Abstract
Purpose
Biologic meshes are being used with increasing frequency to repair contaminated abdominal wall defects despite high long-term recurrence and infection rates associated with their use. Recent clinical reports describing the success of lightweight, macroporous synthetic meshes in contaminated ventral hernia repairs have led some surgeons to challenge the belief that synthetics are contraindicated in contaminated fields. We aimed to determine whether a frequently used biologic mesh (StratticeTM) is more resistant to bacterial colonization than macroporous synthetic mesh (ParietexTM ProgripTM) after inoculation with two common pathogens.
Methods
Rats (n = 48) were implanted subcutaneously with StratticeTM or ProgripTM. Meshes were inoculated with sterile saline or a suspension containing 106 colony-forming units of Staphylococcus aureus or Escherichia coli prior to wound closure (n = 8 per subgroup). Meshes were explanted at 4 weeks and underwent microbiologic and histologic analyses.
Results
ProgripTM demonstrated superior bacterial clearance compared to StratticeTM (E. coli, 88 vs. 17 % clearance, p = 0.03; S. aureus, 75 vs. 50 %, p = 0.61; combined bacterial strains, 81 vs. 36 %, p = 0.02; respectively). In the StratticeTM group, severely degraded meshes were observed in 100 % of animals inoculated with E. coli (but 0 % inoculated with S. aureus). In contrast, all ProgripTM meshes remained intact regardless of inoculum. Scores for neovascularization were higher in the synthetic group irrespective of contamination (p < 0.05).
Conclusions
Biologic meshes may not be more resistant to bacterial colonization than reduced-weight synthetics, and their resistance may differ in response to different pathogens. The routine use of biologics in contaminated ventral hernia repair should be questioned, particularly in the presence of E. coli.
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Acknowledgments
This work was supported using internal funds from the Department of Clinical Investigation at Tripler Army Medical Center. The Strattice™ and Progrip™ mesh materials used in this study were purchased by the authors’ institution.
Conflict of interest
WC declares no conflict of interest. EB declares no conflict of interest. PM declares no conflict of interest. LK declares no conflict of interest. KM declares no conflict of interest. LP declares no conflict of interest.
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The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
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Cole, W.C., Balent, E.M., Masella, P.C. et al. An experimental comparison of the effects of bacterial colonization on biologic and synthetic meshes. Hernia 19, 197–205 (2015). https://doi.org/10.1007/s10029-014-1290-0
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DOI: https://doi.org/10.1007/s10029-014-1290-0