Biocompatibility of bacterial contaminated prosthetic meshes and porcine dermal collagen used to repair abdominal wall defects.
OBJECTIVE
A contaminated or infected surgical site is considered a contraindication for the use of the nonabsorbable alloplastic materials employed to repair abdominal wall defects. Therefore, the biocompatibility of new prosthetic materials was investigated.


METHODS
Meshes measuring 1.5x1.5 cm made of conventional and titanium-coated polypropylene, polyglycol, or porcine dermal collagen were implanted under the abdominal wall of 96 rats (eight groups of 12 animals each) employing the inlay technique. Implantation of all four materials was performed both under semisterile conditions and bacterial contamination of the mesh. The meshes were explanted after 28 days.


RESULTS
All the materials implanted under semisterile conditions were incorporated into the abdominal wall with only few intraabdominal adhesions (mean adhesion scores: 1.0, 1.2, 1.0, 0.8 points, respectively, not significant). With the porcine dermal collagen, proliferation rate and the proportion of inflammatory cells were statistically lower (p<0.01). In the bacterial contamination group, all meshes were associated with a suppurating infection and strong adhesions between the bowel and mesh, which were most prominent in the case of dermal collagen (mean adhesion scores: 1.6, 1.7, 1.7, and 1.9 points, respectively, not significant). In this group, two animals died of peritonitis. In comparison with the other materials, the proliferation rate was significantly elevated (p=0.03). No significant differences were seen between the other materials employed.


CONCLUSIONS
Irrespective of the material employed, implantation of alloplastic meshes in an abdominal wall contaminated with bacteria, is associated with suppurating infections, in particular in the case of the membrane-like porcine dermal collagen. Nonabsorbable alloplastic meshes and dermal skin grafts should therefore not be used to repair infected abdominal wall defects.
Ott
R
R
Department of Surgery II, University of Leipzig, Liebigstr. 20, 04105,Leipzig, Germany. rudolf.ott@medizin.uni-leipzig.de
Hartwig
T
T
Tannapfel
A
A
Blatz
R
R
Rodloff
A C
AC
Madaj-Sterba
P
P
Möbius
Ch
Ch
Köckerling
F
F
D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D001672:Biocompatible Materials; D005260:Female; D011102:Polyhydroxyethyl Methacrylate; D011126:Polypropylenes; D016459:Prosthesis-Related Infections / Q000601:surgery*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013526:Surgical Mesh / Q000382:microbiology*; D013552:Swine
D001672:Biocompatible Materials; D011126:Polypropylenes; D011102:Polyhydroxyethyl Methacrylate