Histologic and Biomechanical Evaluation of Crosslinked and Non-Crosslinked Biologic Meshes in a Porcine Model of Ventral Incisional Hernia Repair Corey.

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Presentation transcript:

Histologic and Biomechanical Evaluation of Crosslinked and Non-Crosslinked Biologic Meshes in a Porcine Model of Ventral Incisional Hernia Repair Corey R. Deeken, PhD, Lora Melman, MD, Eric D. Jenkins, MD, Suellen C. Greco, DVM, Margaret M. Frisella, RN, Brent D. Matthews, MD, FACS Journal of the American College of Surgeons Volume 212, Issue 5, Pages 880-888 (May 2011) DOI: 10.1016/j.jamcollsurg.2011.01.006 Copyright © 2011 American College of Surgeons Terms and Conditions

Figure 1 Biomechanical characteristics of mesh-repaired sites over time compared with de novo strength and native porcine abdominal wall. (A) Maximum load (Newton [N]), (B) tensile strength (N/cm), (C) stiffness (N/mm). All 4 meshes were significantly stronger and stiffer at time 0 compared with their corresponding repair sites (mesh-abdominal wall tissue composites) after 1, 6, or 12 months (p < 0.01 for all comparisons). Although significant differences were observed between the strengths and stiffnesses of the 4 meshes at time 0, no significant differences were detected between mesh-repaired sites at 1, 6, or 12 months due to the type of mesh used to repair the defect (p > 0.05 in all cases). In addition, no significant differences in strength or stiffness of the repair site were detected over time for any of the meshes used (p > 0.05 in all cases). Abd, abdominal. Journal of the American College of Surgeons 2011 212, 880-888DOI: (10.1016/j.jamcollsurg.2011.01.006) Copyright © 2011 American College of Surgeons Terms and Conditions

Figure 2 Composite scores for both non-crosslinked meshes (Veritas and AlloDerm) were significantly higher than the composite scores for both crosslinked meshes (Permacol and Peri-Guard), p < 0.05 and Veritas scored higher than AlloDerm; p < 0.05. Journal of the American College of Surgeons 2011 212, 880-888DOI: (10.1016/j.jamcollsurg.2011.01.006) Copyright © 2011 American College of Surgeons Terms and Conditions

Figure 3 Histologic scores, separated by mesh type and length of time in vivo. (A) Cellular infiltration scores demonstrated that the non-crosslinked meshes (Veritas and AlloDerm) initially permitted more cellular infiltration than the crosslinked meshes (Permacoland Peri-Guard); p < 0.008. By 6 and 12 months, this trend disappeared and all meshes achieved equivalent cellular infiltration (p > 0.05). (B) Cell types scores revealed that fewer inflammatory cells and more fibroblasts were detected at 1 and 6 months in Peri-Guard compared with AlloDerm (p < 0.02), and all other comparisons at these time points were not significant (p > 0.05). By 12 months, Veritas exhibited the greatest number of fibroblasts and least inflammatory infiltrate compared with the other 3 materials (p < 0.04). (C) Extracellular matrix (ECM) deposition scores at 1 month demonstrated that the non-crosslinked meshes (Veritas and AlloDerm) initially permitted more cellular infiltration than the crosslinked meshes (Permacoland Peri-Guard); p < 0.02. At 6 months, Veritas, AlloDerm, and Permacol all demonstrated greater ECM deposition than Peri-Guard (p < 0.02), and by 12 months, the only remaining difference was that Veritas exhibited the highest level of ECM deposition compared with Peri-Guard and AlloDerm (p < 0.03). (D) Scaffold degradation scores showed that non-crosslinked meshes (Veritas and AlloDerm) were markedly more degraded at 1 and 6 months compared with the crosslinked meshes (Permacoland Peri-Guard); p < 0.03. Veritas also exhibited significantly more scaffold degradation than the other non-crosslinked mesh, AlloDerm, at both 1 and 6 months (p = 0.010 and p = 0.002, respectively). (E) Fibrous encapsulation scores revealed that Veritas was significantly less encapsulated (higher score means less encapsulation) than all other meshes at 1 month (p < 0.01). By 6 months, both non-crosslinked materials (AlloDerm and Veritas) scored similarly, and both were significantly less encapsulated than the crosslinked meshes (p < 0.001). However, at 12 months, the crosslinked meshes showed decreasing levels of encapsulation, suggesting that this process might be reversible. (F) Neovascularization scores were significantly higher for both non-crosslinked meshes (Veritas and AlloDerm) at 1 and 6 months compared with both crosslinked meshes (Permacoland Peri-Guard); p < 0.05. By 12 months, however, Veritas and AlloDerm reached significance only in comparison with Peri-Guard, but not Permacol (p < 0.01). Journal of the American College of Surgeons 2011 212, 880-888DOI: (10.1016/j.jamcollsurg.2011.01.006) Copyright © 2011 American College of Surgeons Terms and Conditions

Figure 4 Photographs of hematoxylin and eosin−stained specimens of each mesh-repaired site after 1, 6, and 12 months in vivo (100× magnification). Journal of the American College of Surgeons 2011 212, 880-888DOI: (10.1016/j.jamcollsurg.2011.01.006) Copyright © 2011 American College of Surgeons Terms and Conditions