四种聚丙烯网用于矫正乳房下垂的生物相容性研究

目的探讨外科网片的皱缩和粘连影响其作为内置式乳罩纠正轻、中度乳房下垂的术后效果，通过比较4种不同的聚丙烯网在生物相容性上的差异，找出异物反应与术后效果的关系，以便为内置式乳罩选用聚丙烯网片提供依据。方法以实验用小型诸作为动物模型，将4种不同的聚丙烯网置入腹部皮下，90d后采集标本，比较并发症、肄物反应、胶原纤维与弹力纤维的形成，并在透射电子最微镜下观察超微结构。结果4种聚丙烯网在生物相容性上存存差异。异物反应的程度决定生物相容性的差异，同时对术后乳房形态有显著的影响。结论Premilene Mesh LP作为新型的轻质量网片，生物相容性优于其他网片。     

应用聚丙烯单丝网片纠正轻、中度乳房下垂

目的：介绍一种适用于轻、中度乳房下垂的矫正术。方法：采用乳晕周围环状切口，用聚丙烯单丝网片制成内置式乳罩，行乳腺组织的上提、塑形和固定，并为21例乳房下垂者行矫正术。结果：21例均达到较为理想的上提效果，随访2－16个月，无下垂复发和切口瘢痕增生，未发生异物排斥反应。结论：聚丙烯单丝网片用作乳房塑形的支持材料安全可靠，减少了切口的瘢痕增生，避免了下垂复发。     

乳房下垂矫正术中的乳房悬吊结构重建

目的总结用乳房悬吊结构重建方法矫正轻、中度乳房下垂的临床经验。方法通过乳晕边缘切口，去除上半腺体后松弛的浅筋膜深层，上提腺体至正常位置并固定于深筋膜，腺体浅面按真皮乳罩原理进行悬吊并适当切除乳晕周边多余皮肤，或采用聚丙烯单丝网片对腺体进行悬吊，术后腺体周围形成强大的纤维粘连，从而重建乳腺的悬吊支持结构。同时进行腺体的适当折叠塑形或置入乳房假体增加丰满程度。结果共行轻、中度下垂32例手术（其中单纯悬吊10例，悬吊同时假体隆乳20例，采用聚丙烯网片悬吊2例），手术时间90～150min，平均110min。术中出血量30～100ml，平均58ml。均未发生乳头乳晕坏死感觉障碍等并发症。术后随访6～12个月，平均11．3月，术后外形改善满意率90．6％（29／32）。结论对于不伴腺体肥大的乳房轻、中度下垂，采用乳房悬吊结构重建，是一种创伤相对小，安全，有效的矫正方法。     

三氯生涂层医用聚丙烯抗菌网片的制作和性能研究

目的：探讨三氯生涂层医用抗菌聚丙烯网片的制作,研究其药物的控释性能以及网片上载前后性能。
方法：以三氯生为抗菌剂,乙烯-乙烯醇共聚物为载体,应用溶剂蒸发法,制成三氯生涂层医用抗菌聚丙烯网片。将网片分为A,B,C,D 4组,A,B,C组为三氯生涂层医用抗菌聚丙烯网片实验组,D为对照组。在电镜下观察4组网片的超微结构;测定抗菌网片不同时段的抑菌圈直径;采用浸泡法测定实验前后网片在不同时间段释放药物的抑菌效果;测定实验前后网片在横向和纵向被拉断时所能承受的最大拉力。
结果：实验组网片涂层表面均匀光滑,在生理盐水中能持续释放7 d,在1,3,5,7 d实验组抑菌圈直径明显大于对照组（P＜0.05）,两组网片在不同张力下的横向及纵向所能承受的最大拉力无统计学意义。
结论：经溶剂蒸发法制备的三氯生涂层医用抗菌聚丙烯网片具有药物控释性能和明显抗菌性能,而其生物力学性能在实验前后基本不变,为临床处理无张力疝修补术后的人工补片感染问题提供一个新的方法和途经。     

应用聚丙烯单丝网片纠正轻中度乳房下垂

目的　探讨一种外形美观、瘢痕最小、效果持久的乳房下垂矫正术的手术方法。方法　采用乳晕周围环状切口 ,用聚丙烯单丝网片制成内置式乳罩 ,行乳腺组织的上提、塑形和固定 ,为 2 1例乳房下垂病人行乳房下垂矫正术。结果　全部病人均达到较为理想的上提效果 ,随访 2个月～ 16个月 ,无继发下垂和切口瘢痕增生 ,未发生异物排斥反应。结论　聚丙烯单丝网片用作乳房塑形的支持材料是安全可靠的 ,减少了切口瘢痕增生的机会 ,避免了继发下垂的发生。     

