title: Graft-related complications and biaxial tensiometry following experimental vaginal implantation of flat mesh of variable dimensions.
abstract: OBJECTIVE
  To compare the occurrence of graft-related complications (GRCs) and biomechanical properties of meshes implanted vaginally and abdominally.
  
  
  METHODS
  In vivo animal experiment.
  
  
  METHODS
  Centre for Surgical Technologies, Medical Faculty, KU Leuven, Belgium.
  
  
  METHODS
  Twenty adult parous Texel ewes.
  
  
  METHODS
  Sheep were implanted with Gynemesh M, a 28-g/m² polypropylene mesh reinforced with polyglecaprone fibres, under general anaesthesia. Dissection into the rectovaginal septum was performed to accommodate a flat 50 × 50 mm (n = 10) or 35 × 35 mm (n = 10) mesh, which was sutured to the underlying tissues. A 50 × 50 mm mesh was laid over a primarily sutured, full-thickness, 40-mm longitudinal abdominal wall incision. Sacrifice was at 60 days (n = 10) or 90 days (n = 5).
  
  
  METHODS
  The occurrence of exposure, the degree of contraction and examination of the biomechanical properties of explants with a minimum radius of 32 mm via biaxial tensiometry.
  
  
  RESULTS
  Insertion of a 50 × 50 mm mesh led to exposures in 30% (3/10) of cases, and the average contraction rate was 52 ± 14%. In the 35 × 35 mm implants, there were no exposures, and the contraction rate was 25 ± 26.3%. Vaginal explants with no GRCs and of sufficient size had biomechanical properties that were comparable with those of abdominal explants.
  
  
  CONCLUSIONS
  Vaginal mesh insertion is associated with GRCs, such as exposure and contraction. Although other factors probably play a role, this study illustrates that mesh size may also induce these complications. In a vaginal surgery model, clinically occurring GRCs can be reproduced. In addition, biomechanics of uncomplicated vaginal explants are comparable with those measured on abdominal explants.
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.|Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Manodoro
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.|Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Endo
authors.affiliation: Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Uvin
authors.affiliation: Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Albersen
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.|Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Vláčil
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Engels
authors.affiliation: European Competence Center of Healthcare Engineering, Hemmingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.|Pelvic Floor Unit, University Hospitals Leuven, Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: De Ridder
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.|Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Feola
authors.affiliation: Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.|Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.|Pelvic Floor Unit, University Hospitals Leuven, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Deprest
mesh_terms: D000005:Abdomen / Q000601:surgery; D000818:Animals; D001696:Biomechanical Phenomena; D005260:Female; D005548:Foreign-Body Migration; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation*; D023421:Models, Animal; D011475:Prosthesis Failure; D012756:Sheep; D013526:Surgical Mesh / Q000009:adverse effects*; D013718:Tensile Strength; D014621:Vagina / Q000601:surgery*