Mohamed M Ibrahim1, Luke P Poveromo2, Richard R Glisson3, Agustin Cornejo1, Alfredo E Farjat4, Ken Gall5, Howard Levinson6. 1. Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. 2. Duke University School of Medicine, Duke University Medical Center, Durham, NC 27710, USA. 3. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA. 4. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA. 5. Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27710, USA. 6. 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.
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.
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.
Authors: L Melman; E D Jenkins; N A Hamilton; L C Bender; M D Brodt; C R Deeken; S C Greco; M M Frisella; B D Matthews Journal: Hernia Date: 2011-01-30 Impact factor: 4.739
Authors: Lora Melman; Eric D Jenkins; Corey R Deeken; Michael D Brodt; Shaun R Brown; L Michael Brunt; J Christopher Eagon; Margaret Frisella; Brent D Matthews Journal: Surg Innov Date: 2010-09-03 Impact factor: 2.058
Authors: Giuseppe Amato; Attilio I Lo Monte; Giovanni Cassata; Giuseppe Damiano; Giorgio Romano; Rossana Bussani Journal: Artif Organs Date: 2011-07-13 Impact factor: 3.094