دانلود رایگان ترجمه مقاله پیشرفت ها (به روز رسانی ها) در مش و بیومتریال (نشریه الزویر 2018)

پیشرفت ها (به روز رسانی ها) در مش و بیومتریال

Updates in Mesh and Biomaterials

1 Introduction

Prior publications of the Surgical Clinics of North America have highlighted the technical challenges of abdominal wall reconstruction. In 2008, the issue dedicated to abdominal wall reconstruction discussed the biology of hernia formation, the history of hernia repair, open and laparoscopic ventral hernia repair, and the benefits of the use of prosthetic mesh on patient outcomes. Despite the vast selection of mesh brands available, nearly all mesh continues to use 1 of 3 basic materials—polypropylene, polyester, or polytetrafluoroethylene in various combinations with or without barrier coating. The mesh types differ in many characteristics, including their tensile strength, elasticity, and weight, which depends on pore size and the weight of the polymer. Heavy weight mesh uses thick polymers, small pore size, and high tensile strength, whereas light weight mesh uses thinner polymers and larger pores.

In the 2008 Surgical Clinics of North America publication, Bachman and Ramshaw1 discussed the wide variety of mesh products available for abdominal wall reconstruction and the challenge facing surgeons to choose the most appropriate mesh for ventral hernia repair. Interestingly, they concluded that there was no “best” mesh. Still a decade later, the decision of which mesh to use is based on several factors: the type of procedure being performed, the clinical situation (elective vs emergent, Centers for Diseased Control and Prevention [CDC] wound classification, etc), the desired handling characteristics to optimize mesh placement, material costs, and the products available to the surgeon based on hospital material contracts.1 In the same publication, Jin and Rosen2 described the limited data available specifically when comparing the long-term outcomes of for synthetic to biologic mesh. It seemed that most mesh selections were based on surgeon’s anecdotal experience. Clearly, prospective studies comparing clinical outcomes for the variety of meshes available is needed.2 In that same issue, Earle and Mark3 discussed the many variables of mesh designs, including the polymer used, fiber size, fiber strength, elasticity, pore size, density, and bioreactivity. These multiple variables do not allow for direct comparisons. Earle and Mark also stressed that, as more mesh types are being developed, surgeons must balance the uncertainty of long-term outcomes when introducing a new prosthetic against the more certain outcomes of existing products.3 This challenge remains true a decade later.

The 2013 publication of the Surgical Clinics of North America on abdominal wall reconstruction further addressed the clinical outcomes of biologic mesh and the safety of prosthetic mesh repair in contaminated settings. The literature exploring the use of biologic grafts in infected and contaminated fields was disappointing. Preclinical animal studies failed to demonstrate consistent evidence of biological mesh remodeling and long-term clinical outcomes using biologics revealed higher than expected recurrence rates.4 Alternatively, Carbonell and Cobb5 cited a relatively low morbidity rate associated with the use of light weight and even heavy weight polypropylene mesh in clean-contaminated and contaminated fields. At that time, however, many surgeons remained reluctant to change their practice based on this literature owing to fears of complications, specifically wound and mesh infections, and using prosthetic mesh off-label in CDC class II and III wounds.

The Surgical Clinics of North America is dedicating another publication to abdominal wall reconstruction in 2018, and this article provides an update on biomaterial research. This article specifically reviews synthetic, biologic, and biosynthetic mesh research and concludes with thoughts about the future of mesh research. This update highlights research that has been conducted since the prior publication to guide surgeons to make evidence-based choices about biomaterial for ventral hernia repair that are most appropriate for their patients.