New polymer for intra‐abdominal meshes—PVDF copolymer

Conze, Joachim; Junge, K.; Weiß, Claudia; Anurov, M.; Oettinger, A. P.; Klinge, U.; Schumpelick, Volker

doi:10.1002/jbm.b.31106

Cited by 68 publications

(50 citation statements)

References 19 publications

(39 reference statements)

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“…Until now, PVDF has shown superior properties in multiple studies [15,16,17] and has become one of the most promising mesh materials. Nevertheless, in the literature, there is only little information about PVDF as a suture material in general surgery [18,19].…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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

et al. 2015

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“…Large pores with a diameter of more than 1000 mm for polypropylene or 600 mm for polyvinyl fluoride have been found to prevent the undesirable bridging of scar tissue throughout the pore. 8 The corresponding pore sizes of a device can be characterized by the concept of effective porosity developed by M€ uhl et al, 11 which for the first time considers the geometry of the pores and is able to identify the "good" pore area as area with sufficiently large pores.…”

Section: Discussionmentioning

confidence: 99%

“…According to Conze et al, 8 for polypropylene filaments, a minimum distance of 1000 lm between filaments was set for the calculation of the effective porosity and a minimum distance of 600 mm was used in case of using polyvinyl fluoride. The measurement setup was periodically tested with a perforated plate, and the results were compared with mechanical measurements to ensure reproducible and reliable results.…”

Section: Measurement Setupmentioning

confidence: 99%

Elongation of textile pelvic floor implants under load is related to complete loss of effective porosity, thereby favoring incorporation in scar plates

Otto

Kaldenhoff

Kirschner‐Hermanns

et al. 2013

J Biomedical Materials Res

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Use of textile structures for reinforcement of pelvic floor structures has to consider mechanical forces to the implant, which are quite different to the tension free conditions of the abdominal wall. Thus, biomechanical analysis of textile devices has to include the impact of strain on stretchability and effective porosity. Prolift V R and Prolift 1 M V R , developed for tension free conditions, were tested by measuring stretchability and effective porosity applying mechanical strain. For comparison, we used Dynamesh-PR4 V R , which was designed for pelvic floor repair to withstand mechanical strain. Prolift V R at rest showed moderate porosity with little stretchability but complete loss of effective porosity at strain of 4.9 N/cm. Prolift 1 M V R revealed an increased porosity at rest, but at strain showed high stretchability, with subsequent loss of effective porosity at strain of 2.5 N/cm. Dynamesh PR4 V R preserved its high porosity even under strain, but as consequence of limited stretchability. Though in tension free conditions Prolift V R and Prolift 1 M V R can be considered as large pore class I meshes, application of mechanical strain rapidly lead to collapse of pores. The loss of porosity at mechanical stress can be prevented by constructions with high structural stability. Assessment of porosity under strain was found helpful to define requirements for pelvic floor devices. Clinical studies have to prove whether devices with high porosity as well as high structural stability can improve the patients' outcome.

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“…In contact with the suture surface, inflammatory cells transform to foreign body giant cells. The entire inflammatory infiltrate (inner granuloma) is sealed by a collagen-rich fibrotic capsule (outer granuloma) [3,4]. Impaired biocompatibility leads to extended foreign body response.…”

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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New polymer for intra‐abdominal meshes—PVDF copolymer

Abstract: Large-pore PP and co-PVDF-meshes showed comparable good results in the intra-abdominal position, with a reduced inflammatory tissue reaction for co-PVDF. Large pore meshes should be considered an alternative for the development of intraperitoneal onlay meshes.

Cited by 68 publications

References 19 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

Elongation of textile pelvic floor implants under load is related to complete loss of effective porosity, thereby favoring incorporation in scar plates

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

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