Morphologische Korrelation der funktionellen Bauchwandmechanik nach Mesh-Implantation

Klosterhalfen, B.; Klinge, U.; Henze, U.; Bhardwaj, R.; Conze, Joachim; Schumpelick, Volker

doi:10.1007/bf02465095

Cited by 18 publications

(12 citation statements)

References 7 publications

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“…These findings indicate an improved biocompatibility of PVDF towards the other materials. Since this was also found in other studies for PVDF as a mesh component [21,22,23], it is a new finding concerning monofilamental PVDF sutures. Vicryl induced a CTI which was greater than in other filaments.…”

Section: Discussionmentioning

confidence: 70%

Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma

et al. 2015

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Background: Biocompatibility and tissue integration of a surgical suture are decisive factors for wound healing and therefore for the success of sutures. The optimal suture material is still under discussion. Polyvinylidene fluoride (PVDF) is described to have superior properties of biocompatibility and is therefore frequently used as a mesh component. Only little information is available about its use as a suture material. The aim of this study was to evaluate the biocompatibility of PVDF as a suture material in comparison to 5 different established sutures in a rat model. Methods: In 30 male rats, a monofilamental PVDF suture (Resopren®) and 5 established control suture materials [polyester (Miralene®), polytetrafluoroethylene (Gore®), poliglecaprone (Monocryl®), polydioxanone (Monoplus®), polyglactin 910 (Vicryl®), USP size 3-0] were placed in the subcutaneous layer of the abdominal wall without knot or tension. After 3, 7 or 21 days, the abdominal walls were explanted for histopathological and immunohistochemical investigation with special regard to the size and quality of foreign body granuloma and the length of the comet tail-like infiltrate (CTI). Results: The PVDF sutures showed the smallest size of foreign body granuloma (60 ± 14 µm) and the smallest CTI length (343 ± 60 µm) of all polymers after 21 days. Only PVDF (Resopren) and polydioxanone (Monoplus) showed a significant collagen I/III ratio increase between days 3 and 21 (p = 0.009 and p = 0.016). The quality of foreign body reaction regarding inflammation, proliferation and fibrotic remodeling was similar between all suture materials. Conclusions: Our data indicate that monofilamental PVDF sutures show a favorable foreign body reaction with small granuloma sizes and CTI length in comparison to established sutures. Its use as a suture material in general surgery could therefore be extended in the future. To reinforce these findings, further clinical studies need to be conducted.

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Section: Discussionmentioning

confidence: 70%

Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma

et al. 2015

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“…The CTI was longer in case of thicker sutures and even increased over time. If its length approaches a plateau after 21 days as described in other studies on mesh materials, in which the inflammatory activity seems to be widely constant after day 21 [5], it has to be clarified in further investigations.…”

Section: Discussionmentioning

confidence: 99%

“…Impaired biocompatibility leads to extended foreign body response. The more active a foreign body reaction and the more extended the granuloma, the more fragile will be the surrounding tissue, which is a decisive feature for foreign body migration [5,6]. An excellent biocompatibility is indicated by a small diameter of the granuloma with few inflammatory cells [7,8].…”

Section: Introductionmentioning

confidence: 99%

Comet-Tail-Like Inflammatory Infiltrate to Polymer Filaments Develops in Tension-Free Conditions

Klink¹,

Binnebösel²,

Kaemmer³

et al. 2010

Eur Surg Res

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Background: Mesh reinforcement in hiatal hernia repair becomes more frequent but is charged by complications such as erosion or stenosis of the oesophagus. These complications are accompanied by an intense inflammatory infiltrate around the polymer fibres. To characterize this effect, the response to polypropylene fibres in the absence of tension was examined. Methods: In rats, polypropylene sutures (USP size 1, 3-0 and 7-0) were placed in the subcutis of the abdominal wall without knot or tension. On postoperative days 3, 7 and 21, specimens were excised. The expressions of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 were measured by immunohistochemistry. Results: In the absence of tension, sutures were surrounded by a foreign body granuloma with an inflammatory infiltrate not encircling the fibre but forming almost symmetric comet-tail-like infiltrates on opposite sides. The expression of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 was significantly reduced over time in the comet tail, but not in the granuloma. Conclusions: Even in tension-free conditions, surgical sutures cause a foreign body response with infiltrates of inflammatory cells. This reaction is shaped like a comet tail, and its extension depends on the diameter of the used fibre. Therefore, for reduction of perifilamental infiltrates, not only absence of tension is required, but also a small-sized fibre textile.

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“…These consequences of the biological response to the foreign material are markedly influenced by the amount of incorporated material, particularly depending on the surface and the pore size. 5,6 Theoretical considerations, as well as the intraoperatively measured tensile strength during hernia repair, indicate that most of the currently available mesh materials are oversized with inappropriate elastic properties. 7 Both animal experiments and clinical experience have shown that adapting the mesh to the physiological demands by reducing the amount of introduced material (amount of polypropylene Ͻ 30 g/m 2 ) and enlarging the pore size (as in a multifilament low-weight mesh) results in a significant improvement in biocompatibility.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Both animal experiments 7 and clinical studies 8 show reduced functional impairment and a lowered periprosthetic inflammation with material-reduced meshes. Unfortunately, the construction of large-pore-size, low-weight meshes requires the use of multifilaments to prevent an inappropriate stiffness of the textile material.…”

mentioning

confidence: 96%

Functional and morphological evaluation of a low‐weight, monofilament polypropylene mesh for hernia repair

Klinge

Junge

Stumpf

et al. 2002

J. Biomed. Mater. Res.

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113

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With more than 1 million implantations per year worldwide, mesh repair has become a standard procedure for the treatment of hernias. Apart from various technical problems, the type of material has been proven to be of considerable importance for the functional and histological outcome, particularly for long-term implantation. Whereas the advantageous application of low-weight, large-pore meshes based on multifilaments can be stated without doubt, it is still open whether similar results can be achieved on the basis of pure monofilaments. In the present study, a low-weight polypropylene mesh (LW) made purely of monofilaments was compared to a common heavy-weight polypropylene mesh (HW) in regard to the functional consequences and the tissue response. After implantation in rats as an inlay for 3--90 days, the abdominal-wall mobility of the implant region was recorded by 3D stereography, and the tensile strength of both the suture zone and the mesh was measured. The morphometry of the histological reaction in regard to the inflammatory infiltrate, the connective tissue, the number of granulocytes, macrophages, and fibroblasts served to reflect the tissue response. As parameters for the remodeling process at the interface the cellular activation was evaluated by TUNEL (DNA-strand breaks or apoptosis, respectively), Ki 67 (cell proliferation), and HSP 70 (cell stress). The measured tensile strength of the LW mesh confirmed a sufficient strength of the material-reduced mesh modification. After implantation the consecutive impairment of the abdominal-wall mobility was reduced compared to the HW mesh, concomitant to the reduced fibrotic level at the interface. At the end of the observation period the foreign-body reaction was significantly lowered for the LW mesh, almost reaching physiological values. In conclusion, these data confirm the improved biocompatibility of material-reduced mesh implants.

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Morphologische Korrelation der funktionellen Bauchwandmechanik nach Mesh-Implantation

Cited by 18 publications

References 7 publications

Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma

Polyvinylidene Fluoride as a Suture Material: Evaluation of Comet Tail-Like Infiltrate and Foreign Body Granuloma

Comet-Tail-Like Inflammatory Infiltrate to Polymer Filaments Develops in Tension-Free Conditions

Functional and morphological evaluation of a low‐weight, monofilament polypropylene mesh for hernia repair

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