title: Host reaction to vaginally inserted collagen containing polypropylene implants in sheep.
abstract: OBJECTIVE
  We aimed to characterize the effect of vaginal or abdominal mesh insertion and of different collagen augmentation of polypropylene mesh in a sheep model. Outcome measures were passive and active biomechanical properties and semiquantitative morphometry.
  
  
  METHODS
  Forty-two Texel sheep were used: 6 were nonimplanted controls (n = 6), the rest were implanted with polypropylene mesh (n = 12; Avaulta Solo; Bard Medical, Covington, GA) or collagen-coated meshes: Avaulta Plus (n = 12; Bard Medical) and Ugytex (n = 12; Sofradim International, Trevoux, France). Through a single incision, the rectovaginal septum was dissected and a 35 × 35-mm mesh was sutured to the underlying tissues. Abdominally, a 50 × 50-mm mesh was laid over a primarily sutured full thickness 40-mm longitudinal incisional defect. Animals were explanted after 60 or 180 days (n = 6 per group). Outcome measures were passive biomechanics by biaxial tensiometry, active contractility of vaginal explants, and histologic evidence.
  
  
  RESULTS
  Vaginal explants were 2.4 times stiffer compared with native vaginal tissue (P < .001), but without differences in comfort zone stiffness or slope of the load-elongation in the physiologic range between the products that were tested. Collagen coating was associated with a 16-fold reduction in contractile force at 180 days, compared with native vaginal tissue, both for Avaulta Plus (P = .032) and Ugytex (P = .015). Abdominal explants were 1.3-times stiffer compared with native abdominal wall tissue (P < .001) and were 1.9-times stiffer compared with vaginal explants.
  
  
  CONCLUSIONS
  Vaginal mesh implantation yields less stiff explants compared with abdominal explants. Vaginal mesh implantation also alters the passive and active biomechanical properties compared with native vaginal tissues. Collagen matrices did not reduce the number of graft-related complications.
authors.affiliation: Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Andrew
authors.initials: A
authors.lastname: Feola
authors.affiliation: Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Endo
authors.affiliation: Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium; Institute for Care of Mother and Child, Prague, Czech Republic.
authors.forename: Iva
authors.initials: I
authors.lastname: Urbankova
authors.affiliation: Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium; Institute for Care of Mother and Child, Prague, Czech Republic.
authors.forename: Jaromír
authors.initials: J
authors.lastname: Vlacil
authors.affiliation: Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deprest
authors.affiliation: Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Samantha
authors.initials: S
authors.lastname: Bettin
authors.affiliation: Institute for Pathology, Düren, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Klosterhalfen
authors.affiliation: Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium; Pelvic Floor Unit, University Hospitals, KU Leuven, Leuven, Belgium. Electronic address: Jan.Deprest@uzleuven.be.
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
mesh_terms: D034861:Abdominal Wall / Q000473:pathology / Q000601:surgery; D000818:Animals; D001696:Biomechanical Phenomena; D003094:Collagen; D005260:Female; D011126:Polypropylenes; D011183:Postoperative Complications / Q000209:etiology*; D012756:Sheep; D013526:Surgical Mesh; D014621:Vagina / Q000473:pathology / Q000601:surgery*
chemical_list: D011126:Polypropylenes; D003094:Collagen
keywords: biomechanics; collagen; contractility; mesh; sheep