 53 . Furthermore, the engineered nanofibers in this work are comprised of PCL, which is an already United States Food and Drug Administration (FDA) approved material for certain applications 39 , and according to the FDA if the new device is equivalent to previous device it will be safe and effect as the counterpart, nevertheless supporting safety data may be necessary 54 . Generally, bringing a medical device to the market can take about 3‒7 years, whilst about 12 years for new drugs or drug/medical device combination products 55 .…”

“…However, one challenge with the employment of electrospun nanofibers for hernia repair could be a lack of sufficient mechanical properties 31 . De facto, PCL electrospun fibers 37 , 38 or PCL based meshes 39 have previously been demonstrated as an optional candidate material for hernia repair.…”

Folding, Shrinkage and Infection Relation at Polypropylene Mesh Placed on the Rat Abdominal Wall

“…Mesh, host, and bacterial properties are the main determinants of infection, and changing mesh properties is an option to decrease infection rates. Over 100 different types of mesh are available on the market and new types are being developed (5). Absorbable synthetic, non-absorbable synthetic, or organic materials can be used for mesh production.…”