title: In vivo evaluation of a novel mesh suture design for abdominal wall closure.
abstract: BACKGROUND
  The authors present a novel mesh suture design aimed at minimizing the early laparotomy dehiscence that drives ventral hernia formation. The authors hypothesized that modulation of the suture-tissue interface through use of a macroporous structure and increased aspect ratio (width-to-height ratio) would decrease the suture pull-through that leads to laparotomy dehiscence.
  
  
  METHODS
  Incisional hernias were produced in 30 rats according to an established hernia model. The rat hernias were randomized to repair with either two 5-0 polypropylene sutures or two midweight polypropylene mesh sutures. Standardized photographs were taken before repair and 1 month after repair. Edge-detection software was used to define the border of the hernia defect and calculate the defect area. Histologic analysis was performed on all mesh suture specimens.
  
  
  RESULTS
  Seventeen hernias were repaired with mesh sutures and 13 were repaired with conventional sutures. The mean area of the recurrent defects following repair with mesh suture was 177.8 ± 27.1 mm2, compared with 267.3 ± 34.1 mm2 following conventional suture repair. This correlated to a 57.4 percent reduction in defect area after mesh suture repair, compared with a 10.1 percent increase in defect area following conventional suture repair (p < 0.0007). None (zero of 34) of the mesh sutures pulled through the surrounding tissue, whereas 65 percent (17 of 26) of the conventional sutures demonstrated complete pull-through. Excellent fibrocollagenous ingrowth was observed in 13 of 17 mesh suture specimens.
  
  
  CONCLUSIONS
  Mesh sutures better resisted suture pull-through than conventional polypropylene sutures. The design elements of mesh sutures may prevent early laparotomy dehiscence by more evenly distributing distracting forces at the suture-tissue interface and permitting tissue incorporation of the suture itself.
authors: Chicago, Ill. From the Division of Plastic Surgery, Northwestern University Feinberg School of Medicine.
authors: Jason M
authors: JM
authors: Souza
authors: Zari P
authors: ZP
authors: Dumanian
authors: Anandev N
authors: AN
authors: Gurjala
authors: Gregory A
authors: GA
authors: Dumanian
mesh_terms: D034861:Abdominal Wall / Q000473:pathology; D058107:Abdominal Wound Closure Techniques / Q000295:instrumentation*; D000818:Animals; D004867:Equipment Design; D006555:Hernia, Ventral / Q000601:surgery; D007813:Laparotomy / Q000009:adverse effects; D008422:Materials Testing; D011126:Polypropylenes; D016062:Porosity; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012008:Recurrence; D013526:Surgical Mesh; D013529:Surgical Wound Dehiscence / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D013718:Tensile Strength
chemical_list: D011126:Polypropylenes
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