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Soft tissue substitutes are subjected to large deformation in vivo, so the matching of deformation behavior between substitute and tissue is a complex but important criterion for soft tissue repair. Hernia repair mesh is a typical soft tissue substitute, and the mismatch of mechanical properties between mesh and tissues normally leads to decline in the quality of life and hernia recurrence. Therefore, before clinical applications, the evaluation for the mechanical biocompatibility of mesh is particularly important. Currently, several methods have been developed to evaluate mechanical biocompatibility of soft tissue substitutes, including physicomechanical testing, non-invasive measurement, and numerical modeling, etc. However, a comprehensive summary is lacking to provide reference for the selection, implementation and optimization of these methods. In this paper, taking the hernia repair mesh as an example, we systematically review these methods from following aspects: (1) proposing critical issues that need to be paid attention to when performing physicomechanical testing on substitutes, (2) systematically analyzing characteristics and applicable sample types for several typical physicomechanical testing techniques, (3) comprehensively summarizing the advantages and limitations of the main non-invasive measurement methods, and showing the potentials of these methods, (4) emphasizing and dissecting the merits of numerical modeling compared with physicomechanical testing and non-invasive measurement, and proposing the existing and potential improvements of this method. Furthermore, the application scope and future development direction of these methods are proposed. This paper might play an important role in guiding the selection and improvement of evaluation methods for mechanical biocompatibility of soft tissue substitutes.

Aim: Mechanical principles successfully guide the construction of polymer material composites in engineering. Since the abdominal wall is a polymer composite augmented with a textile during incisional hernia repair we ask: can incisional hernia be repaired safely and durably based on biomechanical principles?Material and Methods: Repair materials were assessed on a self-built bench test using pulse loads to elude influences on the reconstruction of the abdominal wall. Tissue elasticity was analyzed preoperatively as needed with computed tomography at rest and during Valsalva's maneuver. Preoperatively, the critical retention force of the reconstruction to pulse loads was calculated and a biomechanically durable repair was designed based on the needs of the individual patient. Intraoperatively, the design was adjusted as needed. Hernia meshes with high grip factors (Progrip®, Dahlhausen® Cicat) were used for the repairs. Mesh sizes, fixation elements and reconstructive details were oriented on the biomechanical design. All patients recieved single-shot antibiosis. Patients were discharged after full ambulation was achieved.Results: A total of 163 patients (82 males and 81 females) were treated for incisional hernia in four hospitals by ten surgeons. Primary hernia was repaired in 119 patients. Recurrent hernia was operated on in 44 cases. Recurrent hernia was significantly larger (median 161 cm2 vs. 78 cm2; u-test: p = 0.00714). Re-do surgery took significantly longer (median 229 min vs. 150 min; p < 0.00001) since recurrent disease required more often transversus abdominis release (70% vs. 47%). GRIP tended to be higher in recurrent repair (p = 0.01828). Complication rates (15%) and hospital stay were the same (6 vs. 6 days; p = 0.28462). After 1 year, no recurrence was detected in either group. Pain levels were equally low in both primary and recurrent hernia repairs (median NAS = 0 in both groups at rest and under load, p = 0.88866).Conclusion: Incisional hernia can safely and durably be repaired based on biomechanical principles both in primary and recurrent disease. The GRIP concept provides a base for the application of biomechanical principles in incisional hernia repair.

