Biomechanical properties of synthetic and biologic graft materials following long-term implantation in the rabbit abdomen and vagina.

OBJECTIVE We sought to evaluate the effects of anatomic location and ovariectomy on biomechanical properties of synthetic and biologic graft materials after long-term implantation. STUDY DESIGN A total of 35 rabbits underwent ovariectomy or sham laparotomy and were implanted with polypropylene (PP) mesh (n = 17) or cross-linked porcine dermis (PS) (n = 18) in the vagina and abdomen. Grafts were harvested 9 months later and underwent mechanical properties testing. RESULTS After implantation, PS was similar in strength (P = .52) but was twice as stiff as PP (P = .04) and had a maximal elongation only half that of PP (P < .001). Degradation of PS was associated with decreased ultimate tensile strength (P = .03) and elastic modulus (P = .046). Vaginal PP grafts shrunk more (P < .001) and were less stiff than abdominal PP grafts (P = .049) but were not different in strength (P = .19). Ovariectomy had no effect (P > .05). CONCLUSION Cross-linked PS undergoes long-term degradation resulting in compromised biomechanical properties and thus is likely inferior to lightweight PP meshes for pelvic organ prolapse and incontinence procedures.

[1]  J. Goh.  Biomechanical and biochemical assessments for pelvic organ prolapse , 2003, Current opinion in obstetrics & gynecology.

[2]  Ling-ling Lei,et al.  Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women , 2007, International Urogynecology Journal.

[3]  E. Myers,et al.  Vaginal mesh erosion after abdominal sacral colpopexy. , 2001, American journal of obstetrics and gynecology.

[4]  A. Mellgren,et al.  A Three-Year Prospective Assessment of Rectocele Repair Using Porcine Xenograft , 2006, Obstetrics and gynecology.

[5]  S. Giri,et al.  The long-term results of pubovaginal sling surgery using acellular cross-linked porcine dermis in the treatment of urodynamic stress incontinence. , 2006, The Journal of urology.

[6]  John N. Nguyen,et al.  Outcome After Anterior Vaginal Prolapse Repair: A Randomized Controlled Trial , 2008, Obstetrics and gynecology.

[7]  K. Leslie,et al.  Histological and biomechanical evaluation of implanted graft materials in a rabbit vaginal and abdominal model. , 2006, American journal of obstetrics and gynecology.

[8]  Arundhati Rao,et al.  Histologic response of porcine collagen-coated and uncoated polypropylene grafts in a rabbit vagina model. , 2008, American journal of obstetrics and gynecology.

[9]  C. Birch.  The use of prosthetics in pelvic reconstructive surgery. , 2005, Best practice & research. Clinical obstetrics & gynaecology.

[10]  A. Morse,et al.  Changes in tensile strength of cadaveric human fascia lata after implantation in a rabbit vagina model. , 2003, The Journal of urology.

[11]  J. Deprest,et al.  Fate of collagen-based implants used in pelvic floor surgery: a 2-year follow-up study in a rabbit model. , 2008, American journal of obstetrics and gynecology.

[12]  M. Karram,et al.  Scientific basis for use of grafts during vaginal reconstructive procedures , 2005, Current opinion in obstetrics & gynecology.

[13]  A. Morse,et al.  Histologic evaluation of human cadaveric fascia lata in a rabbit vagina model , 2006, International Urogynecology Journal.

[14]  N. Kohli,et al.  Use of synthetic mesh and donor grafts in gynecologic surgery. , 2001, Current women's health reports.

[15]  J. Gebhart,et al.  Effect of host response (incorporation, encapsulation, mixed incorporation and encapsulation, or resorption) on the tensile strength of graft-reinforced repair in the rat ventral hernia model. , 2007, American journal of obstetrics and gynecology.

[16]  R. Munarriz,et al.  Effects of ovariectomy and steroid hormones on vaginal smooth muscle contractility , 2004, International Journal of Impotence Research.

[17]  Severe Mesh Complications Following Intravaginal Slingplasty , 2005, Obstetrics and gynecology.

[18]  J. Gebhart,et al.  Xenograft use in reconstructive pelvic surgery: a review of the literature , 2007, International Urogynecology Journal.

[19]  G. Crépin,et al.  A biomechanical study of the strength of vaginal tissues. Results on 16 post-menopausal patients presenting with genital prolapse. , 2004, European journal of obstetrics, gynecology, and reproductive biology.

[20]  L. Meyn,et al.  Tensile properties of five commonly used mid-urethral slings relative to the TVT™ , 2008, International Urogynecology Journal.

[21]  C. Amundsen,et al.  Pelvic organ prolapse: a review of the current literature. , 2007, Minerva ginecologica.

[22]  L. Brubaker,et al.  Donor fascia in urogynaecological procedures: a canine model , 2001, BJU International.

[23]  R. Goldberg,et al.  Histopathologic changes of porcine dermis xenografts for transvaginal suburethral slings. , 2005, American journal of obstetrics and gynecology.

[24]  M. Zobitz,et al.  Time dependent variations in biomechanical properties of cadaveric fascia, porcine dermis, porcine small intestine submucosa, polypropylene mesh and autologous fascia in the rabbit model: implications for sling surgery. , 2004, The Journal of urology.

[25]  M. Barber,et al.  Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. , 2006, American journal of obstetrics and gynecology.

[26]  J. Colling,et al.  Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence , 1997, Obstetrics and gynecology.

[27]  V. Handa,et al.  Abdominal sacrocolpopexy: anatomic outcomes and complications with Pelvicol, autologous and synthetic graft materials. , 2008, American journal of obstetrics and gynecology.