학술논문
Modifying hernia mesh design to improve device mechanical performance and promote tension-free repair.
Document Type
Academic Journal
Author
Ibrahim MM; Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.; Poveromo LP; Duke University School of Medicine, Duke University Medical Center, Durham, NC 27710, USA.; Glisson RR; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.; Cornejo A; Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.; Farjat AE; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA.; Gall K; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27710, USA.; Levinson H; Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA; Department of Dermatology, Duke University, Durham, NC 27710, USA; Department of Pathology, Duke University, Durham, NC 27710, USA. Electronic address: howard.levinson@duke.edu.
Source
Publisher: Elsevier Science Country of Publication: United States NLM ID: 0157375 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2380 (Electronic) Linking ISSN: 00219290 NLM ISO Abbreviation: J Biomech Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: Approximately 348,000 ventral hernia repairs are performed annually in the United States and the incisional hernia recurrence rate is approximately 20% as a result of suture and mesh device failure. Device failure is related to changes at the suture/tissue interface that leads to acute or chronic suture pull-through and surgical failure. To better manage mechanical tension, we propose a modified mesh design with extensions and demonstrate its mechanical superiority.
Methods: Comparative uniaxial static tensile testing was conducted on polypropylene suture and a modified mesh. Subsequently, a standard of care (SOC) mesh and modified mesh were evaluated using a tensometer in an acute hernia bench-top model.
Results: Modified mesh breaking strength, extension knot breaking strength, extension disruption, and extension anchoring were superior to suture (p < .05). Modified mesh ultimate tensile strength of anchoring was superior to SOC mesh (p < .05). Various stitch patterns and modifications in device design significantly improved device tension-free performance far beyond clinically relevant benchmarks (p < .05).
Conclusions: Testing demonstrates that the modified mesh outperforms SOC mesh and suture in all tested failure modes. SOC hernia mesh tears through tissue at stress levels below maximum physiologic stress, whereas, the modified hernia mesh is up to 200% stronger than SOC mesh at resisting suture tearing through tissue and maintains anchoring at stresses far beyond clinically relevant benchmarks. Modifying hernia mesh design significantly improves device mechanical performance and enhances tension-free repair.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
Methods: Comparative uniaxial static tensile testing was conducted on polypropylene suture and a modified mesh. Subsequently, a standard of care (SOC) mesh and modified mesh were evaluated using a tensometer in an acute hernia bench-top model.
Results: Modified mesh breaking strength, extension knot breaking strength, extension disruption, and extension anchoring were superior to suture (p < .05). Modified mesh ultimate tensile strength of anchoring was superior to SOC mesh (p < .05). Various stitch patterns and modifications in device design significantly improved device tension-free performance far beyond clinically relevant benchmarks (p < .05).
Conclusions: Testing demonstrates that the modified mesh outperforms SOC mesh and suture in all tested failure modes. SOC hernia mesh tears through tissue at stress levels below maximum physiologic stress, whereas, the modified hernia mesh is up to 200% stronger than SOC mesh at resisting suture tearing through tissue and maintains anchoring at stresses far beyond clinically relevant benchmarks. Modifying hernia mesh design significantly improves device mechanical performance and enhances tension-free repair.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)