Persistence of polypropylene mesh anisotropy after implantation: an experimental study

Ozog, Yves; Konstantinovic, M.L.; Werbrouck, E.; Ridder, Dirk De; Mazza, Edoardo; Deprest, Jan

doi:10.1111/j.1471-0528.2011.03018.x

Cited by 42 publications

(34 citation statements)

References 22 publications

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“…UltraPro, on the other hand, was found to display mechanical behavior that was vastly different depending on the loading direction. These results are similar to those previously reported (Saberski et al, 2011; Ozog et al, 2011), and confirm that it is important to consider the biomechanical properties of these grafts prior to implantation. Based on a co-rotational inverse finite element modeling approach, it was found that there is a significant degree of material nonlinearity inherent to each segment, but also that changes in mesh geometry could account for a large degree of structural nonlinearity and anisotropy observed experimentally for the UltraPro mesh.…”

Section: Discussionsupporting

confidence: 91%

Varying degrees of nonlinear mechanical behavior arising from geometric differences of urogynecological meshes

Feola

Pal

Moalli

et al. 2014

Journal of Biomechanics

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Synthetic polypropylene meshes were designed to restore pelvic organ support for women suffering from pelvic organ prolapse; however, the FDA released two notifications regarding the potential complications associated with mesh implantation. Our aim was to characterize the structural properties of Restorelle and UltraPro subjected to uniaxial tension along perpendicular directions, and then model the tensile behavior of these meshes utilizing a co-rotational finite element model, with an imbedded linear or fiber-recruitment local stress-strain relationship. Both meshes exhibited highly nonlinear stress-strain behavior; Restorelle had no significant differences between the two perpendicular directions, while UltraPro had a 93% difference in the low (initial) stiffness (p=0.009) between loading directions. Our model predicted that early alignment of the mesh segments in the loading direction and subsequent stretching could explain the observed nonlinear tensile behavior. However, a nonlinear stress-strain response in the stretching regime, that may be inherent to the mesh segment, was required to better capture experimental results. Utilizing a nonlinear fiber recruitment model with two parameters A and B, we observed improved agreement between the simulations and the experimental results. An inverse analysis found A=120 MPa and B=1.75 for Restorelle (RMSE=0.36). This approach yielded A=30 MPa and B=3.5 for UltraPro along one direction (RMSE=0.652), while the perpendicular orientation resulted in A=130 MPa and B=4.75 (RMSE=4.36). From the uniaxial protocol, Restorelle was found to have little variance in structural properties along these two perpendicular directions; however, UltraPro was found to behave anisotropically.

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Section: Discussionsupporting

confidence: 91%

Varying degrees of nonlinear mechanical behavior arising from geometric differences of urogynecological meshes

Feola

Pal

Moalli

et al. 2014

Journal of Biomechanics

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“…Other studies have focused on analyzing the effects of the anisotropy of a surgical mesh once implanted [8, 9,12]. However, the distensibility and stress produced to the tissues and implant cannot be experimentally addressed.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Response of the Herniated Human Abdomen to the Placement of Different Prostheses

Hernández-Gascón

Peña²,

Grasa

et al. 2013

Journal of Biomechanical Engineering

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This paper describes a method designed to model the repaired herniated human abdomen just after surgery and examine its static mechanical response to the maximum intra-abdominal pressure provoked by a physiological movement (standing cough). The model is based on the real geometry of the human abdomen bearing a large incisional hernia with several anatomical structures differentiated by MRI. To analyze the outcome of hernia repair, the surgical procedure was simulated by modeling a prosthesis placed over the hernia. Three surgical meshes with different mechanical properties were considered: an isotropic heavy-weight mesh (Surgipro®), a slightly anisotropic light-weight mesh (Optilene®), and a highly anisotropic medium-weight mesh (Infinit®). Our findings confirm that anisotropic implants need to be positioned such that the most compliant axis of the mesh coincides with the craneo-caudal direction of the body.

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“…Meshes were implanted via sacrocolpopexy in the Rhesus Macaque. Since UltraPro is highly anisotropic [7][8] , it was implanted with its blue orientation lines perpendicular (low stiffness direction) and parallel (high stiffness direction) to the longitudinal axis of the vagina. The production and degradation of collagen and elastin, collagen subtype III/I ratio as well as the levels of matrix metalloproteinases (MMP) MMPs -1, -2, -8, -9 and -13 were examined.…”

Section: Introductionmentioning

confidence: 99%

Impact of Prolapse Meshes on the Metabolism of Vaginal Extracellular Matrix in Rhesus Macaque

Liang

Zong

Palcsey

et al. 2015

Obstetrical &Amp; Gynecological Survey

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Objective-The impact of polypropylene mesh implantation on vaginal collagen and elastin metabolism was analyzed using a nonhuman primate model to further delineate the mechanism of mesh induced complications.Methods-49 middle aged parous rhesus macaques underwent surgical implantation of 3 synthetic meshes via sacrocolpopexy. Gynemesh PS (n=12) and two lower weight, higher porosity, lower stiffness meshes -UltraPro (n = 19) and Restorelle (n=8) were implanted, in which UltraPro was implanted with its blue orientation lines perpendicular (low stiffness direction, n=11) and parallel (high stiffness direction, n=8) to the longitudinal axis of vagina. Sham operated animals were used as controls (n=10). Twelve weeks after surgery, the meshtissue complex was excised and analyzed.Results-Relative to Sham, Gynemesh PS had a negative impact on the metabolism of both collagen and elastin favoring catabolic reactions while UltraPro only induced an increase in elastin degradation. Restorelle had the least impact. As compared to Sham, the degradation of collagen and elastin in the vagina implanted with Gynemesh PS was increased with a simultaneous increase in active MMP-1, -8, -13 and total MMP-2, -9 (all P<0.05). The degradation of elastin (tropoelastin and mature elastin) was increased in the UltraPro implanted vagina with a concomitant increase of MMP-2, and -9 (all P<0.05). Collagen subtype ratio III/I was increased in both Gynemesh PS and UltraPro perpendicular groups (P<0.05). Condensation:The heavier, less porous and stiffer mesh Gynemesh PS increased the catabolism of collagen and elastin in the vagina, characterized by increased matrix degradation and MMPs.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-Following implantation with the heavier, less porous and stiffer mesh, Gynemesh PS, the degradation of vaginal collagen and elastin exceeded synthesis, most likely as a result of increased activity of MMPs, resulting in a structurally compromised tissue. NIH Public Access

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Persistence of polypropylene mesh anisotropy after implantation: an experimental study

Cited by 42 publications

References 22 publications

Varying degrees of nonlinear mechanical behavior arising from geometric differences of urogynecological meshes

Varying degrees of nonlinear mechanical behavior arising from geometric differences of urogynecological meshes

Mechanical Response of the Herniated Human Abdomen to the Placement of Different Prostheses

Impact of Prolapse Meshes on the Metabolism of Vaginal Extracellular Matrix in Rhesus Macaque

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