乳房上提术中聚丙烯网片生物学特性观察研究

聚丙烯网片（以下简称网片）多用于巨大腹壁疝及腹股沟疝的修补,近年来乔群等将其用于乳房缩小整形术中的乳房上提术。为了解网片在人体内的变化，周围组织的反应，确定网片在乳房上提术中作用，我们在光学显微镜和扫描电子显微镜下，观察了网片本身的变化及其周围组织的结构情况。     

扩张器模拟法选择乳房假体

假体置入隆乳术开展已数十年 ,但对假体选择及术后乳房大小的预测 ,仍无一简单而经济、直观的方法。为此 ,1999～ 2 0 0 1年 ,我们将扩张器模拟法用于隆乳术前选择乳房假体体积及预测术后乳房大小 ,共应用 10 8例 ,取得良好效果。1　方法根据受术者经乳房下皱襞胸围尺寸及术后要求达到的乳罩杯型 ,初步选出术后适合乳罩。让受术者立于镜前 ,佩戴乳罩 ,将圆形扩张器放置于乳罩后 ,并向扩张器内注水。同时观察胸部隆起程度。至满意时 ,扩张器注水容积即为乳房假体体积的参考值。再根据受术者胖瘦、乳腺组织多少、皮肤弹性及置入层次等 ,适当增…     

肋软骨生物力学性能及在耳廓再造手术时机选择中的意义

目的 探讨不同年龄组肋软骨的生物力学特性的变化,以期为肋软骨作为耳廓再造的支架材料应用于整形外科的最佳手术时机提供理论参考.方法 将5～25岁行耳廓再造的患者按年龄分为3组.对不同年龄组肋软骨的应力-应变、应力松弛、蠕变和极限抗拉强度等各项生物力学性能指标进行测试,对测试结果进行统计学分析处理.结果 儿童组肋软骨的极限抗拉强度、应力-应变、应力松弛及蠕变等生物力学指标明显优于青少年组和成人组,3组当中以青少年组的力学性能最差,经统计学分析,差异具有统计学意义(P＜0.05).结论 鉴于肋软骨的生物力学性能随年龄发生变化,综合各方面因素,在利用肋软骨进行耳廓再造手术时,应优先考虑在肋软骨生物力学性能最佳的儿童期进行.     

聚丙烯网乳房塑形和支持作用的实验研究

目的　探讨聚丙烯网的乳房塑形和支持作用。方法　以小型猪作实验动物 ,在其皮下置入聚丙烯网 ,用扩张器扩张未加网和加网的皮肤 ,模拟重力对乳房皮肤和置入的聚丙烯网的牵拉作用。分两次采集标本 ,进行生物力学和组织学研究。结果　与正常皮肤相比 ,未加网扩张皮肤的生物力学性能降低 ,组织学性质改变 ,而加网的扩张皮肤则否 ;聚丙烯网的抗张强度和弹性模量均远小于皮肤。结论　聚丙烯网对受牵拉的皮肤有明显的保护作用 ,加用聚丙烯网能取得较好的乳房塑形和支持效果     

聚丙烯单丝网片用于乳房下垂的矫正

目的介绍一种矫正乳房下垂的新术式.方法采用乳晕周围双环切口,并沿腺体表面向腺体边缘分离,然后置入聚丙烯单丝网片对松弛的乳腺组织上提、塑形、固定,对腺体组织较多者同时行楔形切除外上象限部分乳腺组织的乳房缩小术.结果随访20例患者3～18个月,乳房下垂的矫正效果较理想,无下垂复发和切口瘢痕增生,未发现异物排斥反应.结论聚丙烯单丝网片对于乳房下垂的矫正和塑形较安全可靠,能避免下垂的复发,减少了切口瘢痕的增生.     

Biomechanical properties of raw meshes used in pelvic floor reconstruction

Female urinary incontinence and pelvic organ prolapse are common conditions. The aim of this study was to assess the biomechanical properties of raw meshes commonly used in pelvic floor surgery, particularly the effects of cyclical loading on these meshes. The material properties of nine different types of surgical meshes were examined using uniaxial tensile tests. The strength and extensibility of the mesh designs differed considerably. Most mesh types exhibited curvilinear loading curves. Cyclical loading of mesh samples produced significant permanent deformation in all mesh designs. This non-recoverable extension ranged from about 8.5% to 19% strain. Hysteresis also varied considerably between materials from 30% to 85%. All mesh groups tested for their biomechanical properties displayed differences in results for failure load, stiffness, non-recoverable extension and hysteresis.     

