title: Histologic and biomechanical evaluation of a novel macroporous polytetrafluoroethylene knit mesh compared to lightweight and heavyweight polypropylene mesh in a porcine model of ventral incisional hernia repair.
abstract: OBJECTIVE
  To evaluate the biocompatibility of heavyweight polypropylene (HWPP), lightweight polypropylene (LWPP), and monofilament knit polytetrafluoroethylene (mkPTFE) mesh by comparing biomechanics and histologic response at 1, 3, and 5 months in a porcine model of incisional hernia repair.
  
  
  METHODS
  Bilateral full-thickness abdominal wall defects measuring 4 cm in length were created in 27 Yucatan minipigs. Twenty-one days after hernia creation, animals underwent bilateral preperitoneal ventral hernia repair with 8 × 10 cm pieces of mesh. Repairs were randomized to Bard(®)Mesh (HWPP, Bard/Davol, http://www.davol.com), ULTRAPRO(®) (LWPP, Ethicon, http://www.ethicon.com), and GORE(®)INFINIT Mesh (mkPTFE, Gore & Associates, http://www.gore.com). Nine animals were sacrificed at each timepoint (1, 3, and 5 months). At harvest, a 3 × 4 cm sample of mesh and incorporated tissue was taken from the center of the implant site and subjected to uniaxial tensile testing at a rate of 0.42 mm/s. The maximum force (N) and tensile strength (N/cm) were measured with a tensiometer, and stiffness (N/mm) was calculated from the slope of the force-versus-displacement curve. Adjacent sections of tissue were stained with hematoxylin and eosin (H&E) and analyzed for inflammation, fibrosis, and tissue ingrowth. Data are reported as mean ± SEM. Statistical significance (P < 0.05) was determined using a two-way ANOVA and Bonferroni post-test.
  
  
  RESULTS
  No significant difference in maximum force was detected between meshes at any of the time points (P > 0.05 for all comparisons). However, for each mesh type, the maximum strength at 5 months was significantly lower than that at 1 month (P < 0.05). No significant difference in stiffness was detected between the mesh types or between timepoints (P > 0.05 for all comparisons). No significant differences with regard to inflammation, fibrosis, or tissue ingrowth were detected between mesh types at any time point (P > 0.09 for all comparisons). However, over time, inflammation decreased significantly for all mesh types (P < 0.001) and tissue ingrowth reached a slight peak between 1 and 3 months (P = 0.001) but did not significantly change thereafter (P > 0.09).
  
  
  CONCLUSIONS
  The maximum tensile strength of mesh in the abdominal wall decreased over time for HWPP, LWPP, and mkPTFE mesh materials alike. This trend may actually reflect inability to adequately grip specimens at later time points rather than any mesh-specific trend. Histologically, inflammation decreased with time (P = 0.000), and tissue ingrowth increased (P = 0.019) for all meshes. No specific trends were observed between the polypropylene meshes and the monofilament knit PTFE, suggesting that this novel construction may be a suitable alternative to existing polypropylene meshes.
authors.affiliation: Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box #8109, St. Louis, MO, USA.
authors.forename: L
authors.initials: L
authors.lastname: Melman
authors.forename: E D
authors.initials: ED
authors.lastname: Jenkins
authors.forename: N A
authors.initials: NA
authors.lastname: Hamilton
authors.forename: L C
authors.initials: LC
authors.lastname: Bender
authors.forename: M D
authors.initials: MD
authors.lastname: Brodt
authors.forename: C R
authors.initials: CR
authors.lastname: Deeken
authors.forename: S C
authors.initials: SC
authors.lastname: Greco
authors.forename: M M
authors.initials: MM
authors.lastname: Frisella
authors.forename: B D
authors.initials: BD
authors.lastname: Matthews
mesh_terms: D034861:Abdominal Wall / Q000473:pathology*; D000704:Analysis of Variance; D000818:Animals; D001696:Biomechanical Phenomena; D004195:Disease Models, Animal; D004548:Elasticity; D006555:Hernia, Ventral / Q000601:surgery*; D007249:Inflammation / Q000473:pathology; D008422:Materials Testing; D011126:Polypropylenes / Q000009:adverse effects; D011138:Polytetrafluoroethylene / Q000009:adverse effects; D013526:Surgical Mesh / Q000009:adverse effects; D013552:Swine; D013718:Tensile Strength; D013997:Time Factors
chemical_list: D011126:Polypropylenes; D011138:Polytetrafluoroethylene