Introduction: With so many prosthetics available, it can be difficult for surgeons to choose the most appropriate hernia mesh. Successful hernia repair mandates an understanding of how the patient's inflammatory response influences surgical outcomes. Failure to appreciate the importance of the biological aspect of hernia repair can be very costly as emerging evidence supports that biofilm formation and reduction in effective mesh porosity gives rise to long-term mesh complications including fibrosis, chronic mesh infection, and pain. In this pilot study, we utilized a large animal (porcine) model to develop a numerical Mesh Tissue Integration (MTI) Index focused on visible tissue ingrowth, fibrosis, adhesion formation and resorption of mesh. The aim is to help surgeons adopt an evidence-based approach in selecting the most appropriate mesh according to its tissue ingrowth characteristics, matched to the patient to achieve improved surgical outcomes and optimal patient-centered care.Methods: Two forty kg female Landrace pigs were recruited for this pilot study. A total of eight commonly used hernia mesh products and two controls measuring 5 × 5cm were surgically implanted in subrectus and intraperitoneal planes. The pigs were euthanised at 2 and 4 weeks, respectively. The abdominal wall was explanted, and the mesh specimens underwent macroscopic, histologic and biomechanical analysis, with engineering and pathology teams blinded to the mesh.Results: Significant differences between the degrees of MTI were observed at 2 weeks and the distinctions were even more apparent at 4 weeks. One of the interesting incidental findings we observed is that mesh products placed in the subrectus plane displayed greater degrees of adhesion strength and integration than those placed intraperitoneally.Conclusion: This pilot study is one of the first to propose a functional, biological standardized model for comparing hernia mesh products. The results are encouraging and demonstrate that this is a robust and transferrable model for assessing MTI in hernia mesh. The intention for this model is that it will be utilized synergistically with long term mesh/patient outcome registries and databases to inform improved matching of mesh to patient, particularly in the setting of the complex hernia repair and abdominal wall reconstruction.

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The three-dimensional forming property of the hernia repair mesh is very important in the application. In order to study the correlation between process parameters and formability property, three variables are set for the test: diameter of raw materials, structure and drawing-off density. Results show that within a certain range, the forming performance of the patch becomes better with the increasing of the diameter of raw materials, and comparing with the double-comb opening through structure, the forming properties of the double-comb velveteen structure are better. Besides, in the same conditions, the forming property is better with the draw-off density increases. [ABSTRACT FROM AUTHOR]

Abstract: Despite the relative safety of the procedure, hernia repairs are often associated with chronic post‐operative pain. Although this complication has been linked among others to mesh deterioration, details of the processes that lead this deterioration are still unknown. This work aims to bridge this gap by analyzing the chemical, physical and structural alterations in hernia repair meshes exposed to oxidative stress in vitro. Here, we developed a methodology to characterize effect of oxidation stress on structure and properties of polymeric hernia repair meshes. It was shown that structural changes in polypropylene meshes exposed to oxidative stress may involve formation of cross‐links between the polymer chains, chain scissions, and hydrogen bonds between the carboxyl groups, which are formed in the material during the oxidation. These effects result in mesh stiffening, ultimately leading to chronic post‐operative pain. Moreover, we demonstrated that Composix meshes are more vulnerable to the oxidative stress when compared with UltraPro meshes. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2225–2234, 2018. [ABSTRACT FROM AUTHOR]

In this paper, warp-knitted knitted fabrics with chitosan fibers for ventral hernia repair were fabricated with three kinds of structures. The properties of chitosan fiber, yarns, and fabrics were tested. The results demonstrated that the properties of a mesh fabricated with 1-0/1-2/2-3/2-1// structure were slightly better than those of other fabrics. The mechanical properties of the three produced fabrics were weak. However, the results demonstrated that chitosan meshes have many advantages, such as excellent hygroscopicity, and thermal and antimicrobial properties, which makes them one of the best materials for ventral hernia repair. The findings have theoretical and practical significance for the industrial uses of chitosan in ventral hernia repair.

The medical polypropylene monofilament with a diameter of 0.10 mm was used as the material. Four different pull densities and two different warp run-ins were set up on the electronic traverse high-speed Tricot warp knitting machine, with the gauge of E28. The raw material was used to knit four variations of single bar plain knitted fabrics with 1 in-1 miss setting. Each variation required eight samples. The mechanical properties of the above 32 warp-knitted fabric samples are tested, including their tensile stress (in both vertical and horizontal directions), tearing stress (in both vertical and horizontal directions) and bursting stress. The results obtained shows that the relationship between the vertical, the horizontal stress, and the pull density are not monotonic. The tensile stress in the vertical direction firstly decreases and then increases with an increase of the pull density; however, the tensile stress in the horizontal direction firstly increases and then slightly decreases with an increase of the pull density; again the vertical tensile stress of all fabrics was always higher than the horizontal tensile stress. The bursting stress has a positive linear relation to the pull density. The vertical tearing stresses of four samples were greater than the horizontal tearing stress.