Differences in biomechanical stability using various fibrin glue compositions for mesh fixation in endoscopic inguinal hernia repair

Background

In hernia surgery, mesh fixation with fibrin glue instead of tacks and sutures can demonstrably reduce postoperative morbidity without increasing recurrence rates. In some cases there are significant differences in the biomechanical properties, depending on the functional structure of the meshes. Furthermore, there are various fibrin glue products on the market and these are used for mesh fixation. This study compared the fixation strength of fibrin glues in combination with various meshes.

Methods

Three different lightweight polypropylene meshes (TiMESH? light, ULTRAPRO?, Optilene^? LP) were tested. All meshes were fixed using 2?ml of each of the three different fibrin glues (TISSUCOL^?, QUIXIL^?, EVICEL^?) and tested for their biomechanical stability. The defect in the muscle tissue used was 45?mm for a mesh size of 10?×?15?cm. Measurements were conducted using a standardized stamp penetration test, while aiming not to use a fixation strength of less than 32?N.

Results

With TISSUCOL, the fixation of Optilene LP proved to be significantly better than that of TiMESH or ULTRAPRO (97.3 vs. 47.9 vs. 34.9?N, p?<?0.001). With EVICEL, it was possible to also achieve good tissue fixation for the ULTRAPRO mesh, while the results obtained for Optilene and TiMESH were relatively poorer [114.7 vs. 92.4?N (p?=?0.056), vs. 64.3?N (p?<?0.001)]. With QUIXIL, satisfactory results were obtained only for Optilene LP (43.6?N).

Conclusion

This study showed that there were significant differences in the fixation strength of different polypropylene meshes in combination with various fibrin glues. Experiments demonstrated that for each mesh there is an optimum combination with a particular fibrin glue with respect to the fixation strength. It must now be verified whether these results can be extrapolated to clinical practice.     

Biological behavior of polypropylene meshes suitable for intra-abdominal implantation in animal model

The expected incisional hernia rate is between 11-20% after laparotomy. Using mesh repair the results of the hernioplasty have recently improved. However the complication of mesh implants--especially in intraperitoneal position--can be life threatening. Additionally the appropriate mesh is expensive. We tried to create a mesh, which can be used intraperitoneally and generates adhesion in the abdominal wall, but keeps the intraabdominal organs adhesion free. Our experiments were divided into four groups. In the first we used different materials to cover the intraperitoneal side of polypropylene mesh. In the second phase three different pore-sized meshes were compared. In the third part the biological behavior of three different material-reduced meshes were investigated. Based on our previous results in the last session we used only silicone membrane protected material-reduced polypropylene meshes to cover the abdominal defects. Our experiments have shown that intraperitoneal implant with silicone-covered Vypro (Ethicon)/Premilene (B. Braun Medical) mesh significantly decreases the formations of adhesion.     

Partially absorbable meshes for hernia repair offer advantages over nonabsorbable meshes

BACKGROUND: The aim of this study was to establish whether new prosthetic materials with absorbable components, designed to reduce the amount of foreign material in abdominal wall repair, offer advantages over the conventional polypropylene meshes. METHODS: Seven x 5 cm defects created in the anterior abdominal wall of New Zealand white rabbits were repaired by using a nonabsorbable polypropylene prosthesis (Surgipro; Tyco, Barcelona, Spain) or 1 of 2 partially absorbable prostheses available on the market (Vypro II and Ultrapro; Johnson & Johnson, St. Stevens-Woluwe, Belgium). At 14 and 90 days after surgery, tissue/prosthesis specimens were subjected to histological studies, biomechanical strength tests, and shrinkage evaluation. RESULTS: At 90 days, the absorbable filaments of Vypro II had been completely reabsorbed, whereas Ultrapro only showed signs of biodegradation in a few zones. Host tissue infiltration and collagen I deposition in the 3 reticular meshes was optimal. Macrophage counts, mesh shrinkage, and biomechanical resistance values were similar. CONCLUSIONS: Partially absorbable prostheses perform as well as the standard polypropylene mesh and have the benefit that less foreign material remains in the recipient, without compromising mechanical resistance.     

