Page 243 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Discussion
In this experimental contaminated environment, the collagen-coated polypropylene mesh Parietene Composite® and the condensed PTFE Omyramesh® had a low risk of infection, moderate adhesion formation and good incorporation. The biological Strattice® mesh did not become infected and showed remarkably little adhesion formation, but poor incorporation.
If a mesh is used in a contaminated environment, consensus exists that a biological collagen mesh or a synthetic macroporous, mono lament mesh may be advantageous(5, 16-18). Biological collagen meshes have been developed speci cally for a contaminated environment and Strattice® did not show any mesh infection in this experiment. Biological meshes, particularly Strattice®, have shown improved clearance of bacteria, which decreases the possibility of infection and formation of adhesions(19). A prospective multicentre study of contaminated ventral hernia repair with Strattice® reported a similar low infection rate with little need to remove the mesh(20).
The macroporous Parietene®, Parietene Composite®, Sepramesh® and Omyramesh® had a low risk of infection. Large pores allow admission of macrophages, broplasia and angiogenesis, which improves the ability to clear infection(5, 6). In this study, however, the macroporous C-Qur® mesh showed a high infection rate. This polypropylene mesh is coated with anti-in ammatory omega-3 fatty acids. In an experimental clean environment macrophages were scarcely present in the mesh after implantation(11, 21). It might be hypothesized that the anti-in ammatory properties of the omega-3 fatty acid coating have prevented macrophage penetration, although no clinical or experimental literature on the characteristics of omega-3 fatty acids in the presence of bacteria has yet been published.
Dualmesh® showed a high infection rate, probably because of its partially microporous structure (smaller than 10 μm). The increased risk of infection after surgery with Dualmesh®, and the need to remove the prosthesis in case of infection, is notorious in the clinical situation(22-24). Mesh infection is caused by in ltration and proliferation of bacteria within the pores and interstices of synthetic materials. Small pores prevent in ltration of immune cells and make microporous meshes more susceptible to infection(5, 25).Additionally, the hydrophobic visceral surface of Dualmesh® decreases adhesion of tissue cells, allowing bacteria a free passage to the implant surface(16).
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Meshes in a contaminated environment
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