Department of Experimental Surgery, Russian State Medical University, Moscow, Russia.
Hernia. 2012 Apr;16(2):199-210. doi: 10.1007/s10029-011-0877-y. Epub 2011 Sep 10.
We aimed to compare the effectiveness of experimental middle hernia defect repair in regard to the transverse and longitudinal positioning of anisotropic lightweight surgical mesh.
The mechanical properties of fascial layers and surgical mesh DynaMesh(®)-PP Light were determined in two perpendicular directions under uniaxial tension. In 12 male Wistar rats, middle hernia defect was repaired by the sublay technique. In six animals, the mesh was positioned across (DLH group) and in the other six along (DLV group) the midline. At 6 months after implantation, mesh deformation, structural rearrangement, and repaired abdominal wall biomechanics were evaluated. Histological sections were stained with van Giesen and Mallory's trichrome.
The anisotropic mechanical properties of the mesh and fascial layers coincided in the DLH group, but did not correspond to each other in the DLV group. In the DLV group, meshes were stretched in width by 11.4% and reduced in length by 12.7%. In all animals, the lower edge of the mesh was shifted to a defect area with margin hernia formation in two rats. Constant shear stress caused disproportional connective tissue formation. Repaired abdominal wall lost its natural elasticity. In the DLH group, the mesh deformation was minimal. Formed connective tissue was tightly associated with the anterior layer and did not differ from it in composition. The mechanical properties of repaired abdominal wall were close to those of the anterior layer.
In prosthetic hernia repair, the mechanical properties of surgical mesh should correspond with those of the fascia being repaired. A mismatch of mechanical properties may result in implant deformation, abdominal wall biomechanics impairment, and recurrent herniation at the edges of the meshes.
我们旨在比较实验性腹直肌旁疝缺损修补术在各向异性轻质手术网片的横向和纵向定位方面的效果。
在单轴拉伸下，确定筋膜层和外科网片 Dynamesh®-PP Light 的机械性能在两个垂直方向上的各向异性。在 12 只雄性 Wistar 大鼠中，采用下置法修复中间疝缺损。在 6 只动物中，网片横跨（DLH 组）放置，在另外 6 只动物中沿中线（DLV 组）放置。植入后 6 个月，评估网片变形、结构重排和修复腹壁生物力学。组织学切片用范·吉森（van Giesen）和马罗利氏三色（Mallory's trichrome）染色。
网片和筋膜层的各向异性机械性能在 DLH 组中是一致的，但在 DLV 组中并不对应。在 DLV 组中，网片宽度拉伸 11.4%，长度缩短 12.7%。在所有动物中，网片的下缘在 2 只动物中向缺陷区域移位，形成边缘疝。恒定的剪切应力导致不成比例的结缔组织形成。修复的腹壁失去了其自然弹性。在 DLH 组中，网片变形最小。形成的结缔组织与前层紧密相连，在组成上与前层没有区别。修复腹壁的机械性能与前层相近。
在假体疝修复中，手术网片的机械性能应与修复的筋膜相匹配。机械性能不匹配可能导致植入物变形、腹壁生物力学受损以及网片边缘的疝复发。
