Macroporous condensed poly(tetra fluoro‐ethylene). II. In vivo effect on adhesion formation and tissue integration

Abstract

This study investigated the in vivo correlation between construct parameters (surface area, pore size) and polymer chemistry in modulating mesh-intestinal adhesions and mesh-abdominal wall integration of condensed poly(tetra fluoro-ethylene) (cPTFE) in hernia repair. A defect created by excising a 2 cm circular section of the abdominal wall from a rat was repaired with cPTFE or either one of the following synthetic meshes: expanded PTFE (ePTFE), ePTFE + polypropylene (PP), PP or PP + oxidized regenerated cellulose (ORC). The intestinal adhesion and abdominal wall integration were studied quantitatively by measuring the pull-out force required to separate each mesh from the respective tissue at 1 and 3 months postimplantation. The hydrophobic, large pore meshes, such as cPTFE and ePTFE + PP led to reduced adhesions. Further, the presence of ORC contributed to reduction in adhesions of the more hydrophilic PP + ORC mesh. The large pore size, thinner meshes such as cPTFE and PP + ORC led to better tissue integration compared to the other meshes tested. Through hydrophobic chemistry, low profile, and increased pore size, cPTFE balances the rapid resolution of the inflammatory and wound healing response that resists adhesion formation, with efficient integration within the surrounding abdominal tissue.

Fibrin Sealant (Tissucol) Enhances Tissue Integration of Condensed Polytetrafluoroethylene Meshes and Reduces Early Adhesion Formation in Experimental Intraabdominal Peritoneal Onlay Mesh Repair

“…The choice of the mesh in this study was based on our own previous experiences and on encouraging reports from literature [14,28,32]. The MM are macroporous foils produced from condensed layers of the PTFE compound without fibers or knots [12,13] and are therefore distinctively different from classical meshes. Unfortunately, our results, created in a well-established animal model, demonstrate that MM cannot be recommended for the use in IPOM repair without fibrin sealing.…”

“…Synthetic meshes designed for intraabdominal use are coated with antiadhesive layers or are uncoated with a porous mesh design preserved, e.g., Motif Meshes (MM; Proxy Biomedical, Galway, Ireland) [12,13]. So-called "biomeshes" are derived from animal or human sources and include porcine small intestine submucosa, porcine cross-linked collagen, or human cadaveric decellularized skin [14 -16].…”

Synthetic Implants in Hernia Surgery

“…PTfE is hydrophobic: neither water nor water-containing substances wet PTfE, as fluorocarbons demonstrate mitigated London dispersion forces due to the high electronegativity of fluorine. This property determines the resistance of PTfE implants to the formation of adhesions with abdominal viscera [18]. It is non-reactive, partly because of the strength of carbon-fluorine bonds.…”

A Comparison of Woven Versus Nonwoven Polypropylene (PP) and Expanded Versus Condensed Polytetrafluoroethylene (PTFE) on Their Intraperitoneal Incorporation and Adhesion Formation

“…Condensed polytetrafluoroethylene (cPTFE) is a new macroporous mesh, which is designed to be extremely non-stick and to be highly resistant to bacterial colonization, but to 'incorporate' due to a specifically laser cut motif. Two recent studies in rats showed that cPTFE led to reduced adhesion formation (when compared to PP), better tissue integration and a better resolution to an inflammatory response (when compared to ePTFE) [8,9].…”