Introduction: With so many prosthetics available, it can be difficult for surgeons to choose the most appropriate hernia mesh. Successful hernia repair mandates an understanding of how the patient's inflammatory response influences surgical outcomes. Failure to appreciate the importance of the biological aspect of hernia repair can be very costly as emerging evidence supports that biofilm formation and reduction in effective mesh porosity gives rise to long-term mesh complications including fibrosis, chronic mesh infection, and pain. In this pilot study, we utilized a large animal (porcine) model to develop a numerical Mesh Tissue Integration (MTI) Index focused on visible tissue ingrowth, fibrosis, adhesion formation and resorption of mesh. The aim is to help surgeons adopt an evidence-based approach in selecting the most appropriate mesh according to its tissue ingrowth characteristics, matched to the patient to achieve improved surgical outcomes and optimal patient-centered care. Methods: Two forty kg female Landrace pigs were recruited for this pilot study. A total of eight commonly used hernia mesh products and two controls measuring 5 × 5cm were surgically implanted in subrectus and intraperitoneal planes. The pigs were euthanised at 2 and 4 weeks, respectively. The abdominal wall was explanted, and the mesh specimens underwent macroscopic, histologic and biomechanical analysis, with engineering and pathology teams blinded to the mesh. Results: Significant differences between the degrees of MTI were observed at 2 weeks and the distinctions were even more apparent at 4 weeks. One of the interesting incidental findings we observed is that mesh products placed in the subrectus plane displayed greater degrees of adhesion strength and integration than those placed intraperitoneally. Conclusion: This pilot study is one of the first to propose a functional, biological standardized model for comparing hernia mesh products. The results are encouraging and demonstrate that this is a robust and transferrable model for assessing MTI in hernia mesh. The intention for this model is that it will be utilized synergistically with long term mesh/patient outcome registries and databases to inform improved matching of mesh to patient, particularly in the setting of the complex hernia repair and abdominal wall reconstruction., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Patiniott, Stagg, Karatassas and Maddern.)

In this paper, warp-knitted knitted fabrics with chitosan fibers for ventral hernia repair were fabricated with three kinds of structures. The properties of chitosan fiber, yarns, and fabrics were tested. The results demonstrated that the properties of a mesh fabricated with 1-0/1-2/2-3/2-1// structure were slightly better than those of other fabrics. The mechanical properties of the three produced fabrics were weak. However, the results demonstrated that chitosan meshes have many advantages, such as excellent hygroscopicity, and thermal and antimicrobial properties, which makes them one of the best materials for ventral hernia repair. The findings have theoretical and practical significance for the industrial uses of chitosan in ventral hernia repair. [ABSTRACT FROM AUTHOR]

The medical polypropylene monofilament with a diameter of 0.10 mm was used as the material. Four different pull densities and two different warp run-ins were set up on the electronic traverse high-speed Tricot warp knitting machine, with the gauge of E28. The raw material was used to knit four variations of single bar plain knitted fabrics with 1 in-1 miss setting. Each variation required eight samples. The mechanical properties of the above 32 warp-knitted fabric samples are tested, including their tensile stress (in both vertical and horizontal directions), tearing stress (in both vertical and horizontal directions) and bursting stress. The results obtained shows that the relationship between the vertical, the horizontal stress, and the pull density are not monotonic. The tensile stress in the vertical direction firstly decreases and then increases with an increase of the pull density; however, the tensile stress in the horizontal direction firstly increases and then slightly decreases with an increase of the pull density; again the vertical tensile stress of all fabrics was always higher than the horizontal tensile stress. The bursting stress has a positive linear relation to the pull density. The vertical tearing stresses of four samples were greater than the horizontal tearing stress. [ABSTRACT FROM AUTHOR]