Mechanics of Soft Tissue Reactions to Textile Mesh Implants

Chapter

Abstract

For pelvic floor disorders that cannot be treated with non-surgical procedures, minimally invasive surgery has become a more frequent and safer repair procedure. More than 20 million prosthetic meshes are implanted each year worldwide. The simple selection of a single synthetic mesh construction for any level and type of pelvic floor dysfunctions without adopting the design to specific requirements increase the risks for mesh related complications. Adverse events are closely related to chronic foreign body reaction, with enhanced formation of scar tissue around the surgical meshes, manifested as pain, mesh erosion in adjacent structures (with organ tissue cut), mesh shrinkage, mesh rejection and eventually recurrence. Such events, especially scar formation depend on effective porosity of the mesh, which decreases discontinuously at a critical stretch when pore areas decrease making the surgical reconstruction ineffective that further augments the re-operation costs. The extent of fibrotic reaction is increased with higher amount of foreign body material, larger surface, small pore size or with inadequate textile elasticity. Standardized studies of different meshes are essential to evaluate influencing factors for the failure and success of the reconstruction. Measurements of elasticity and tensile strength have to consider the mesh anisotropy as result of the textile structure. An appropriate mesh then should show some integration with limited scar reaction and preserved pores that are filled with local fat tissue. This chapter reviews various tissue reactions to different monofilament mesh implants that are used for incontinence and hernia repairs and study their mechanical behavior. This helps to predict the functional and biological outcomes after tissue reinforcement with meshes and permits further optimization of the meshes for the specific indications to improve the success of the surgical treatment.

Notes

Acknowledgements

The first author has been partially funded by the German Federal Ministry of Education and Research through the FHprofUnt project BINGO (03FH073PX2). We would also like to thank our project partner FEG Textiltechnik mbH, Aachen, Germany for providing the prostheses, Nils Andreas Krämer, PD MD, Uniklinikum RWTH Aachen, Germany for providing MRI data, and Andreas Horbach, DI, and our students Christian Halbauer, Viola Gruben for their help with experiments and providing the results from their bachelor theses. The authors would also like to acknowledge Prof. Dr. Melinda Harman, Clemson University for providing permission to use the images reprinted in Fig. 9.

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Biomechanics LaboratoryInstitute for Bioengineering, University of Applied Sciences AachenJülichGermany

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