<i>In vitro</i> study on the deterioration of polypropylene hernia repair meshes

Gil, Dmitry; Rex, James; Reukov, Vladimir; Vertegel, Alexey

doi:10.1002/jbm.b.34029

Cited by 5 publications

(13 citation statements)

References 41 publications

(99 reference statements)

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“…Our experimental approach (infrared scan and swelling measurements) did show here that aqueous solutions did not alter PP materials in our experiments, which includes also aggressive liquids such as urea and hydrogen peroxide. These findings are in accordance with former studies [ 3 , 9 ]. Swelling mechanisms primarily triggered by water intake appear to be limited relevant as well ( Table 2 ).…”

Section: Discussionsupporting

confidence: 94%

“…Totally disregarded within this concept remain the shearing forces working at the margins of the meshes at the junction to the native tissue. The increased elasticity modulus of PP due to the aforementioned leaching out of plasticizers together with the mechanically induced stress of the now recalcitrant surface would be such a hypothetical mechanism [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown under in vitro conditions that oxidative stress seems to change the mechanical properties of PP meshes via chain entanglements and cross-linking [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…The oxidative stress dissolves the additives out of the PP; this led to an increase of elasticity modules presenting an embrittlement phenomenon on the surface of the polymer. Nevertheless, there is a lack of consensus regarding the mechanisms [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is also the fact that these alloplastic materials, which are supposed to be clinically inert [ 3 , 4 ], are often described as showing structural changes [ 5 , 6 , 7 , 8 ]. The reasons of the surface alterations are assessed differently; they range from obviously water triggered swelling and modifications due to shrinking of the isolated PP fiber [ 5 ] to the impact of lysosomal enzymes to the formation of free radicals [ 6 , 8 ] and oxidative stress [ 9 ]. Conditions not common for the human body are often used as an explanation for the mesh alterations [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Increased Elasticity Modulus of Polymeric Materials Is a Source of Surface Alterations in the Human Body

Kapischke

Erlichman²,

Pries³

2021

JFB

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The introduction of alloplastic materials (meshes) in hernia surgery has improved patient outcome by a radical reduction of hernia recurrence rate, but discussion about the biocompatibility of these implanted materials continues since observations of surface alterations of polypropylene and other alloplastic materials were published. This study intends to investigate if additives supplemented to alloplastic mesh materials merge into the solution and become analyzable. Four polypropylene and one polyester alloplastic material were incubated in different media for three weeks: distilled water, saline solution, urea solution, formalin, and hydrogen peroxide. No swelling or other changes were observed. Infrared spectroscopy scanning of incubated alloplastic materials and NMR studies of extracted solutions were performed to investigate loss of plasticizers. The surface of the mesh materials did not show any alterations independent of the incubation medium. FT-IR spectra before and after incubation did not show any differences. NMR spectra showed leaching of different plasticizers (PEG, sterically hindered phenols, thioester), of which there was more for polypropylene less for polyester. This could be the reason for the loss of elasticity of the alloplastic materials with consecutive physically induced surface alterations. A mixture of chemical reactions (oxidative stress with additive leaching from polymer fiber) in connection with physical alterations (increased elasticity modulus by loss of plasticizers) seem to be a source of these PP and PE alterations.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

“…It has been shown under in vitro conditions that oxidative stress seems to change the mechanical properties of PP meshes via chain entanglements and cross-linking [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Increased Elasticity Modulus of Polymeric Materials Is a Source of Surface Alterations in the Human Body

Kapischke

Erlichman²,

Pries³

2021

JFB

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Accelerated in vitro oxidative degradation testing of polypropylene surgical mesh

Jain,

Tantisuwanno,

Paul

et al. 2023

J Biomed Mater Res

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Polypropylene (PP) surgical mesh had reasonable success in repair of hernia and treatment of stress urinary incontinence (SUI); however, their use for the repair of pelvic organ prolapse (POP) resulted in highly variable results with lifelong complications in some patients. One of several factors that could be associated with mesh‐related POP complications is changes in the properties of the implanted surgical mesh due to oxidative degradation of PP in vivo. Currently, there are no standardized in vitro bench testing methods available for assessing the susceptibility to oxidative degradation and estimating long‐term in vivo stability of surgical mesh. In this work, we adapted a previously reported automated reactive accelerated aging (aRAA) system, which uses elevated temperatures and high concentrations of hydrogen peroxide (H2O2), for accelerated bench‐top oxidative degradation testing of PP surgical mesh. Since H2O2 is highly unstable at elevated temperatures and for prolonged periods, the aRAA system involves a feedback loop based on electrochemical detection methods to maintain consistent H2O2 concentration in test solutions. Four PP mesh samples with varying mesh knit designs, filament diameter, weight, and % porosity, were selected for testing using aRAA up to 4 weeks and characterized using thermal analysis, Fourier‐transform infrared spectroscopy‐attenuated total reflectance (FTIR‐ATR) and scanning electron microscopy (SEM). Additionally, the oxidation index (OI) values were calculated based on the FTIR‐ATR spectra to estimate the oxidative degradation and oxidation reaction kinetics of PP surgical mesh. The OI values and surface damage in the form of surface flaking, peeling, and formation of transverse cracks increased with aRAA aging time. The aRAA test method introduced here could be used to standardize the assessment of long‐term stability of surgical mesh and may also be adopted for accelerated oxidative degradation testing of other polymer‐based medical devices.

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Analyzing material changes consistent with degradation of explanted polymeric hernia mesh related to clinical characteristics

Harman

Heniford

et al. 2022

Surg Endosc

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In vitro study on the deterioration of polypropylene hernia repair meshes

Cited by 5 publications

References 41 publications

Increased Elasticity Modulus of Polymeric Materials Is a Source of Surface Alterations in the Human Body

Increased Elasticity Modulus of Polymeric Materials Is a Source of Surface Alterations in the Human Body

Accelerated in vitro oxidative degradation testing of polypropylene surgical mesh

Analyzing material changes consistent with degradation of explanted polymeric hernia mesh related to clinical characteristics

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