An experimental comparison of the effects of bacterial colonization on biologic and synthetic meshes
- 1 August 2014
- journal article
- research article
- Published by Springer Science and Business Media LLC in Hernia
- Vol. 19 (2), 197-205
- https://doi.org/10.1007/s10029-014-1290-0
Abstract
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 (Strattice(TM)) is more resistant to bacterial colonization than macroporous synthetic mesh (Parietex(TM) Progrip(TM)) after inoculation with two common pathogens. Rats (n = 48) were implanted subcutaneously with Strattice(TM) or Progrip(TM). Meshes were inoculated with sterile saline or a suspension containing 10(6) 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. Progrip(TM) demonstrated superior bacterial clearance compared to Strattice(TM) (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 Strattice(TM) group, severely degraded meshes were observed in 100% of animals inoculated with E. coli (but 0% inoculated with S. aureus). In contrast, all Progrip(TM) meshes remained intact regardless of inoculum. Scores for neovascularization were higher in the synthetic group irrespective of contamination (p < 0.05). 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.Keywords
This publication has 26 references indexed in Scilit:
- A 5-Year Clinical Experience With Single-Staged Repairs of Infected and Contaminated Abdominal Wall Defects Utilizing Biologic MeshAnnals of Surgery, 2013
- Biologic meshes are not superior to synthetic meshes in ventral hernia repair: an experimental study with long-term follow-up evaluationSurgical Endoscopy, 2013
- Prospective study of single-stage repair of contaminated hernias using a biologic porcine tissue matrix: The RICH StudySurgery, 2012
- Histologic and Biomechanical Evaluation of Biologic Meshes following Colonization with Pseudomonas aeruginosaJournal of Surgical Research, 2012
- Outcomes of Complex Abdominal HerniorrhaphyAnnals of Plastic Surgery, 2012
- The Effect of Bacterial Infection on the Biomechanical Properties of Biological Mesh in a Rat ModelPLOS ONE, 2011
- A Review of Available Prosthetics for Ventral Hernia RepairAnnals of Surgery, 2011
- Searching for the best polypropylene mesh to be used in bowel contaminationHernia, 2010
- Use of biological meshes for abdominal wall reconstruction in highly contaminated fieldsWorld Journal of Gastroenterology, 2010
- Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use?Journal of the American College of Surgeons, 2000