Adrienne N Christopher1, Jonathan Sanchez2, John P Fischer3. 1. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania. 2. Paradigm Surgical, LLC, Philadelphia, Pennsylvania. 3. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: john.fischer2@pennmedicine.upenn.edu.
Abstract
INTRODUCTION: Research indicates that prophylactic mesh may help prevent incisional hernia after laparotomy, but best practice patterns in these situations are still evolving. Here, we compare the failure loads (FLs) and biomechanical stiffness (BMS) of 35 porcine abdominal wall laparotomy incisions reinforced with meshes of various widths and fixation distances using biomechanical testing. METHODS: In each specimen, a 10-cm incision was made and closed using continuous 1-0 Maxon suture. Specimens were randomized to mesh width (none, 2.5 cm, 3 cm, 4 cm, 6 cm, 8 cm) and tack separation (1.5 cm, 2 cm apart) and the meshes secured in an onlay fashion. Cyclic loads oscillating from 15 N to 140 N were applied to simulate abdominal wall stress, and the specimens subsequently loaded to failure. FLs (N) and BMS (N/mm) were comparatively analyzed. RESULTS: All specimens failed via suture pull-through. FLs and BMS were lowest in specimens with suture-only (421.43 N; 11.69 N/mm). FLs and BMS were significantly higher in 4-cm mesh specimens (567.51 N) than those with suture, 2.5-cm, and 3.0-cm mesh (all P < 0.05). FLs in specimens with a greater number of tacks were consistently higher in meshes of similar sizes, although these did not reach significance. CONCLUSIONS: A 4-cm mesh reenforcement was superior to suture-only and smaller meshes at preserving strength in laparotomy closure in a porcine model but larger meshes (6 cm, 8 cm) did not provide an additional benefit. Meshes with more fixation points may be advantageous, but additional data are needed to make definitive conclusions.
INTRODUCTION: Research indicates that prophylactic mesh may help prevent incisional hernia after laparotomy, but best practice patterns in these situations are still evolving. Here, we compare the failure loads (FLs) and biomechanical stiffness (BMS) of 35 porcine abdominal wall laparotomy incisions reinforced with meshes of various widths and fixation distances using biomechanical testing. METHODS: In each specimen, a 10-cm incision was made and closed using continuous 1-0 Maxon suture. Specimens were randomized to mesh width (none, 2.5 cm, 3 cm, 4 cm, 6 cm, 8 cm) and tack separation (1.5 cm, 2 cm apart) and the meshes secured in an onlay fashion. Cyclic loads oscillating from 15 N to 140 N were applied to simulate abdominal wall stress, and the specimens subsequently loaded to failure. FLs (N) and BMS (N/mm) were comparatively analyzed. RESULTS: All specimens failed via suture pull-through. FLs and BMS were lowest in specimens with suture-only (421.43 N; 11.69 N/mm). FLs and BMS were significantly higher in 4-cm mesh specimens (567.51 N) than those with suture, 2.5-cm, and 3.0-cm mesh (all P < 0.05). FLs in specimens with a greater number of tacks were consistently higher in meshes of similar sizes, although these did not reach significance. CONCLUSIONS: A 4-cm mesh reenforcement was superior to suture-only and smaller meshes at preserving strength in laparotomy closure in a porcine model but larger meshes (6 cm, 8 cm) did not provide an additional benefit. Meshes with more fixation points may be advantageous, but additional data are needed to make definitive conclusions.
Authors: Gerard M Cooney; Spencer P Lake; Dominic M Thompson; Ryan M Castile; Des C Winter; Ciaran K Simms Journal: J Mech Behav Biomed Mater Date: 2017-01-24
Authors: Shiva M Rangwani; Casey T Kraft; Steven J Schneeberger; Ibrahim Khansa; Jeffrey E Janis Journal: Plast Reconstr Surg Date: 2021-02-01 Impact factor: 4.730
Authors: Moritz A Konerding; Michael Bohn; Tanja Wolloscheck; Boris Batke; Jörg-L Holste; Stephen Wohlert; Jürgen Trzewik; Thorsten Förstemann; Christoph Hartung Journal: Med Eng Phys Date: 2011-02-17 Impact factor: 2.242
Authors: Irfan A Rhemtulla; Michael G Tecce; Robyn B Broach; Charles A Messa; Jaclyn T Mauch; John P Fischer Journal: Plast Reconstr Surg Glob Open Date: 2019-04-11
Authors: Charles A Messa; Jonathan Sanchez; Geoffrey M Kozak; Snehal Shetye; Ashley Rodriguez; John P Fischer Journal: J Surg Res Date: 2020-09-30 Impact factor: 2.192