Bioprosthetic Versus Synthetic Mesh: Analysis of Tissue Adherence and Revascularization in an Experimental Animal Model

Background: Both synthetic and bioprosthetic meshes play important roles in surgical procedures such as ventral hernia repair. Although sometimes used interchangeably, these devices have inherently different properties. We therefore sought to better understand how these materials interact with the host environment to optimize surgical techniques and to improve outcomes. Methods: Synthetic mesh (polypropylene, Prolene) or bioprosthetic mesh (acellular fetal/neonatal bovine dermis, SurgiMend) was implanted intraperitoneally into rats lateral to a ventral incision in a novel intra-abdominal implant model. Two variables were modified with each material: (1) tight or loose tissue apposition, altered by modifying suture placement; and (2) abdominal wall injury, altered by selective abrasion of the peritoneal lining. After 5 weeks, the meshes and abdominal wall were evaluated grossly and histologically. The analysis focused on the degree of inflammatory response, neovascularization, and mesh adherence to the surrounding tissues. Results: Synthetic mesh adhered to the abdominal wall and visceral organs, regardless of the degree of apposition or tissue injury, due to a foreign body–mediated inflammatory reaction. In areas of noninjured peritoneal lining, SurgiMend was adherent peri-suture. Neovascularization entered the mesh from these apposition points and spread outward. In areas of denuded peritoneal lining, the adherent and vascularized areas were significantly greater and not merely coincident with suture placement. Conclusions: The inflammatory and wound healing responses with bioprosthetic mesh seem fundamentally different from synthetic mesh. Understanding these differences may lead to varied outcomes in adherence and vascularization of the materials, and ultimately the efficacy of hernia repair. Additionally, these differences highlight the need for further basic research to optimize mesh selection for surgical technique.

[1]  J. Selber,et al.  Bovine versus Porcine Acellular Dermal Matrix: A Comparison of Mechanical Properties , 2014, Plastic and reconstructive surgery. Global open.

[2]  Maureen Martin,et al.  A Preliminary Comparison Study of Two Noncrosslinked Biologic Meshes Used in Complex Ventral Hernia Repairs , 2012, World Journal of Surgery.

[3]  D. Oleynikov,et al.  Not all biologics are equal! , 2011, Hernia.

[4]  M. Rosen,et al.  Abdominal hernia repair with bridging acellular dermal matrix--an expensive hernia sac. , 2008, American journal of surgery.

[5]  A. Mathur,et al.  Human versus Non-Cross-Linked Porcine Acellular Dermal Matrix Used for Ventral Hernia Repair: Comparison of In Vivo Fibrovascular Remodeling and Mechanical Repair Strength , 2011, Plastic and reconstructive surgery.

[6]  Jun Liu,et al.  Bovine versus Porcine Acellular Dermal Matrix for Complex Abdominal Wall Reconstruction , 2013, Plastic and reconstructive surgery.

[7]  M. Rosen,et al.  Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. , 2010, Surgery.

[8]  W. Lineaweaver,et al.  Bovine fetal collagen reinforcement in a small animal model of hernia with component repair. , 2016, The Journal of surgical research.

[9]  Corey R Deeken,et al.  Differentiation of Biologic Scaffold Materials Through Physicomechanical, Thermal, and Enzymatic Degradation Techniques , 2012, Annals of surgery.

[10]  M. Rosen,et al.  Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? , 2007, Journal of the American College of Surgeons.

[11]  A. Landsman,et al.  Extracellular matrix biomaterials for soft tissue repair. , 2009, Clinics in podiatric medicine and surgery.

[12]  Jun Liu,et al.  Primary fascial closure with mesh reinforcement is superior to bridged mesh repair for abdominal wall reconstruction. , 2013, Journal of the American College of Surgeons.