Clinically relevant mechanical testing of hernia graft constructs

Sahoo, Sambit; DeLozier, Katherine R.; Erdemir, Ahmet; Derwin, Kathleen A.

doi:10.1016/j.jmbbm.2014.10.011

Cited by 23 publications

(10 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to van’t Riet et al ( 24 ), a maximum of seven sutures should be necessary to securely fasten a hernia mesh to bridge a 5-cm hernial orifice in pig tissue. Since this work was done on tissue stripes pulling only in one direction, circumferential strain either biplanar or ball-related might give different results ( 25 ). Since DIS testing uses circumferential strain the relative contribution of the fixation can be added to MDAR.…”

Section: Discussionmentioning

confidence: 99%

Assessing the GRIP of Ventral Hernia Repair: How to Securely Fasten DIS Classified Meshes

et al. 2018

View full text Add to dashboard Cite

Recurrences are frequently observed after ventral hernia repair. Based on clinical data, the mesh–defect area ratio (MDAR) can lead to lower recurrence rates. Using dynamic intermittent strain (DIS) in a pig tissue model, MDAR can be modified to give a measure called grip to better assess the mechanical stability of ventral hernia repair. The focus of this experimental study is to assess the different aspects of mesh overlap (OL) and fixation only in bridging repair of ventral hernias. DIS mimics coughing actions in an ex vivo model with the repetition of submaximal impacts delivered via a hydraulically driven plastic containment. Tissue derived from pig bellies simulates a ventral hernia with varying defect sizes. MDAR is calculated from the hernia orifice and the mesh OL. Commercially available meshes were strengthened with glue, tacks, and sutures to bridge the defects. The reconstructions are strained with up to 425 dynamic impacts. The grip of each repair is assessed using MDAR modified by the strength of the fixation. The DIS classification is based on bridging of a 5 cm ventral hernia orifice with an OL of 5 cm in a sublay position. The classification discriminates meshes properties upon DIS strain. MDAR is calculated to be 9 under these conditions. Decreasing the OL or increasing the hernia orifice reduces MDAR to numbers below 9. MDAR is modified to reach GRIP. Closure of the peritoneum adds about 4 to the grip given by MDAR. The multiplying factor of a transmural suture or one tack of Securestrap® or Protack® is 0.5 times the number of tacks applied. The multiplier given by a bonding spot of Glubran® is similar to that of an Absorbatack® being 0.33. Plotting the likelihood of a bridging repair to survive more than 400 DIS impacts versus the grip estimated from the factors given above, the grip to be passed for a durable repair is 10 for Parietex Progrip®, and Dynamesh Cicat® and 25 for Dynamesh IPOM®. Clinical data previously published can be reculculated to assess MDAR and permit an estimation of the grip of the reconstruction. In these recalculations, a correlation between MDAR and long-term recurrence rates is found. A dimensionless number called grip can be calculated. The grip can be modified by fixation in a reproducible way. A higher grip can improve the durability of ventral hernia repair. We believe that a higher grip leads to lower recurrence rates in the clinical setting.

show abstract

Section: Discussionmentioning

confidence: 99%

Assessing the GRIP of Ventral Hernia Repair: How to Securely Fasten DIS Classified Meshes

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Due to high recurrence rates and rising socioeconomic cost, ventral hernia repair requires better standardization [ 1 ]. Considering biomechanical stability as a prerequisite for a stable scar formation there is a need for mechanical testing of reconstructions [ 4 ]. Efforts have been made to calculate the contribution of the meshes, the implantation procedures and of the fixation methods [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…With submaximal load no failure of the mesh-tissue-interface is observed with increasing pressures below a threshold of about 150 mmHg [ 4 , 11 ]. In patients, up to 400 coughs were observed within 24 h which can reach intraabdominal pressures well above 200 mmHg [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Increasing hernia size requires higher GRIP values for a biomechanically stable ventral hernia repair

Kallinowski

Gutjahr

Vollmer

et al. 2019

Annals of Medicine and Surgery

View full text Add to dashboard Cite

Background Increasing hernia sizes lead to higher recurrence rates after ventral hernia repair. A better grip might reduce the failure rates. Material and methods A biomechanical model delivering dynamic intermittent strain (DIS) was used to assess grip values at various hernia orifices. The model consists of a water-filled aluminium cylinder covered with tissues derived from pig bellies which are punched with a central defect varying in diameter. DIS was applied mimicking coughs lasting for up to 2 s with peak pressures between 180 and 220 mmHg and a plateau phase of 0.1 s. Ventral hernia repair was simulated with hernia meshes in the sublay position secured by tacks, glue or sutures as needed to achieve certain grip values. Grip was calculated taking into account the mesh: defect area ratio and the fixation strength. Data were assessed using non-parametric statistics. Results Using a mesh classified as highly stable upon DIS testing (DIS class A) a reduced overlap without fixation led to early slippage (p < 0.001). With the application of 16 fixation points, transmural sutures were better than tacks with Securestrap ® being better than Absorbatack ® (p < 0.001). Plotting the likelihood of a durable repair as a function of the calculated grip higher grip values were needed with increasing hernia diameter to achieve biomechanical stability. This is important for clinical work since the calculated grip values both from a registry and from published data tend to drop as hernia sizes increase indicating biomechanical instability. Conclusion The experimental work reported here demonstrates for the first time that higher grip values should be reached when repairing larger ventral hernias.

show abstract

“…Common terminal sterilization methods, such as ETO exposure and irradiation, can achieve effective sterilization but these processes are known to affect the ultrastructure and mechanical properties of the ECM[14]. Material and structural properties, such as burst strength and stiffness, are important parameters for clinical applications such as ventral hernia repair[15]. Although ECM scaffolds tend to degrade quickly after implantation due to the host tissue response and the remodeling process, initial material and structural properties are important when the scaffold is intended for load bearing applications[16].…”

mentioning

confidence: 99%

The effect of terminal sterilization on the material properties and in vivo remodeling of a porcine dermal biologic scaffold

et al. 2016

View full text Add to dashboard Cite

The FDA typically regulates biologic scaffolds derived from mammalian tissues as medical devices, thus requiring terminal sterilization prior to clinical use. However, there is little data and no consensus for the most effective yet minimally destructive sterilization protocol for such materials. The present study characterized the effect of common sterilization methods: ethylene oxide, gamma irradiation and electron beam irradiation on the material properties and the elicited in vivo remodeling response of a porcine dermal biologic scaffold. The results of the study will aid in the meaningful selection of sterilization methods for biologic scaffold materials.

show abstract

Clinically relevant mechanical testing of hernia graft constructs

Cited by 23 publications

References 41 publications

Assessing the GRIP of Ventral Hernia Repair: How to Securely Fasten DIS Classified Meshes

Assessing the GRIP of Ventral Hernia Repair: How to Securely Fasten DIS Classified Meshes

Increasing hernia size requires higher GRIP values for a biomechanically stable ventral hernia repair

The effect of terminal sterilization on the material properties and in vivo remodeling of a porcine dermal biologic scaffold

Contact Info

Product

Resources

About