Laparoscopic evaluation of abdominal adhesions with different prosthetic meshes in rabbits.

BACKGROUND: The use of prosthetic materials to reinforce the abdominal wall is associated with a low index of recurrence; however, intraperitoneal placement of a foreign body may lead to adhesions. The present investigation was designed to determine adhesion formation with commercially available meshes implanted laparoscopically in rabbits. METHODS: Three different meshes were implanted laparoscopically in 24 rabbits: polypropylene (mesh A), polypropylene and sodium hyaluronate-carboxymethylcellulose (mesh B), and polypropylene and expanded polytetrafluoroethylene (mesh C). Sites of implantation for each mesh (the left lower quadrant, right lower quadrant, and lower midline) were randomly determined so that every rabbit had all 3 meshes implanted. All animals underwent diagnostic laparoscopy after 28 days to grade adhesions and histological analysis of inflammation. RESULTS: Adhesions were noticed in 46 of the 72 meshes implanted (64%). The number of adhesions was higher for mesh C (87.5%) compared with meshes A (62.5%) and B (41.6%). The severity of adhesions was also higher for mesh C (grade I in 14, II in 6, and III in 1) compared with mesh A (grade I in 10, II in 4, and III in 1 case) and B (all of them grade II). Histological inflammatory reaction was classified as mild in 23 cases of mesh A, 15 of mesh B, and 23 of mesh C. A moderate reaction was found in 1 case of mesh A, 4 cases of mesh B, and 1 case of mesh C. Severe reaction was induced in 5 cases of mesh B. Mesh B induced a higher inflammatory reaction compared with the other meshes. CONCLUSIONS: All meshes induced adhesions of different grades. Mesh B had fewer adhesions and more intense inflammation them did the others.     

Coated meshes for hernia repair provide comparable intraperitoneal adhesion prevention

Background

Laparoscopic incisional hernia repair with intraperitoneal mesh is associated with a certain degree of adhesion formation to the mesh. This experimental study examined the efficacy of several coated meshes for adhesion reduction.

Methods

Five commercially available meshes with a layered coating were placed intraperitoneally in rats and followed up for 90 days: polypropylene and polyester meshes, both coated with absorbable collagen (Parietene Composite and Parietex Composite, respectively), and three polypropylene meshes respectively coated with absorbable omega-3 fatty acids (C-Qur Edge), absorbable cellulose (Sepramesh IP), and nonabsorbable expanded polytetrafluoroethylene (Intramesh T1). Uncoated polypropylene and collagen meshs (Parietene and Permacol, respectively) served as the control condition. Adhesions, incorporation, and tissue reaction were evaluated macro- and microscopically. Additionally, the development of the neoperitoneum was examined.

Results

All the coated meshes performed equally well in terms of adhesion reduction. The collagen mesh performed comparably, but the uncoated polypropylene mesh performed significantly worse. The different coatings led to very differing degrees of inflammation. Ingrowth was observed only at the place of suture but was comparable for all the meshes except C-Qur Edge, which showed the weakest incorporation. Development of a neoperitoneum on the mesh surface occurred independently of whether an absorbable or nonabsorbable coating or no coating at all was present.

Conclusions

Commercially available meshes with a layered coating deliver comparable adhesion reduction. The physical presence of a layered coating between the intraperitoneal content and the abdominal wall seems to be more important than the chemical properties of the coating in adhesion formation.     

Fibrin sealant for mesh fixation in Lichtenstein repair: biomechanical analysis of different techniques

Background Mesh fixation using sealants is becoming increasingly popular in hernia surgery. Fibrin sealant is an atraumatic alternative to suture or stapler fixation and is currently the most frequently used sealant. There are currently no biomechanical data available for evaluation of the quality of adhesion achieved with fibrin sealant during Lichtenstein hernia repair. Methods Five different suture and sealant techniques were evaluated and compared during simulated Lichtenstein hernia repair in an established, standardised biomechanical model for abdominal wall hernias. Results Significantly greater stability was achieved with fibrin sealant fixation of meshes than with point-by-point suture fixation. Fibrin adhesion protected meshes from dislocation at least as well as suture fixation with additional running-suture closure of the hernia orifice. Fibrin mesh fixation combined with additional support from running-suture hernia closure was significantly (P ≤ 0.002) superior to all other methods. Conclusions On the basis of these favourable biomechanical properties, mesh fixation using fibrin sealant can be recommended for use in onlay repair of transinguinal hernias.