Tissue integration and inflammatory reaction in full-thickness abdominal wall repair using an innovative composite mesh
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When composite meshes are used in abdominal wall repair, seroma formation may persist and delay the desired integration leading to recurrence. This study compares tissue integration and inflammatory response in abdominal wall repair with composites with different absorbable synthetic barriers.
Full-thickness defects created in the abdominal wall of rabbits were repaired using polypropylene prosthesis or the following composites: Physiomesh™ (Phy); Ventralight™ (Vent) and “new composite mesh” (Ncm) not yet used clinically in humans. The collected seroma was evaluated for IFN-γ/IL-4 by ELISA. Tissue integration, anti- (IL-13/TGFβ-1/IL-10/IL-4) and pro-inflammatory (TNF-α/IL-6/IFN-γ/VEGF) cytokine mRNA expression and TGFβ/VEGF immunolabeling were evaluated at 14 and 90 days post-implant.
Seroma was observed in 10 of 12 Phy/Vent and 4 of 12 Ncm. Wound fluid IFN-γ showed a time-dependent significant increase in Vent and tendency to decrease in Ncm, while all composites exhibited IL-4 upward trend. Prostheses were fully infiltrated by an organized connective tissue at end time although the area had shown prior seroma. A stable mesothelium was developed, except in adhesion areas. Vent/Phy displayed a significant increase in TNF-α/IFN-γ-mRNA over time. Significant decrease in VEGF mRNA was observed in Phy/Ncm, while a significant increase of TGFβ-1 mRNA was evident in all composites over time. Ncm exhibited the highest TGFβ protein expression area at short term and the greatest percentage of VEGF positive vessels at end time.
Ncm could be an appropriate candidate to improve clinical outcome showing the lower development of seroma and optimal tissue integration with minimal pro-inflammatory cytokine response over time and consistent pro-wound healing cytokine expression.
KeywordsComposite mesh Abdominal wall repair Hernia Tissue integration Cytokines Inflammatory reaction Seroma
We thank Nicolas Prost, Sébastien François, Julie Lecuivre and Sébastien Ladet from Covidien for the design and the preparation of the new composite mesh. In addition, we thank Robert Westberg for editorial comments on the manuscript.
Conflict of interest
Study sponsored and funded by Covidien–Sofradim Production (Trévoux, France). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Co-author Yves Bayon is employed by Covidien–Sofradim Production. There are no patents, products in development or marketed products to declare.