Biologic Mesh Choices for Surgical Repair

Published on 09/04/2015 by admin

Filed under Surgery

Last modified 22/04/2025

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Chapter 18 Biologic Mesh Choices for Surgical Repair

1 Indications for the Use of Biologic Mesh Materials

2 Tissue Sources for Biologic Mesh Materials (Table 18-1)

3 Biologic Mesh Modification and Processing

image The importance of preserving the native dermal matrix structure and to what degree is still debated. Cross-linking of dermal matrix xenografts was introduced as a method to increase mechanical strength and to protect the collagen-based implant against enzymatic degradation by collagenases. Cross-linking also is believed to reduce the immunogenic potential of the acellularized matrix, due mainly to expression of galactose-alpha-1,3-galactose molecular epitopes. In its simplest form, cross-linking causes molecular bonds to form between native collagen molecules. Several steps during biologic mesh processing can cause matrix cross-linking, as with the use of detergents, enzymes, or high-energy beams for sterilization. These steps, in addition to intentional chemical modification of the matrix or terminal sterilization, all induce varying degrees of matrix cross-linking. The level of matrix cross-linking can be quantified by measuring the mesh collagen melting point. Higher degrees of cross-linking result in higher matrix melting points. Examination by electron microscopy also can be used to look for the preservation of biologic matrix structure. If the goal of biologic mesh–based soft tissue reconstruction is to support the repopulation of the donor matrix with host cells, like endothelial cells and fibroblasts, it appears that high levels of cross-linking impair that recellularization process. The host may even recognize a highly cross-linked material as foreign and induce a foreign body capsule response. A balance must therefore be struck between biologic mesh durability and regenerative potential. The end result is observed to be varying degrees of incorporation, resorption, or encapsulation. It appears that the outcome depends on material source, material processing, host response, surgical technique, and the level of wound contamination or inflammation. Further experimental studies and well-designed clinical trials are needed to characterize the optimum materials and methods.

4 Mechanism of Action of Biologic Meshes (Table 18-2)

5 Reported Clinical Results with Biologic Meshes